Journal of General Internal Medicine

, Volume 26, Issue 11, pp 1265–1271 | Cite as

Attention to Inpatients’ Religious and Spiritual Concerns: Predictors and Association with Patient Satisfaction

  • Joshua A. WilliamsEmail author
  • David Meltzer
  • Vineet Arora
  • Grace Chung
  • Farr A. Curlin
Original Research



Little is known about how often patients desire and experience discussions with hospital personnel regarding R/S (religion and spirituality) or what effects such discussions have on patient satisfaction.

Objective, Design and Participants

We examined data from the University of Chicago Hospitalist Study, which gathers sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center.

Main Measures

Primary outcomes were whether or not patients desired to have their religious or spiritual concerns addressed while hospitalized, whether or not anyone talked to them about religious and spiritual issues, and which member of the health care team spoke with them about these issues. Primary predictors were patients’ ratings of their religious attendance, their efforts to carry their religious beliefs over into other dealings in life, and their spirituality.

Key Results

Forty-one percent of inpatients desired a discussion of R/S concerns while hospitalized, but only half of those reported having such a discussion. Overall, 32% of inpatients reported having a discussion of their R/S concerns. Religious patients and those experiencing more severe pain were more likely both to desire and to have discussions of spiritual concerns. Patients who had discussions of R/S concerns were more likely to rate their care at the highest level on four different measures of patient satisfaction, regardless of whether or not they said they had desired such a discussion (odds ratios 1.4–2.2, 95% confidence intervals 1.1–3.0).


These data suggest that many more inpatients desire conversations about R/S than have them. Health care professionals might improve patients’ overall experience with being hospitalized and patient satisfaction by addressing this unmet patient need.


patient satisfaction physician/patient communication quality of care religion spirituality 




We gratefully acknowledge Andrea Flores, Benjamin Vekhter, and Ainoa Mayo for their help with data cleaning and analysis, for which they did not receive compensation.


Financial support for this work was provided by the Agency for Healthcare Quality and Research through the Hospital Medicine and Economics Center for Education and Research in Therapeutics (CERT) (U18 HS016967-01, Meltzer, PI), a Midcareer Career Development Award from the National Institute of Aging (1 K24 AG031326-01, Meltzer, PI), and the Robert Wood Johnson Investigator Program, (RWJF Grant ID 63910 Meltzer, PI). Mr. Williams’ effort was supported by the Pritzker School of Medicine Summer Research Program through a grant from the Gold Foundation and a Ruth L. Kirschstein National Research Service Award Short-Term Institutional Research Training Grant (5T35AG029795, Meltzer, PI) from the National Institutes of Health, Bethesda, Maryland. Dr. Curlin is supported by a career development award from the national Center for Complementary and Alternative Medicine (1 K23 AT002749-01A1).

Prior Presentations

Please note that a poster presentation of a previous draft of the manuscript was made under the title Discussion of Inpatients’ Spiritual and Religious Concerns during Hospitalization on June 4, 2010, at the AAMC’s Integrating Quality Conference in Chicago, IL. An oral presentation of this current version of the manuscript was made at The Gerontological Society of America’s 63rd Annual Scientific Meeting on November 20, 2010, in New Orleans, LA.

Conflicts of Interest

We wish to make the following disclosures: Joshua Williams, David Meltzer, and Grace Chung have no potential conflicts of interest. Dr. Arora reports receiving funding from the National Institutes of Aging (NIA), the Agency for Healthcare Research and Quality (AHRQ), the ABIM Foundation, and the ACP Foundation. Dr. Curlin has no conflicts of interest relevant to this paper. In his only industry relationship, he was paid $6,700 by Boehringer-Ingelheim in 2008 to participate in an advisory board regarding religion and sexual dysfunction.


