Journal of Religion and Health

, Volume 54, Issue 4, pp 1387–1402 | Cite as

Religion, Spirituality, or Existentiality in Bad News Interactions: The Perspectives and Practices of Physicians in India

  • Lawrence MartisEmail author
  • Anne Westhues
Original Paper


A qualitative study was conducted to identify the role of religion, spirituality, or existentiality in clinical interactions. Grounded theory design was used to generate narrative data from 27 physicians working in four teaching hospitals in Karnataka, India, using a semi-structured interview schedule. Physicians reported that they explored religious, spiritual, and existential beliefs and practices of patients, along with other psychosocial and disease aspects, to assess their tolerance to bad news, to make decisions about delivering it, and to address the distress that might emerge from receiving bad news. They also reported taking recourse to religious or spiritual practices to cope with their own stress and feelings of failure.


Physicians in India Breaking bad news Truth telling Life-limiting disease Religion Spirituality Palliative care 



This study was funded by the Shastri Indo-Canadian Institute under the doctoral fellowship program 2010–2011.

Conflict of interest

We declare that there is no conflict of interest that might bias the outcomes of our study or of this paper.


  1. Ando, M., Morita, T., Akechi, T., & Takuya, O. (2010). Efficacy of short-term life-review interviews on the spiritual well-being of terminally ill cancer patients. Journal of Pain and Symptom Management, 39(6), 993–1002.PubMedCrossRefGoogle Scholar
  2. Baile, W. F., Buckman, R., Lenzi, R., Glober, G., Beale, E. A., & Kudelka, A. P. (2000). SPIKES-A six-step protocol for delivering bad news: Application to the patient with cancer. Oncologist, 5(4), 302–311.PubMedCrossRefGoogle Scholar
  3. Bauer-Wu, S., Barret, R., & Yeager, K. (2007). Spiritual perspectives and practices at the end-of-life: A review of the major world religions and application to palliative are. Indian Journal of Palliative Care, 13, 53–58.CrossRefGoogle Scholar
  4. Blackhall, L. J., Frank, G., Murphy, S., & Michel, V. (2001). Bioethics in different tongues: The case of truth-telling. Journal of the Urban Health, 78(1), 59–71.CrossRefGoogle Scholar
  5. Boston, P., Bruce, A., & Schreiber, R. (2011). Existential suffering in the palliative care setting: An integrated literature review. Journal of Pain and Symptom Management, 41(9), 604–618.PubMedCrossRefGoogle Scholar
  6. Considine, J., & Miller, K. (2010). The dialectics of care: Communicative choices at the end of life. Health Communication, 25, 165–174.PubMedCrossRefGoogle Scholar
  7. Cordella, M. (2012). Negotiating religious beliefs in a medical setting. Journal of Religion and Health, 51, 837–853.PubMedCrossRefGoogle Scholar
  8. Creswell, J. W. (2007). Qualitative inquiry and research design: Choosing among five approaches. New Delhi: Sage Publications.Google Scholar
  9. Curlin, F. A., Sellergren, S. A., Lantos, J. D., & Chin, M. H. (2007). Physicians’ observations and interpretations of the influence of religion and spirituality on health. Archives of Internal Medicine, 167, 649–654.PubMedCentralPubMedCrossRefGoogle Scholar
  10. Friedrichsen, M., & Milberg, A. (2006). Concerns about losing control when breaking bad news to terminally ill patients with cancer: Physicians’ perspective. Journal of Palliative Medicine, 9(3), 673–682.PubMedCrossRefGoogle Scholar
  11. Friedrichsen, M. J., & Strang, P. M. (2003). Doctors’ strategies when breaking bad news to terminally ill patients. Journal of Palliative Medicine, 6(4), 565–574.PubMedCrossRefGoogle Scholar
