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Patient preference for physician discussion and practice of spirituality

Results from a multicenter patient survey


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.

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Author information



Corresponding author

Correspondence to Charles D. MacLean MD.

Additional information

This study was supported by the UNC General Internal Medicine Faculty Development Fellowship Program, which is funded by Health Resources and Services Administration grant 5-D08-HP54004. Additional support was provided by grants from the Charlotte-Mecklenburg Health Services Foundation, Inc., the University of Florida College of Medicine Education Center, and the Moses Cone Medical Education Research Committee.

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MacLean, C.D., Susi, B., Phifer, N. et al. Patient preference for physician discussion and practice of spirituality. J GEN INTERN MED 18, 38–43 (2003).

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Key words

  • religion and medicine
  • physician-patient relations
  • primary health care