Spirituality and medical treatment go hand in hand

Schools offering more resources for physicians

The link between patients' spirituality and their response to medical treatment is gaining more attention, and according to a recent study, more than nine out of 10 doctors surveyed believe it is appropriate to discuss spiritual or religious issues when a patient brings them up.

However, the same survey (published in the May issue of Medical Care) showed that if their patients do not bring up religion or spiritual beliefs, only half of the doctors inquire about their patients' faith.

"Physicians should take a spiritual history for all new patients for whom they are doing a new physical history or who they are admitting," says Harold G. Koenig, MD, professor of psychiatry and behavioral sciences and assistant professor of medicine at Duke University Medical Center in Durham, NC. "It should be a part of their social history, and if the patient is not competent, take [the spiritual history] from the guardian, next of kin, or person acting as power of attorney."

Koenig says although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that spiritual histories be taken for all patients admitted to accredited hospitals, many hospitals rely on a question on admittance forms that asks if the patient has any religious preference.

"The checkbox isn't sufficient for JCAHO standards," says Koenig. "It doesn't provide the doctor with the kind of information he or she needs."

Little data, so far

Koenig says there is not much data on the effects that taking a spiritual history can have on a patient's care, but one study published on physician inquiry into patients' spirituality, indicates the impact might be significant.

In the International Journal of Psychiatry in Medicine article, the authors report that in a study of 118 cancer patients whose physicians (Christian and non-Christian) did a brief spiritual history, 85% of the physicians felt comfortable administering the spiritual history, 70% of the patients felt the history was useful, and in follow-up, there was a greater reduction in depressive symptoms in those patients and an increase in functional well-being.1

"I was amazed that with a couple of questions addressing this subject, there was a statistically significant impact on the patients' coping and well-being," says Koenig. "How many things do we do in health care that have that kind of effect?"

The positive effects might come even if the physician and patient never discuss religion or spiritual beliefs after the history is taken, Koenig says. The benefit may be in merely letting the patient know that if he or she ever wants or needs to talk about spiritual beliefs, the door is open. He adds that the spiritual history should elicit whether the patient is comfortable talking about his or her religious beliefs, or if such discussions make the patient uncomfortable. (See sample questions for a spiritual history.)

The study published in Spiritual Care found that 76% of the most religious doctors asked about their patients' beliefs, compared to 23% of minimally religious physicians. Thirty-eight percent of physicians surveyed said they thought doctors spent too little time addressing spiritual needs.

The majority of medical schools in the United States offer courses in spirituality in medicine, but most are not required courses.

The Birmingham, AL-based Southern Medical Association has undertaken a project to study and provide resources on the overlapping worlds of spirituality and medicine. The Spirituality/Medicine Interface Project will provide educational activities, regular journal articles, and live conferences. An educational conference for physicians, physicians-in-training, chaplains, social workers, and nurses will be held Sept. 14-17 at the Emory Conference Center in Atlanta, addressing the medical-spiritual roles played in chronic illness, palliative care, substance abuse, cancer, depression, STDs, domestic violence, and catastrophes. For information about the Spirituality/Medicine Interface Project, visit the Southern Medical Association web site at www.sma.org/spirituality.

Resource

  1. Kristeller JL, Rhodes M, Cripe LD, et al. Oncologist assisted spiritual intervention study (OASIS): Patient acceptability and initial evidence of effects. Int J Psych Med 2005; 35:329.

Sources/Resources

  • Harold G. Koenig, MD, professor of psychiatry and behavioral sciences, Duke University Medical Center, Durham, NC. E-mail: koenig@geri.duke.edu.