OBJECTIVE: To determine patient preferences for addressing religion and spirituality in the medical encounter.
DESIGN: Multicenter survey verbally administered by trained research assistants. Survey items included questions on demographics, health status, health care utilization, functional status, spiritual well-being, and patient preference for religious/spiritual involvement in their own medical encounters and in hypothetical medical situations.
SETTING: Primary care clinics of 6 academic medical centers in 3 states (NC, Fla, Vt).
PATIENTS/PARTICIPANTS: Patients 18 years of age and older who were systematically selected from the waiting rooms of their primary care physicians.
MEASUREMENTS AND MAIN RESULTS: Four hundred fifty-six patients participated in the study. One third of patients wanted to be asked about their religious beliefs during a routine office visit. Two thirds felt that physicians should be aware of their religious or spiritual beliefs. Patient agreement with physician spiritual interaction increased strongly with the severity of the illness setting, with 19% patient agreement with physician prayer in a routine office visit, 29% agreement in a hospitalized setting, and 50% agreement in a near-death scenario (P<.001). Patient interest in religious or spiritual interaction decreased when the intensity of the interaction moved from a simple discussion of spiritual issues (33% agree) to physician silent prayer (28% agree) to physician prayer with a patient (19% agree; P<.001). Ten percent of patients were willing to give up time spent on medical issues in an office visit setting to discuss religious/spiritual issues with their physician. After controlling for age, gender, marital status, education, spirituality score, and health care utilization, African-American subjects were more likely to accept this time trade-off (odds ratio, 4.9; confidence interval, 2.1 to 11.7).
CONCLUSION: Physicians should be aware that a substantial minority of patients desire spiritual interaction in routine office visits. When asked about specific prayer behaviors across a range of clinical scenarios, patient desire for spiritual interaction increased with increasing severity of illness setting and decreased when referring to more-intense spiritual interactions. For most patients, the routine office visit may not be the optimal setting for a physician-patient spiritual dialog.
religion and medicine physician-patient relations primary health care
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Byrd RC. Positive therapeutic effects of intercessory prayer in a coronary care unit population. South Med J. 1988;81:826–9.PubMedCrossRefGoogle Scholar
Harris WS, Gowda M, Kolb JW, Strychacz CP, Vacek JL, Jones PG. A randomized, controlled trial of the effects of remote, intercessory prayer on outcomes in patients admitted to the coronary care unit. Arch Intern Med. 1999;159:2273–8.PubMedCrossRefGoogle Scholar
Koenig HG, Cohen HJ, George LK, Hays JC, Larson DB, Blazer DG. Attendance at religious services, interleukin-6, and other biological parameters of immune function in older adults. Int J Psychiatry Med. 1997;27:233–50.PubMedCrossRefGoogle Scholar
Koenig HG, George LK, Larson DB, McCullough ME, Branch PS, Kuchibhatla M. Depressive symptoms and nine-year survival of 1,001 male veterans hospitalized with medical illness. Am J Geriatr Psychiatry. 1999;7:124–31.PubMedGoogle Scholar
Koenig HG, Hays JC, Larson DB, George LK, Cohen HJ, McCullough ME. Does religious attendance prolong survival? A six-year follow-up study of 3,968 older adults. J Gerontol A Biol Sci Med Sci. 1999;54:M370–6.PubMedGoogle Scholar
Koenig HG, George LK, Peterson BL. Religiosity and remission of depression in medically ill older patients. Am J Psychiatry. 1998;155:536–42.PubMedGoogle Scholar
Levin JS, Chatters LM. Religion, health, and psychological well-being in older adults: findings from three national surveys. J Aging Health. 1998;10:504–31.PubMedCrossRefGoogle Scholar
Matthews DA, Larson DB. An Annotated Bibliography of Clinical Research on Spiritual Subjects. Vol III. Rockville, Md: National Institute for Healthcare Research; 1995.Google Scholar
Strawbridge WJ, Cohen RD, Shema SJ, Kaplan GA. Frequent attendance at religious services and mortality over 28 years. Am J Public Health. 1997;87:957–61.PubMedCrossRefGoogle Scholar
Larson DB, Koenig HG. Is God good for your health? The role of spirituality in medical care. Cleve Clin J Med. 2000;67:80–4.PubMedGoogle Scholar
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;159:1803–6.PubMedCrossRefGoogle Scholar
Kaldjian LC, Jekel JF, Friedland G. End-of-life decisions in HIV-positive patients: the role of spiritual beliefs. AIDS. 1998;12:103–7.PubMedCrossRefGoogle Scholar
Anderson JM, Anderson LJ, Felsenthal G. Pastoral needs for support within an inpatient rehabilitation unit. Arch Phys Med Rehabil. 1993;74:574–8.PubMedCrossRefGoogle Scholar
Jones AW. A survey of general practitioners’ attitudes to the involvement of clergy in patient care. Br J Gen Pract. 1990;40:280–3.PubMedGoogle Scholar
Ellis MR, Vinson DC, Ewigman B. Addressing spiritual concerns of patients: family physicians’ attitudes and practices. J Fam Pract. 1999;48:105–9.PubMedGoogle Scholar
Daaleman TP, Frey B. Prevalence and patterns of physician referral to clergy and pastoral care providers. Arch Fam Med. 1998;7:548–53.PubMedCrossRefGoogle Scholar
Murray A, Montgomery JE, Chang H, Rogers WH, Inui T, Safran DG. Doctor discontent. A comparison of physician satisfaction in different delivery system settings, 1986 and 1997. J Gen Intern Med. 2001;16:452–9.PubMedCrossRefGoogle Scholar
Linzer M, Konrad TR, Douglas J, et al. Managed care, time pressure, and physician job satisfaction: results from the physician worklife study. J Gen Intern Med. 2000;15:441–50.PubMedCrossRefGoogle Scholar
Levin JS, Taylor RJ, Chatters LM. Race and gender differences in religiosity among older adults: findings from four national surveys. J Gerontol. 1994;49:S137–45.PubMedCrossRefGoogle Scholar
Koenig HG. Religious attitudes and practices of hospitalized medically ill older adults. Int J Geriatr Psychiatry. 1998;13:213–24.PubMedCrossRefGoogle Scholar
Chatters LM, Taylor RJ, Lincoln KD. Advances in the measurement of religiosity among older African Americans: implications for health and mental health researchers. J Mental Health Aging. 2001;7:181–200.Google Scholar
Koenig HG. Spiritual assessment in medical practice. Am Fam Physician. 2001;63:30–3.PubMedGoogle Scholar
Matthews DA, McCullough ME, Larson DB, Koenig HG, Swyers JP, Milano MG. Religious commitment and health status: a review of the research and implications for family medicine. Arch Fam Med. 1998;7:118–24.PubMedCrossRefGoogle Scholar
Anandarajah G, Hight E. Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. Am Fam Physician. 2001;63:81–9.PubMedGoogle Scholar
Lo B, Ruston D, Kates LW, et al. Discussing religious and spiritual issues at the end of life: a practical guide for physicians. JAMA. 2001;287:749–54.CrossRefGoogle Scholar