Spiritual Assessment in Primary Care
Abstract & Commentary
By Jeff Unger, MD. Director, Metabolic Studies, Catalina Research Institute, Chino, CA. Dr. Unger reports no financial relationships relevant to this field of study.
Synopsis: Evidence-based spiritual assessment tools are presented in this manuscript, which open a dialogue between patients and physicians. These adjunctive therapeutic interventions have been found to improve outcomes for patients with depression, cardiovascular disease, pain, anxiety, and adolescent risk behaviors.
Source: Saguil A, Phelps K. The spiritual assessment. Am Fam Physician 2012;86:546-550.
Gallup polls indicate that 91% of u.s. adults believe in God and that 81% consider religion as being important in their lives.1 A national survey found that 78% of family physicians feel either somewhat or extremely close to God.2 Published guidelines have recommended the use of spirituality in addressing both chronic pain and palliative care.3,4 Despite the fact that 90% of physicians feel they should be aware of patients' spiritual orientation, few patients report having any meaningful discussions with their doctors regarding religion or spirituality.5
Most physicians feel that they lack the time or expertise to speak with their patients regarding issues related to spirituality. Importantly, research supports a beneficial link between spirituality and conditions such as cardiovascular disease, cancer, depression, adolescent risk behaviors, anxiety, pain, poor self-reported health, and death.6 Tools are available that may enhance spiritual assessment within primary care.
The most appropriate patients on whom to perform a spiritual assessment would include the elderly, hospitalized patients, and those with terminal illnesses. Any patient who faces a crisis diagnosis should be assessed. The American Academy of Family Practice SORT evidence rating system rates the need to perform a spiritual assessment upon hospital admission, the fact that a spiritual discussion may help manage patients with chronic pain, and that a discussion of spirituality is a core component of palliative care as being Level C.
Several spiritual history tools, which are available online, may be downloaded and used to help guide physicians toward affecting a meaningful spiritual discussion with their patients (see Table 1).
A spiritual assessment is strongly recommended when providing care to certain religious groups, such as Muslim or Hindu women who tend to decline certain forms of examinations from male physicians. Blood glucose control may be influenced by fast days practiced by Muslims during Ramadan and by Jews on Yom Kippur. African American patients may delay medical interventions so that they may participate in prayer sessions with their churches.7
The use of spiritual assessments often provides clinicians with an important means to intervene with patients who are suffering from traumatic life-changing events for which no medical or psychological counseling would provide comfort.
Commentary
Each day I pray for my patient, "Reverend Lloyd," and each day he returns the favor and prays for me. The Reverend has become one of my most important allies in the health care field because he is my "spiritual specialist."
When one of my patients lost her young daughter to cancer several years ago, I was confronted with a very difficult dilemma. At 4 p.m. on a Thursday afternoon when the office was packed with patients, I was in an exam room with the grieving husband and wife. They were seeking comfort and answers on the worst day of their young lives. I had no medicine that would help them, nor words which could turn back time. They told me that they would give "anything they had just to hold their 7-year-old daughter one more time."
We are not trained in our residency programs to handle these life changing events. Although my brother is an ordained Rabbi, I cannot even read Hebrew. Yet, I do have a strong sense of spirituality. I asked the parents if they belonged to a local church to which they responded, "No, but we do believe in God."
I explained to the family that I planned to get in touch with Reverend Lloyd on their behalf. The Reverend has very special powers and spiritual connections. Not only will Reverend Lloyd call you and provide comfort to you, he will pray for you. He will also set up prayer groups on your behalf and soon hundreds of people, none of whom you personally know, will be praying for you and your family. The power of prayer will touch you and will help you through this most difficult time in your lives. Reverend Lloyd even told me once that he does not need to know your last names or reasons you are feeling such a loss, because God understands your pain.
The tears stopped and for the first time since I appeared in the room, the gaze of both parent's eyes drifted from the floor toward my hand and then to my face. "Thank you, Doctor!" Reverend Lloyd did call the parents that same evening, after which he called to thank me for giving him the "referral." He was touched by this wounded family, but understood that the love of God would someday rescue them from their pain.
Doctors do not always have therapeutic interventions for incurable diseases, chronic pain, domestic violence, grief, and broken relationships. By incorporating spiritual assessments and action points into our daily lives and practices, we can become more complete and compassionate physicians.
References
1. Gallup, Inc. Religion. http://www.gallup.com/poll/1690/Religion.aspx?version=print. Accessed September 21, 2012.
2. Daaleman TP, Frey B. Spiritual and religious beliefs and practices of family physicians: A national survey. J Fam Pract 1999;48:98-104.
3. Institute for Clinical Systems Improvement. Assessment and management of chronic pain. Bloomington, MN: Institute for Clinical Systems Improvement; 2011. http://www.icsi.org/pain__chronic__assessment_and_management_of_14399/pain__chronic__assessment_and_management_of__guideline_.html. Accessed March 28, 2012.
4. National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. 2nd ed. Pittsburgh; 2009.
5. Maugans TA, Wadland WC. Religion and family medicine: A survey of physicians and patients. J Fam Pract 1991;32:210-213.
6. O'Hara DP. Is there a role for prayer and spirituality in health care? Med Clin North Am 2002;86:33-46.
7. Unger J. Diabetes Management in Primary Care. 2nd ed. Philadelphia: Lippincott; Publication pending.
Evidence-based spiritual assessment tools are presented in this manuscript, which open a dialogue between patients and physicians. These adjunctive therapeutic interventions have been found to improve outcomes for patients with depression, cardiovascular disease, pain, anxiety, and adolescent risk behaviors.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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