Illness and other life-altering events often lead people to question the meaning and purpose of life. "Why? Why me? Why now?" The population health policy community has begun to understand the critical role that religion or spirituality can play in quality care.
Spirituality -- the broader of the two terms -- can be defined as a sensitivity or attachment to religious or other values that helps a person gain insight, self-knowledge, and a heightened understanding of life.
For many patients, spirituality provides the foundation and support that enables them to move from dissonance and brokenness to a sense of wellbeing and wholeness.
In this context, "healing" is more than a technical cure or fix -- it becomes part of a life journey.
Spirituality is integral to whole -- or holistic -- patient care in that it helps to address individuals' understanding of illness and change. Spiritual perspectives and practices can provide a context wherein anxieties about physical and mental functioning may be faced, felt, and understood.
A steadily building body of research shows that spiritual and religious practices support health. Empirical studies show relationships between measures of health and religious indices that include prayer, religious observance, and self-rated religiousness/spirituality.
Religious institutions provide social support mechanisms and practices that encourage healthy behaviors, as well as a personal sense of meaning.
Individuals, particularly elders and those with chronic medical conditions, often turn to religious coping methods, such as seeking spiritual support from clergy or church members, when faced with mental and physical health difficulties.
Less is known about how the healthcare system and providers are trained to address the intersection of religion, spirituality, and health.
Today, topics on spirituality and health are frequently taught in medical schools in the U.S. The number of medical schools that offer courses on spirituality has increased from three schools in 1992 to 84 in 2004.
In its Medical School Objectives Report (1999), the American Association of Medical Colleges introduced spiritual care as important among communication practices, acknowledging the value that many patients place on their spiritual and religious practices.
Spiritual care is by nature interdisciplinary and often involves pastoral care counselors or chaplains.
A range of suggested methodologies is available to assist physicians and other healthcare professionals in identifying and addressing spiritual needs.
Of equal, or perhaps greater, importance is determining the appropriate time for a conversation regarding spirituality and understanding the impact of physician involvement in this area.
There are ethical boundaries to physician involvement, which may include:
- lack of knowledge, training, or time
- discomfort with subject
- fear of imposing religious views
- consent and confidentiality requirements, and
- religious conflicts
For healthcare providers, basic information on their patients' spiritual and emotional needs can be gathered by taking a spiritual history.
The questions in a spiritual history help providers understand patients' spiritual beliefs and the role that they play in patients' coping. They also help to identify any spiritual needs to be addressed.
Domains within such a history include:
- Does the patient use religion to help cope or is it a source of stress?
- Is the patient a member of a supportive spiritual community?
- Does the patient have any troubling spiritual questions or concerns?
- Does the patient have any spiritual or religious beliefs that might influence medical care?
- Are there ethical boundaries?
In fact, a "spiritual work-up" may soon become integrated into the physician's standard history and physical examination process. The Joint Commission has specified that a "spiritual history" be documented by patients in hospitals and nursing homes.
All medical professionals have the responsibility to compassionately care for those who are sick and suffering. These human interactions often lead to questions of "meaning" which are beyond the science of medicine and touch the very heart of our existence.
Ongoing support and training for healthcare providers with regard to patients' spiritual issues is challenging.
Medical students may have time and opportunity to reflect upon pivotal moments in their educational experience, such as their reactions to gross anatomy class, their first exposure to the process of birth or death, or their first experience breaking bad news to a patient or family. However, the realities and time constraints of routine clinical practice may not allow for such self-reflection.
One of our friends, a first year internal medicine intern, spoke recently of his rotation on the cancer floor of his hospital. He expressed his frustration with not having enough time to spend with his very sick patients and their families. Despite this, he actively sought to make the most of the few moments he was able to spend with them.
The learning for him became a focused search for the human quality within each patient encounter.
This learning was connected to recognizing his own human limitations and frailties as well as those of his patients.
But physicians' personal religious and spiritual supports are often neglected in medical practice discussions.
These supports may lend critical ethical and behavioral guidelines for the clinician's practice of medicine, and perhaps imbue it with heightened meaning in these stressful times.
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