What Do Family Physicians Think About Spirituality In Clinical Practice?

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Original Research

What Do Family Physicians Think About Spirituality In Clinical Practice?

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

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References

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Barriers to spiritual assessment

Our respondents noted significant barriers, including physician barriers, mutual physician–patient barriers, physician-perceived patient barriers, and situational barriers (Table 3). An example of a physician–patient barrier is the mutual feeling that neither wants to raise issues of spirituality for fear of alienating or causing discomfort in the other.

TABLE 3
SELECTED BARRIERS TO SPIRITUAL DISCUSSIONS AND FACILITATORS OF THEM

Barriers
Physician Barriers Lack of comfort or training Lack of spiritual awareness or inclination Fear of inappropriately influencing patients
Mutual Physician–Patient Barriers Discomfort with initiating discussions Lack of concordance between physician and patient spiritual or cultural positions No common “spiritual language”
Physician-Perceived Patient Barriers Fear that it’s wrong to ask doctor spiritual questions Belief that spiritual views are private Perception of physician time pressure
Situational Barriers Time Setting (examination room) Lack of continuity or managed care
Facilitators
Actions Expressing interest over time in person’s life to develop rapport Reinforcing importance of spiritual coping mechanisms Use of similar approach as in discussions of sexuality, other sensitive issues
Situational Factors Visiting patients at bedside or home
Resources Coworkers (reinforce physician’s role)
Physician Qualities Inner strength, balance, and spiritual centeredness Openness, assurance of “helper” role
For the complete table, see Table W3.

Facilitators of spiritual discussions

Respondents noted that characteristics facilitating patients’ discussions of sexuality and other sensitive issues also facilitate conversations about spirituality. These characteristics include communicating a willingness to engage in (and having the time for) such discussions and assuring patients that spiritual confidences will be received in a nonjudgmental fashion.

Physicians who are more spiritually inclined may be more likely to address spiritual issues with patients. As one respondent stated, “When I have conversations about spiritual issues, it’s [sic] usually been at my initiation . . . because I’m more concerned about religious sorts of things than many physicians.”

A final theme expressed by respondents is that physicians who model a life characterized by balance and spiritual maturity can facilitate patients’ spiritual growth. One stated, “My patients perceive something about my balance and spiritual strength that makes them believe they can do anything. It allows me to move to the next level with them . . . [by showing them how to foster] that strength in themselves with the help of family, community, and God.” Other facilitators are listed in Table 3.

Discussion

The relationship between religiosity and positive health outcomes does much to justify spiritual assessment.^1-3 Other justifications include enhanced coping in chronic illness states,²³ providing patients with hope in illness-coping and recovery;^24,25 the possibility that neglect of spiritual needs may drive patients away from medical treatment,²⁴ and evidence that some patients desire physicians to raise spiritual issues.^6,25,26

We sought to explore the context of spiritual assessment rather than to further justify such assessments. The context of spiritual assessment refers to the philosophical question of whether physicians should address spiritual questions and to practical questions of how spiritual matters arise, how physicians approach them, and what barriers and facilitators they perceive with regard to discussing spirituality. Our study adds to knowledge about this context in several important ways.

We found variance of opinion concerning the physician’s role in spiritual assessment. Respondents reporting infrequent spiritual assessment expressed the view that spiritual issues have lower priority than other medical concerns. Yet those who regularly address spiritual issues justified this with scientific evidence associating spirituality and health. They also proposed a justification not found in previous studies: that spirituality is central to life and therefore important for its own sake rather than simply as a means to a medical end. These findings support and augment previously cited justifications for physicians assisting patients with spiritual health issues.^1-3,6,24-26

Our study results add to the list of categories that prompt discussions of spiritual issues. Respondents affirmed a role for physicians in discussing end-of-life issues and advanced care directives, as in previous studies.^27-29 In addition, they observed that patients’ spiritual questions arise from their unique responses to chronic illness, terminal illness, and life stressors. They identified 2 new categories prompting spiritual discussions: unexplained symptoms and treatment failure.

All respondents affirmed a role for physicians in supporting patients who initiate spiritual discussions. As in a previous study,¹⁴ they viewed themselves as facilitators and encouragers of patients’ spiritual values and as resources rather than as spiritual counselors. The most reticent physicians believed in responding to patients’ questions rather than initiating discussions, an approach that may fail to identify spiritual issues. All respondents supported a patient-centered approach to spiritual assessment in which physicians act with integrity and take care not to abuse their position.

Many physicians saw value in spiritual history taking, though none reported routine use of spiritual assessment tools. The potential Judeo-Christian bias in assessment questions noted by one respondent highlights the need to use culturally sensitive, generic assessment tools³⁰ and to work toward further development of such tools.