Advertisement

Journal of General Internal Medicine

, Volume 16, Issue 10, pp 685–692 | Cite as

Patient perspectives on spirituality and the patient-physician relationship

  • Randy S. Heabert
  • Mollie W. Jenckes
  • Daniel E. Ford
  • Debra R. O’Connor
  • Lisa A. Cooper
Original Articles

Abstract

OBJECTIVE: To identify the preferences and concerns of seriously ill patients about discussing religious and spiritual beliefs with physicians.

DESIGN: Three focus group discussions with patients who had experienced a recent life-threatening illness. Discussions were audiotaped, transcribed verbatim, and reviewed independently by two investigators to identify discrete comments for grouping into domains. A third investigator adjudicated differences in opinion. Comments were then independently reviewed for relevance and consistency by a health services researcher and a pastoral counselor.

SETTING: Academic medical center.

PARTICIPANTS: Referred sample of 22 patients hospitalized with a recent life-threatening illness.

MEASUREMENTS AND MAIN RESULTS: Almost all of the 562 comments could be grouped into one of five broad domains: 1) religiosity/spirituality, 2) prayer, 3) patient-physician relationship, 4) religious/spiritual conversations, and 5) recommendations to physicians. God, prayer, and spiritual beliefs were often mentioned as sources of comfort, support, and healing. All participants stressed the importance of physician empathy. Willingness to participate in spiritual discussions with doctors was closely tied to the patient-physician relationship. Although divided on the proper context, patients agreed that physicians must have strong interpersonal skills for discussions to be fruitful. Physician-initiated conversation without a strong patient-physician relationship was viewed as inappropriate and as implying a poor prognosis.

CONCLUSION: Religion and spirituality are a source of comfort for many patients. Although not necessarily expecting physicians to discuss spirituality, patients want physicians to ask about coping and support mechanisms. This exploratory study suggests that if patients then disclose the importance of spiritual beliefs in their lives, they would like physicians to respect these values.

