EXECUTIVE SUMMARY

Most health professionals agreed they should take a screening spiritual history, but few do so currently, found a recent study.

• Inadequate assessment of spiritual values may mean patient preferences aren’t honored.

• Addressing spiritual needs aids in the healing process.

• Patient preferences should be documented and communicated to the entire healthcare team.


Should health professionals take a screening spiritual history (SSH) of their patients? Most clinicians (45% of 427 physicians, 56% of 86 mid-level practitioners, and 54% of 224 nurses) agreed they should, a recent survey found.1

“What was surprising was that many clinicians already take a spiritual history and address spiritual needs, either themselves or refer patients to chaplains, and that patients are often very receptive to such discussions,” says Harold G. Koenig, MD, director of Duke University Medical Center’s Center for Spirituality, Theology, and Health.

Still, comparatively few (11 to 17%) of the respondents, all providers in outpatient practice in the Adventist Health System, currently performed spiritual assessments in their own practice.

“Given that medical patients often have spiritual needs related to medical illness, in order to provide holistic healthcare to patients — physically, mentally, socially, and spiritually — such needs should be assessed and addressed as part of routine healthcare,” says Koenig.

Education, training, and support may help health professionals identify and address patients’ values, beliefs, and preferences, the researchers say.

“We believe that this kind of healthcare will improve medical outcomes, improve patient satisfaction, and reduce burnout among healthcare professionals because of the improved results that they see in their patients,” says Koenig.

Integral to Care

Addressing the spiritual and religious needs of patients and families is integral to quality patient care, says Margie Atkinson, DMin, BCC, director of pastoral care, ethics, and palliative care at Morton Plant Mease Hospitals/BayCare Health System in Clearwater, FL.

An interdisciplinary approach to patient care includes professional chaplains and always addresses spiritual and religious aspects of care, says Atkinson.

“Failure to do so can result in a lack of understanding of patients’ wishes and prevent appropriately addressing patient goals of care, which connect to quality of life,” she adds. Spirituality and/or religious beliefs often influence a patient’s values, preferences for care, and end-of-life decision-making. If such beliefs aren’t addressed, it could mean that patient preferences aren’t honored, she says.

A recent case involved a man who was admitted to the hospital and was found to have a terminal illness. “His illness resulted in his incapacity to make complex medical decisions,” says Atkinson. The patient’s religious preference was Protestant, and he had an advance care plan and living will in place. The patient had named his brother-in-law as the legal surrogate with the patient’s wife as a secondary, both of whom were Muslim. The patient’s subsequent diagnosis by more than two physicians deemed that he was in a terminal condition with no chance of meaningful recovery with or without treatment. This diagnosis statutorily should have activated the patient’s living will. “However, his surrogate refused to give permission for cessation of aggressive care due to his religious beliefs, which were different from the patient’s,” says Atkinson. Since his wife also was of a different faith tradition than her husband, she would not take responsibility for honoring the patient’s wishes, either.

An ethics consult was called. Ultimately, the ethics team consulted the hospital’s legal department in order to get a court order to honor the patient’s wishes. Chart documentation from previous visits include chaplain and counselor notations that the patient was “at peace with God” and affirmed his Protestant religious beliefs. After reviewing all of the documentation, the judge agreed that the living will should take effect. The brother-in-law and the wife were relieved because they did not have to make a decision going against their own religious beliefs, and the patient’s wishes were honored.

“Addressing spiritual needs aids in the healing process, both physically and emotionally,” says Atkinson. “It helps patients and families tap into their own sources of strength and resilience.”

Proactive Approach

Institutions must provide spiritual caregivers who are trained and competent to meet needs based on the patient’s and family’s spiritual preferences — not the healthcare providers’ own preferences, says Rabbi Jodie Futornick, MA, BCC, staff chaplain and ethics consultant at Swedish Medical Center in Seattle.

Trained professional chaplains focus on providing spiritual care and addressing spiritual needs of patients, regardless of faith tradition, spiritual paradigm, or no religious preference. They also may serve as a liaison with a patient or family’s own clergy.

“Professional chaplains are able to document and communicate these preferences to the entire healthcare team,” says Futornick. “This frequently becomes a key component in addressing ethical issues.”

This is because spiritual and religious values often impact patients’ and families’ complex medical decision-making. Ethicists should consider advocating for the institution to hire professionally trained, board-certified chaplains, says Futornick: “This ensures a proactive approach to patient rights issues, patient preferences, and provision of care that is in the patient’s best interest.”

REFERENCE

1. Koenig HG, Perno K, Hamilton T. The spiritual history in outpatient practice: attitudes and practices of health professionals in the Adventist Health system. BMC Med Educ 2017; 17:102.

SOURCES

• Margie Atkinson, DMin, BCC, Director, Pastoral Care, Ethics and Palliative Care, Morton Plant Mease Health Care/BayCare Health System, Clearwater, FL. Phone: (727) 461-8061. Email: margie.atkinson@baycare.org.

• Rabbi Jodie Futornick, DBe, MA, BCC, Staff Chaplain/Ethics Consultant, Swedish Medical Center, Seattle. Phone: (847) 471-3080. Email: jodie.futornick@swedish.org.

• Harold G. Koenig, MD, Director, Center for Spirituality, Theology, and Health, Duke University Medical Center. Email: harold.koenig@duke.edu.