What Do Family Physicians Think About Spirituality In Clinical Practice?

,

Original Research

What Do Family Physicians Think About Spirituality In Clinical Practice?

J Fam Pract. 2002 March;51(3):249-254

By

Mark R. Ellis, MD, MSPH

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References

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ABSTRACT

OBJECTIVES: To describe the context in which physicians address patients’ spiritual concerns, including their attitudes toward this task, cues to discussion, practice patterns, and barriers and facilitators.

STUDY DESIGN: This was a qualitative study using semistructured interviews of 13 family physicians.

POPULATION: We selected board-certified Missouri family physicians in a nonrandom fashion to represent a range of demographic factors (age, sex, religious background), practice types (academic/community practice; urban/rural), and opinions and practice regarding physicians’ roles in addressing patients’ spiritual issues.

OUTCOMES MEASURED: We coded and evaluated transcribed interviews for themes.

RESULTS: Physicians who reported regularly addressing spiritual issues do so because of the primacy of spirituality in their lives and because of the scientific evidence associating spirituality with health. Respondents noted that patients’ spiritual questions arise from their unique responses to chronic illness, terminal illness, and life stressors. Physicians reported varying approaches to spiritual assessment; affirmed that spiritual discussions should be approached with sensitivity and integrity; and reported physician, patient, mutual physician–patient, and situational barriers. Facilitators of spiritual discussions included physicians’ modeling a life that includes a spiritual focus.

CONCLUSIONS: These physicians differ in their comfort and practice of addressing spiritual issues with patients but affirm a role for family physicians in responding to patients’ spiritual concerns. Factors that form a context for discussions of spiritual issues with patients include perceived barriers, physicians’ role definition, familiarity with factors likely to prompt spiritual questions, and recognition of principles guiding spiritual discussions.

KEY POINTS FOR CLINICIANS

Family physicians differ in their views regarding the appropriateness of addressing patients’ spiritual issues, but they widely support a patient-centered approach to any spiritual assessment that is performed.
Physician barriers to spiritual assessment may include upbringing and culture, lack of spiritual inclination or awareness, resistance to exposing personal beliefs, and belief that spiritual discussions will not have an impact on patients’ illnesses or lives.
Facilitators to spiritual assessment may include communicating a willingness to have these discussions and the physician’s modeling a life of balance and spiritual maturity.

An emerging body of research supports the inclusion of spiritual issues in healthcare. Studies have correlated religious commitment with health.^1-3 Many patients affirm the importance of spiritual factors in their lives.^4-5 Recent studies demonstrate that many patients wish to have spirituality considered in their health care, especially during grave illness or emotional crisis.^4-6 How to accomplish this objective is less clear. Although physicians possess spiritual assessment tools,^7-11 broader issues such as physician attitudes, roles, and varied ways of dealing with spirituality have not been widely studied. Understanding this context is crucial if physicians are to include spiritual assessment in patient care.

Two studies of Midwestern family physicians found strong support for addressing patients’ spiritual concerns. In one survey, family physicians in Illinois (n = 210) believed that strong religious convictions positively affect older patients’ mental health (68%) and physical health (42%).¹² These doctors supported physicians’ pursuing spiritual issues at patients’ request (88%) and when patients faced bereavement or impending death (66%). Similarly, Missouri family physicians (n = 231) affirmed that spiritual well-being is an important health component (96%) and that hospitalized patients with spiritual concerns should be referred to chaplains (86%).¹³ A far smaller percentage of these physicians, however, felt they should personally address patients’ spiritual questions (58%).

Despite acknowledging the importance of spiritual issues, the Missouri physicians seldom engaged patients in conversations about death and dying, meditation or quiet reflection, prayer, forgiveness, giving and receiving love, the role of a deity in illness, and the meaning or purpose of illness. They reported such barriers to spiritual discussions as lack of time (71%), inadequate training for taking spiritual histories (59%), and difficulty in identifying patients who want to discuss spiritual issues (56%). The gulf between physicians’ attitudes and practice of spiritual assessment suggests an incomplete understanding of their role in spiritual health.

A study by Craigie and Hobbs¹⁴ of 12 family physicians who are themselves deeply spiritual represents early progress toward understanding this role. These physicians perceived that their spirituality enabled them to experience sacredness in patient encounters, to view medicine as a mission, to maintain centeredness, and to serve as instruments of healing. They described themselves as facilitators and encouragers of patients’ spiritual values and resources. We reasoned that unlike the deeply spiritual respondents in the Craigie and Hobbs study, family physicians in general are likely to have a broad range of attitudes and practices regarding spiritual assessment. We sought to better understand the spectrum of views about the physician’s role in spiritual encounters, to describe family physicians’ approaches to addressing spiritual issues, and to further explore barriers to spiritual discussions and facilitators of these discussions.