  1. 1.
    Curlin FA, Lantos JD, Roach CJ, Sellergren SA, Chin MH. Religious characteristics of US physicians: A national survey. J Gen Intern Med. 2005;20(7): 629–34.PubMedCrossRefGoogle Scholar
  2. 2.
    Update: Americans and religion. [Gallup Poll web site]. December 23, 2004. Available at: Accessed June 11, 2011.
  3. 3.
    MacLean CD, Susi B, Phifer N, Schultz L, Bynum D, Franco M, et al. Patient preference for physician discussion and practice of spirituality. J Gen Intern Med. 2003 Jan;18(1):38–43.PubMedCrossRefGoogle Scholar
  4. 4.
    Ellis MR, Campbell JD. Patients’ views about discussing spiritual issues with primary care physicians. South Med J. 2004 Dec;97(12):1158–64.PubMedCrossRefGoogle Scholar
  5. 5.
    Daaleman, TP, Frey B. Prevalence and patterns of physician referral to clergy and pastoral care providers. Arch Fam Med. 1998 Nov-Dec;(7):548–553Google Scholar
  6. 6.
    Balboni TA, Vanderwerker LC, Block SD, Block SD, Paulk ME, Lathan CS, Peteet JR, Prigerson HG. Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. J Clin Onco. 2007 Feb 10;25(5):555–60.CrossRefGoogle Scholar
  7. 7.
  8. 8.
    Joint Commission: The Source February 2005, Volume 3. [Professional Chaplains web site] Available at: Accessed June 11, 2011.
  9. 9.
    Ehman JW, Ott BB, Short TH, Ciampa RC, Hansen-Flaschen J. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Arch Intern Med. 1999 Aug 9–23;159(15):1803–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Maugans TA, Wadland WC. Religion and family medicine: A survey of physicians and patients. J Fam Pract. 1991 Feb;32(2):210–3.PubMedGoogle Scholar
  11. 11.
    Cohen CB, Wheeler SE, Scott DA. Anglican Working Group in Bioethics. Walking a fine line. Physician inquiries into patients’ religious and spiritual beliefs. Hastings Cent Rep. 2001 Sep-Oct;31(5):29–39.PubMedCrossRefGoogle Scholar
  12. 12.
    Balboni T, Balboni M, Paulk E, Phelps A, Wright A, Peteet J, Block S, Lathan C, VanderWeele T, Prigerson H. Support of cancer patients’ spiritual needs and associations with medical care costs at the end of life. Cancer. 2011 May 11. doi: 10.1002/cncr.26221.Google Scholar
  13. 13.
    Clark PA, Drain M, Malone MP. Addressing patients’ emotional and spiritual needs. Jt Comm J Qual Saf. 2003 Dec;29(12):659–70.PubMedGoogle Scholar
  14. 14.
    Ross L. Spiritual care in nursing: An overview of the research to date. J Clin Nurs. 2006 Jul;15(7):852–62.PubMedCrossRefGoogle Scholar
  15. 15.
    Curlin FA, Chin MH, Sellergren SA, Roach CJ, Lantos JD. The association of physicians’ religious characteristics with their attitudes and self-reported behaviors regarding religion and spirituality in the clinical encounter. Med Care. 2006 May;44(5):446–53.PubMedCrossRefGoogle Scholar
  16. 16.
    Koenig HG. Religion, spirituality, and medicine: research findings and implications for clinical practice. South Med J. 2004 Dec;97(12):1194–200.PubMedCrossRefGoogle Scholar
  17. 17.
    Lo B, Ruston D, Kates LW, Arnold RM, Cohen CB, Faber-Langendoen K, et al. Discussing religious and spiritual issues at the end of life: A practical guide for physicians. JAMA. 2002 Feb 13;287(6):749–54.PubMedCrossRefGoogle Scholar
  18. 18.
    Ellis MR, Vinson DC, Ewigman B. Addressing spiritual concerns of patients: Family physicians’ attitudes and practices. J Fam Pract. 1999 Feb;48(2):105–9.PubMedGoogle Scholar
  19. 19.
    Sloan RP, Bagiella E, VandeCreek L, Hover M, Casalone C, Jinpu Hirsch T, et al. Should physicians prescribe religious activities? N Engl J Med. 2000 Jun 22;342(25):1913–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Cadge W, Freese J, Christakis NA. The provision of hospital chaplaincy in the United States: A national overview. South Med J. 2008 Jun;101(6):626–30.PubMedCrossRefGoogle Scholar
  21. 21.
    Meltzer D, Manning WG, Morrison J, Shah MN, Jin L, Guth T, et al. Effects of physician experience on costs and outcomes on an academic general medicine service: Results of a trial of hospitalists. Ann Intern Med. 2002 Dec 3;137(11):866–74.PubMedGoogle Scholar
  22. 22.
    Koenig H, Parkerson GR,Jr, Meador KG. Religion index for psychiatric research. Am J Psychiatry. 1997 Jun;154(6):885–6.PubMedGoogle Scholar
  23. 23.
    Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research. A Report of the Fetzer Institute/National Institute on Aging Working Group. Kalamazoo: Fetzer Institute; 1999.Google Scholar
  24. 24.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40(5):373–83.PubMedCrossRefGoogle Scholar
  25. 25.
    Gertis M, Edgman-Levitan S, Daley J, Delbanco T. Through the Patients Eyes: Understanding and Promoting Patient Centered Care. Hoboken, NJ: Jossey-Bass; 1993.Google Scholar
  26. 26.
    Cleary PD, Edgman-Levitan S, Roberts M, Moloney TW, McMullen W, Walker JD, et al. Patients evaluate their hospital care: a national survey. Health Aff (Milwood). 1991;(10):254–67.Google Scholar
  27. 27.
    King DE, Bushwick B. Beliefs and attitudes of hospital inpatients about faith healing and prayer. J Fam Pract. 1994 Oct;39(4):349–52.PubMedGoogle Scholar
  28. 28.
    Johnson KS, Elbert-Avila KI, Tulsky JA. The influence of spiritual beliefs and practices on the treatment preferences of African Americans: A review of the literature. J Am Geriatr Soc. 2005 Apr;53(4):711–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Moadel A, Morgan C, Fatone A, Grennan J, Carter J, Laruffa G, et al. Seeking meaning and hope: Self-reported spiritual and existential needs among an ethnically-diverse cancer patient population. Psychooncology. 1999 Sep-Oct;8(5):378–85.Google Scholar
  30. 30.
    Monroe MH, Bynum D, Susi B, Phifer N, Schultz L, Franco M, et al. Primary care physician preferences regarding spiritual behavior in medical practice. Arch Intern Med. 2003 Dec 8–22;163(22):2751–6PubMedCrossRefGoogle Scholar
  31. 31.
    Wachholtz AB, Pearce MJ, Koenig H. Exploring the relationship between spirituality, coping, and pain. J Behav Med. 2007;30(4):311–8.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Joshua A. Williams
    • 1
    Email author
  • David Meltzer
    • 2
  • Vineet Arora
    • 3
  • Grace Chung
    • 3
  • Farr A. Curlin
    • 3
  1. 1.Pritzker School of MedicineUniversity of Chicago-Pritzker School of MedicineChicagoUSA
  2. 2.Section of Hospital Medicine, Department of MedicineUniversity of Chicago-Pritzker School of MedicineChicagoUSA
  3. 3.Section of General Internal Medicine, Department of MedicineUniversity of Chicago-Pritzker School of MedicineChicagoUSA

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