Recognition of patients’ spiritual needs grows
Patient’s spiritual beliefs important to treatment
Spirituality is recognized as a factor that many patients say contributes to their health; but now experts — even some who previously had doubts — are embracing patients’ and their own spirituality as an essential part of treatment.
"Spirituality can affect how patients and health care providers perceive health and illness, and how they interact with each other," says Christine M. Puchalski, MD, director of the George Washington Institute for Spirituality and Health (GWISH) at The George Washington University Medical Center. "We need additional research and evidence as to the benefits of spirituality in health care, but we did a consensus with the naysayers — physicians, psychiatrists — and the group concluded that spirituality is essential to health care, and not just an amenity."
Puchalski describes spirituality as the "values, beliefs, practices, relationships, and experiences that lead one to an awareness of God or the divine or a transcendence and a sense of ultimate value and purpose in life."
Spirituality is found in all cultures, and is expressed in people’s search for ultimate meaning through participation in religion and/or their belief in God, family, naturalism, rationalism, humanism, and the arts.
A spiritual or religious base can provide a seriously ill patient with immeasurable support when confronting unanswerable questions like, "Why me?" and "Why now?"
"Clinically what happens is that illness and stress can cause people to question their ultimate meaning," says Puchalski.
Attention to spirituality important to patients
Addressing the audience at a recent conference on Spirituality and Healing in Medicine, Puchalski pointed out that the nation’s largest physician and nurse associations have addressed the importance of spirituality to patient care.
The American College of Physicians’ ethical standards state that physicians "should extend their care for those with serious medical illness attentiveness to include psychosocial, existential, or spiritual suffering," and the American Nurses Association code of ethics states, "An individual’s lifestyle, values system, and religious beliefs should be considered in planning health care with and for each patient."
The Dalai Lama even addressed the spiritual aspect of caring for the sick, Puchalski says, when he said, "Deprived of human warmth and a sense of value, other forms of treatment prove less effective. Real care of the sick does not begin with costly procedures, but with simple gifts of affection, love, and concern."
Treating a patient’s spiritual distress sometimes bears similarities to treating physical distress; for example, one important part of addressing spiritual distress is to take a spiritual history.
Taking the time to document a patient’s spiritual history can provide an important complement to his or her medical history.
Prompted by the mnemonic FICA, clinicians can find out what motivates, inspires, and supports a sick patient. (See table.)
Puchalski points out data indicating that physicians can feel comfortable broaching the subject with patients. A study of pulmonary patients at the University of Pennsylvania revealed that most (66%) said their trust in their health care providers increased if they were asked about their spiritual beliefs.
Not surprisingly, Puchalski says, inquiries about spirituality were most welcome by patients who were very seriously ill or dying (94%), and those suffering from or just diagnosed with a chronic or serious illness (91%).
Don’t medicate spiritual distress
Though treating a patient’s spiritual side in some ways can mimic treating his or her physical condition, Puchalski says health care providers must guard against medicating away a patient’s spiritual distress.
"It’s a question of healing vs. cure," she explains. "The medical system is cure-oriented. We want to make a good diagnosis and fix it.
"But a lot of healing is in the context of the incurable [condition], and so healing may mean helping the patient be at peace, to tap in to hope, and to find value in their life."
Spiritual distress, unlike physical pain, should not be masked with medications, she advises.
"It has to be experienced. It’s not like physical distress. There is so much we can do to help the patient move through spiritual distress and reach peace," she points out.
Theoretical, ethical framework helps guide
Puchalski lays out a spiritual and ethical framework that involves compassionate, patient-centered care and the biopsychosocialspiritual model, which holds that spirituality and medicine should go hand in hand because of the personal nature of the practice of medicine.
"Compassionate care has long been addressed in professional standards [set forth in medical and nursing codes]," she says. "That caring presence and attention to suffering.’"
Patient-centered care consists of shared decision making, respect for the patient’s values and beliefs, and the involvement of a larger community of caregivers. Because a patient’s understanding of illness and health is impacted by his or her spiritual, religious, and cultural beliefs, illness can trigger questions about the meaning and purpose of the patient’s life.
A physician’s understanding of the patient and his or her spiritual beliefs can be important to the patient’s response to treatment, and to the course of treatment. For example, Muslim faith dictates that the patient be alert at the time of death; Jehovah’s Witnesses do not believe in receiving blood transfusions.
"You try to work within the belief system of the patient, and incorporate their spiritual practices as appropriate," Puchalski suggests. "Identify his or her resources of strength — what gives them hope and faith, what their support community is.
"Research shows that patients’ spiritual beliefs impact their recovery from illness, how they cope with illness, their will to live, their resiliency to stress and the adverse effects of stress on their quality of life, and the mind-body connection."
Medical schools in the United States are recognizing the medical role of spirituality. From 1992 to 2004, the number of medical schools offering courses in spirituality and health went from three schools out of 141 to 102 out of 141. More than half (58%) offer more than one course, and the courses are required at 70% of schools.
Topics addressed in the courses include spirituality and end of life, childbirth, chronic illness, and surgery; coping with stress in patients and health care workers; taking a spiritual history; ethical guidelines; suffering; spiritual models; how different religions and cultures view ethical issues in health care; the role of ritual, prayer, and customs in health care decision making; and the spirituality of the health care provider.
- Christine M. Puchalski, MD, director, The George Washington Institute for Spirituality and Health, The George Washington University Medical Center, Washington, DC. Web site: www.gwish.org.