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Importance of religion in healthcare

By Walt Larimore, MD | October 08, 2015

Excerpted from "Religion rarely part of ICU conversation," Reuters. August 31, 2015 — In less than 20 percent of family meetings in the intensive care unit do doctors and other health care providers discuss religion or spirituality, a new study finds. For many patients and families, religion and spirituality are important near the end of life, and understanding these beliefs may be “important to delivering care that is respectful of the patient as an individual,” said senior author Dr. Douglas B. White of the University of Pittsburgh School of Medicine, in an email to Reuters Health.

Researchers used audio recordings to analyze 249 meetings between health care professionals and an ICU patient’s surrogate decision maker at six medical centers between 2009 and 2012. Three-quarters of the decision makers rated religion or spirituality as fairly or very important in their lives.

Religion or spirituality came up in 40 of the 249 conversations. More than half of the time, the surrogate decision maker, rather than the doctor, brought up the subject, the authors reported in JAMA Internal Medicine. Surrogates most often mentioned their religious beliefs, practices or community, or that the doctor is a healing instrument of god, or that the end of life will be a new beginning for the patient.

Doctors frequently redirected these conversations to medical considerations, referred surrogates to other hospital providers or expressed empathy, but very rarely asked further questions about the patient’s religion or opened up about their own religious beliefs.

“Regardless of whether the patient has decision making capacity, clinicians should try to determine whether patients’ religious and spiritual beliefs may affect the kind of medical care that is respectful of what is important to the patient as a person,” White said. “Separately, many family members of critically ill patients find solace in their religious or spiritual beliefs and it may be helpful for clinicians to understand this to better support them.”


Commentaries

Dr. Walt LarimoreAward-winning Family Physician and Best-Selling Author Walt Larimore, MD:Studies have shown that up to 90 percent of patients want their healthcare professional to address their religious/spiritual (R/S) needs. This is because the vast majority of patients rely on R/S to cope when facing illness—especially for those with serious, life-threatening disease.1

“R/S beliefs influence medical decisions made by both patients and healthcare professionals, and these decisions often involve the use of expensive, high tech treatments, especially toward the end of life.2 Assessing and addressing patients’ R/S needs is associated with greater satisfaction with care, better quality of life measures, less depression, fewer unnecessary health services, better functioning and a better doctor-patient relationship.3 Furthermore, addressing R/S issues may benefit the healthcare professionals as well by providing intrinsic rewards associated with delivering whole-person healthcare.

“As a result, the ability to identify and address patient spiritual needs has become an important clinical competency for healthcare professionals. Yet, we, in general, fail miserably to do so. As a result, healthcare professionals and health systems are depriving their patients of the spiritual support and comfort on which their hope, health and wellbeing may hinge.4

“It is highly ethical for healthcare professionals (and healthcare systems) to assess their patients’ R/S needs and to provide indicated and desired spiritual interventions. At stake is the health and wellbeing of our patients and the satisfaction that we experience in delivering care that addresses the whole person—body, mind and, of most eternal significance, spirit.”5

1 Harold G. Koenig. Religious attitudes and practices of hospitalized medically ill older adults. International Journal of Geriatric Psychiatry. 1998(Dec 4);13(4):213–224.
2 Phelps AC, Maciejewski PK, Nilsson M, et al. Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer. Journal of the American Medical Association. 2009(Mar);301(11):1140–1147.
3 Koenig HG, King DE, Carson VB. Handbook of Religion and Health, 2nd edition. New York: Oxford University Press, 2012.
4 Larimore WL, Parker M, Crowther M. Should clinicians incorporate positive spirituality into their practices? What does the evidence say? Annals of Behavioral Medicine. 2002(Winter);24(1):69-73.
5 Koenig HG. Religion, spirituality, and health: The research and clinical implications. ISRN Psychiatry. 2012(Dec16): Article ID 278730.
 

Steve NoblettChristian Community Health Fellowship Executive Director Steve Noblett: “Even in Christian clinics and with missionally motivated providers, spiritual care happens less than we think. The biggest complaint is that physicians don’t have enough time. I hear that same complaint from those who see four patients per hour as I do from those who see two per hour or less. The truth is that the healthcare professionals who do the best job of addressing spiritual issues are those who see 20 or more patients per day.

“If time is not the real obstacle, how can we do this and do it well? There are three keys to helping us do a better job of providing spiritual care for our patients.

“First, we must see spiritual health as a ‘vital.’ You’ve never seen a patient and not had time to take their temperature and blood pressure. Our patients’ spiritual condition is the underlying vital that impacts virtually every other area of their health. Start with a couple of quick, simple questions: ‘On a scale of 1-10, how do you rate your own spiritual health?’ followed by, ‘Why did you give yourself that score?’

“Second, providing appropriate, effective spiritual care in a doctor/patient relationship is a learned skill. Stop treating this important area differently than every other area of patient care. We need training. Grace Prescriptions and METS are two excellent programs that teach spiritual care delivery in the healthcare context. Invest in training.

“Third, spiritual health assessments and interventions should be part of the medical record. We measure what is important. One seasoned doctor I shadowed recently was shocked at how seldom he was actually addressing spiritual health with his patients. There was a time when he had always prayed with every patient. A simple check box in the record is a good start, enabling you to keep track of how you are doing. Keeping notes of conversations and interventions is important, and makes your patients realize that this is something they need to take seriously.”

Resources

Spiritual Assessment in Clinical Care: Part 1–The Basics by Walt Larimore, MD
Spiritual Assessment in Clinical Care: Part 2–The LORD’s LAP by Walt Larimore, MD
Grace Prescriptions - Learn How to Share Your Faith with Your Patients

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