  12. Friedrichsen, M. J., Strang, P. M., & Carlsson, M. E. (2000). Cancer patients’ perceptions of their participation and own resources after receiving information about discontinuation of active tumour treatment. Acta Oncologica, 39(8), 919–925.PubMedCrossRefGoogle Scholar
  13. Glaser, B. (1978). Theoretical sensitivity. Mill Valley, CA: Sociology Press.Google Scholar
  14. Glaser, B. (1991). Basics of grounded theory analysis. Mill Valley, CA: Sociology Press.Google Scholar
  15. Glaser, B., & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative research. New York, NY: Aldine.Google Scholar
  16. Kolva, E., Rosenfeld, B., Pessin, H., Breitbart, W., & Brescia, R. (2011). Anxiety in terminally ill cancer patients. Journal of Pain and Symptom Management, 42(5), 691–701.PubMedCentralPubMedCrossRefGoogle Scholar
  17. Leung, K. K., Chiu, T. Y., & Chen, C. Y. (2006). The influence of awareness of terminal condition on spiritual well-being in terminal cancer patients. Journal of Pain and Symptom Management, 31(5), 449–456.PubMedCrossRefGoogle Scholar
  18. McClain-Jacobson, C., Rosenfeld, B., Kosinski, A., Pessin, H., Cimino, J. E., & Breitbart, W. (2004). Belief in an afterlife, spiritual well-being and end-of-life despair in patients with advanced cancer. General Hospital Psychiatry, 26, 484–486.PubMedCrossRefGoogle Scholar
  19. O’Kelly, C. P., Urch, C., & Brown, E. A. (2011). The impact of culture and religion on truth telling at the end of life. Nephrology Dialysis Transplant, 26, 3838–3842.CrossRefGoogle Scholar
  20. O’Brien, M. E. (2003). Spirituality in nursing. London, UK: Jones and Bartlett.Google Scholar
  21. Rabow, M. W., & McPhee, S. J. (1999). Beyond breaking bad news: How to help patients who suffer. Western Journal of Medicine, 171, 260–263.PubMedCentralPubMedGoogle Scholar
  22. Rodin, G., Lo, C., Mikulincer, M., Donner, A., Gagliese, L., & Zimmermann, C. (2009). Pathways to distress: The multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients. Social Science and Medicine, 68, 562–569.PubMedCrossRefGoogle Scholar
  23. Sand, L., & Strang, P. (2006). Existential loneliness in a palliative home care setting. Journal of Palliative Medicine, 9(6), 1376–1387.PubMedCrossRefGoogle Scholar
  24. Sato, S. (2011). Spiritual Pain. Japanese Journal of Anesthesiology, 60(9), 1037–1045.PubMedGoogle Scholar
  25. Speck, P. (2005). The evidence base for spiritual care. Nursing Management, 12(6), 28–31.PubMedCrossRefGoogle Scholar
  26. Steinhauser, K. E., Voils, C. I., Clipp, E. C., Bosworth, H. B., Christakis, N. A., & Tulsky, J. A. (2006). Are you at peace? One item to probe spiritual concerns at the end of life. Archives of Internal Medicine, 166, 101–105.PubMedCrossRefGoogle Scholar
  27. Strang, S., Strang, P., & Ternestedt, B. M. (2001). Existential support in brain tumor patients and their spouses. Supportive Care in Cancer, 9, 625–633.PubMedCrossRefGoogle Scholar
  28. Tavakol, M., Murphy, R., & Torabi, S. (2008). Educating doctors about breaking bad news: An Iranian perspective. Journal of Cancer Education, 23, 260–263.PubMedCrossRefGoogle Scholar
  29. Udo, C., Melin-Johansson, C., & Danielson, E. (2011). Existential issues among health care staff in surgical cancer care: Discussions in supervision sessions. European Journal of Oncology Nursing, 15(5), 447–453.PubMedCrossRefGoogle Scholar
  30. World Health Organization (WHO). (2002). National cancer control programmes: Policies and managerial guidelines (2nd ed.). Geneva, Switzerland: WHO.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Social Aetiology of Mental Illness (SAMI) CIHR Postdoctoral FellowCentre for Addiction and Mental HealthTorontoCanada
  2. 2.Faculty of Social WorkWilfrid Laurier UniversityKitchenerCanada

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