TY - JOUR
AU1 - Koenig, Harold G.
AB - In a recent multicenter survey of 476 physicians' attitudes toward spirituality in clinical practice, 85% said physicians should be aware of a patient's religious and spiritual beliefs.1 This finding was consistent with a 1992 survey of 594 family physicians, of whom 93% agreed or strongly agreed that physicians should consider patients' spiritual needs.2 However, only 31% and 39% of physicians believed that physicians should ask patients about their spiritual beliefs in outpatient and inpatient settings, respectively.1 It has been reported, however, that fewer than 10% of physicians actually do so,3 even among dying patients.4 Although no published studies have yet examined the benefits of taking a spiritual history, there is some indirect evidence in support of this practice. First, religious practice is one of the most common ways that patients cope with medical illness,5 and it predicts both successful coping6 and faster remission from depression in medical settings.7 Second, religious beliefs have been found to influence medical decisions that patients with serious medical illness make.8 Third, the faith community is a primary source of support for many medically ill patients,9 and social support has been associated with better adherence to therapy and medical outcomes.10 Fourth, based on a survey of 1 732 562 patients representing 33% of all hospitals in the United States, patient satisfaction with the emotional and spiritual aspects of care had one of the lowest ratings among all clinical care indicators and was one of the highest areas in need of quality improvement.11 Finally, unmet spiritual needs indicated by "religious struggles" (ie, feeling punished or deserted by God) are a predictor of increased mortality among medical patients following hospital discharge.12 These are many barriers to obtaining a spiritual history, including lack of time, lack of training, concern about activity outside physicians' area of expertise, discomfort with the subject, worries about imposing religious beliefs on patients, and lack of interest or awareness.13 It is probably most appropriate to obtain a spiritual history when the physician is collecting comprehensive information, such as when taking a complete history on a new patient, when a patient is admitted to the hospital, or during a well-patient checkup. Furthermore, not every patient needs a spiritual history documented. Those with terminal or chronic, disabling medical illness with whom the physician has an ongoing relationship are ideal candidates.6 Clinical experience suggests that a typical spiritual history in an outpatient setting adds an additional 2 minutes to the visit.14 The purpose is not to address spiritual issues, but rather to identify them through a series of brief screening questions. The purpose of the spiritual history is to learn about how patients cope with their illnesses, the kinds of support systems available to them in the community, and any strongly held beliefs that might influence medical care. If the patient denies that religious or spiritual matters are important to him/her, then there is probably no need for further questions. On the other hand, it is important to know whether the patient has any spiritual beliefs that might influence decisions about medical care. Some patients are members of a spiritual community, which may or may not be supportive. Patients may have specific spiritual needs that caregivers ought to address.9 A number of activities should also be avoided by physicians when taking a spiritual history, especially prescribing religion to nonreligious patients, forcing a spiritual history upon patients who are not religious, coercing patients to believe or practice in specific ways, providing spiritual counsel to patients, any activity that is not patient-centered, and arguing with patients over religious matters.15 References 1. Monroe MH, Bynum D, Susi B. et al. Primary care physician preferences regarding spiritual behavior in medical practice. Arch Intern Med.2003;163:2751-2756.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14662629&dopt=AbstractGoogle Scholar 2. King DE, Sobal J, Haggerty J. et al. Experiences and attitudes about faith healing among family physicians. J Fam Pract.1992;35:158-162.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1645108&dopt=AbstractGoogle Scholar 3. Chibnall JT, Brooks CA. Religion in the clinic: the role of physician beliefs. South Med J.2001;94:374-379.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11332900&dopt=AbstractGoogle Scholar 4. King DE, Wells BJ. End-of-life issues and spiritual histories. South Med J.2003;96:391-393.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12916559&dopt=AbstractGoogle Scholar 5. Koenig HG. Religious attitudes and practices of hospitalized medically ill older adults. Int J Geriatr Psychiatry.1998;13:213-224.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9646148&dopt=AbstractGoogle Scholar 6. Koenig HG, Cohen HJ, Blazer DG. et al. Religious coping and depression among elderly, hospitalized medically ill men. Am J Psychiatry.1992;149:1693-1700.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1443246&dopt=AbstractGoogle Scholar 7. Koenig HG, George LK, Peterson BL. Religiosity and remission of depression in medically ill older patients. Am J Psychiatry.1998;155:536-542.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9546001&dopt=AbstractGoogle Scholar 8. Silvestri GA, Knittig S, Zoller JS. et al. Importance of faith on medical decisions regarding cancer care. J Clin Oncol.2003;21:1379-1382.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12663730&dopt=AbstractGoogle Scholar 9. Ell KO, Mantell JE, Hamovitch MB. et al. Social support, sense of control, and coping among patients with breast, lung, or colorectal cancer. J Psychosoc Oncol.1989;7:63-89.Google Scholar 10. House JS, Landis KR, Umberson D. Social relationships and health. Science.1988;241:540-545.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3399889&dopt=AbstractGoogle Scholar 11. Clark PA, Drain M, Malone MP. Addressing patients' emotional and spiritual needs. Jt Comm J Qual Safety.2003;29:659-670.Google Scholar 12. Pargament KI, Koenig HG, Tarakeshwar N. et al. Religious struggle as a predictor of mortality among medically ill elderly patients: a two-year longitudinal study. Arch Intern Med.2001;161:1881-1885.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11493130&dopt=AbstractGoogle Scholar 13. Ellis MR, Campbell JD, Detwiler-Breidenbach A, Hubbard DK. What do family physicians think about spirituality in clinical practice? J Fam Pract.2002;51:249-254.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11978236&dopt=AbstractGoogle Scholar 14. Kristeller JL, Zumbrun CS, Schilling RF. "I would if I could": how oncologists and oncology nurses address spiritual distress in cancer patients. Psychooncology.1999;8:451-458.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10559804&dopt=AbstractGoogle Scholar 15. Butler SM, Koenig HG, Puchalski C. et al. Is Prayer Good for Your Health? A Critique of the Scientific Research. Heritage Lecture 816, September 2003. Available at: http://www.heritage.org/Research/Religion/HL816.cfm. Accessed May 20, 2004.
TI - Taking a Spiritual History
JF - JAMA
DO - 10.1001/jama.291.23.2881
DA - 2004-06-16
UR - https://www.deepdyve.com/lp/american-medical-association/taking-a-spiritual-history-bd1pmcfp5S
SP - 2881
EP - 2882
VL - 291
IS - 23
DP - DeepDyve
ER -