Key words

religion spirituality patient-physician communication 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Princeton Religion Research Center 1996 Report. Will the Vitality of the Church be the Surprise of the 21st Century? Princeton, New Jersey: Princeton Religion Research Center; 1996.Google Scholar
  2. 2.
    Hatch RL, Burg MA, Naberhaus DS, Hellmich LK. The spiritual involvement and beliefs scale. development and testing of a new instrument. J Fam Pract. 1998;46:476–86.PubMedGoogle Scholar
  3. 3.
    Sulmasy DP. The Healer’s Calling: A Spirituality for Physicians and other Health Care Professionals. New York: Paulist Press; 1997.Google Scholar
  4. 4.
    Sulmasy DP. Is medicine a spiritual practice? Acad Med. 1999;74:1002–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Cassell EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982;306:639–45.CrossRefGoogle Scholar
  6. 6.
    Williamson P, Beitman BD, Katon W. Beliefs that foster physician avoidance of psychosocial aspects of health care. J Fam Pract. 1981;13:999–1003.PubMedGoogle Scholar
  7. 7.
    Maugans TA, Wadland WC. Religion and family medicine: a survey of physicians and patients. J Fam Pract. 1991;32:210–3.PubMedGoogle Scholar
  8. 8.
    Porter R. The Greatest Benefit to Mankind: A Medical History of Humanity. New York: W. W. Norton and Company, Inc.; 1997.Google Scholar
  9. 9.
    Knight JA. The relevance of Osler for today’s humanity-oriented medical student. In: McGovern JP, Burn CR, eds. Humanism in Medicine. Springfield, Ill: Charles C Thomas; 1973:90–8.Google Scholar
  10. 10.
    Cantwell JD. Osler: a role model for today’s physician. J Med Assoc Ga. 1983;72:493–4.PubMedGoogle Scholar
  11. 11.
    Stone MJ. The wisdom of Sir William Osler. Am J Cardiol. 1995;75:269–76.PubMedCrossRefGoogle Scholar
  12. 12.
    Reiser DE, Rosen DH. Medicine as a Human Experience. Baltimore, Md: University Park Press; 1984.Google Scholar
  13. 13.
    Wheeler HB. Shattuck lecture—healing and heroism. N Engl J Med. 1990;322:1540–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Thiel MM, Robinson MR. Physicians’ collaboration with chaplains: difficulties and benefits. J Clin Ethics. 1997;8:94–103.PubMedGoogle Scholar
  15. 15.
    Post SG, Puchalski CM, Larson DB. Physicians and patient spirituality: professional boundaries, competency, and ethics. Ann Intern Med. 2000;132:578–83.PubMedGoogle Scholar
  16. 16.
    O’Connell LJ. Religious dimensions of dying and death. West J Med. 1995;163:231–5.PubMedGoogle Scholar
  17. 17.
    Grodin MA. Religious advance directives: the convergence of law, religion, medicine, and public health. Am J Public Health. 1993;83:899–903.PubMedCrossRefGoogle Scholar
  18. 18.
    Koenig HG, Pargament KI, Nielsen J. Religious coping and health status in medically ill hospitalized older adults. J Nerv Ment Dis. 1998;186:513–21.PubMedCrossRefGoogle Scholar
  19. 19.
    Koenig HG, Cohen HJ, Blazer DG, et al. Religious coping and depression among elderly, hospitalized medically ill men. Am J Psychiatry. 1992;149:1693–700.PubMedGoogle Scholar
  20. 20.
    Bearon LB, Koenig HG. Religious cognitions and use of prayer in health and illness. Gerontologist. 1990;30:249–53.PubMedCrossRefGoogle Scholar
  21. 21.
    Yates JW, Chalmer BJ, St James P, Follansbee M, McKegney FP. Religion in patients with advanced cancer. Med Pediatr Oncol. 1981;92:121–8.CrossRefGoogle Scholar
  22. 22.
    Schreiber K. Religion in the physician-patient relationship. JAMA. 1991;266:3062–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Thomason CL, Brody H. Inclusive spirituality. J Fam Pract. 1999;48:96–7.PubMedGoogle Scholar
  24. 24.
    Thomsen RJ. Spirituality in medical practice. Arch Dermatol. 1998;134:1443–6.PubMedCrossRefGoogle Scholar
  25. 25.
    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
  26. 26.
    Kristeller JL, Zumbrun CS, Schilling RF. ‘I would if I could’: how oncologists and oncology nurses address spiritual distress in cancer patients. Psychooncology. 1999;8:451–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Koenig HG, Bearon LB, Dayringer R. Physician perspectives on the role of religion in the physician-older patient relationship. J Fam Pract. 1989;28:441–8.PubMedGoogle Scholar
  28. 28.
    Sloan RP, Bagiella E, VandeCreek L, et al. Should physicians prescribe religious activities? N Engl J Med. 2000;342:1913–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Graner J. Physicians and patient spirituality. Ann Intern Med. 2000;1339:748.Google Scholar
  30. 30.
    Gerteis M, Edgman-Levitan S, Daley J, Delbanco TL. Through the Patient’s Eyes. Understanding and Promoting Patient-Centered Care. San Francisco: Jossey-Bass Publishers; 1993.Google Scholar
  31. 31.
    Wilkinson S. Focus groups in health research. J Health Psychol. 1998;3:323–42.CrossRefGoogle Scholar
  32. 32.
    Farquhar C. Are focus groups suitable for ‘sensitive’ topics? In: Barbour R, Kitinger J, eds. Developing Focus Group Research: Politics, Theory and Practice. London: Sage; 1999.Google Scholar
  33. 33.
    Kitzinger J. Focus groups with users and providers of health care. In: Pope C, Mays N, eds. Qualitative Research in Health Care. London: BMJ Publishing Group; 1995.Google Scholar
  34. 34.
    Allport GW. The Individual and His Religion. New York: MacMillian; 1962.Google Scholar
  35. 35.
    Ellis D. Whatever happened to the spiritual dimension? Can Nurse. 1980;76:42–3.PubMedGoogle Scholar
  36. 36.
    Merton RK. The focused interview and focus group: continuities and discontinuities. Public Opin Q. 1987;51:550–6.CrossRefGoogle Scholar
  37. 37.
    Lincoln Y, Guba E. Naturalistic Inquiry. Beverly Hills, Ca: Sage; 1985.Google Scholar
  38. 38.
    King DE, Bushwick B. Beliefs and attitudes of hospital inpatients about faith healing and prayer. J Fam Pract. 1994;39:349–52.PubMedGoogle Scholar
  39. 39.
    Daaleman TP, Nease DE Jr. Patient attitudes regarding physician inquiry into spiritual and religious issues. J Fam Pract. 1994;39:564–8.PubMedGoogle Scholar
  40. 40.
    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
  41. 41.
    Cleary PD, Edgman-Levitan S, Roberts M, et al. Patients evaluate their hospital care: a national survey. Health Aff. 1991;10:254–67.CrossRefGoogle Scholar
  42. 42.
    Woolley FR, Kane RL, Hughes CC, Wright DD. The effects of doctor-patient communication on satisfaction and outcome of care. Soc Sci Med. 1978;12:123–8.PubMedGoogle Scholar
  43. 43.
    DiMatteo MR, Prince LM, Taranta A. Patients’ perceptions of physicians’ behavior: determinants of patient commitment to the therapeutic relationship. J Community Health. 1979;4:280–90.PubMedCrossRefGoogle Scholar
  44. 44.
    Stiles WB, Putnam SM, Wolf MH, James SA. Interaction exchange structure and patient satisfaction with medical interviews. Med Care. 1979;17:667–81.PubMedCrossRefGoogle Scholar
  45. 45.
    DiMatteo MR, Taranta A, Friedman HS, Prince LM. Predicting patient satisfaction from physicians’ nonverbal communication skills. Med Care. 1980;18:376–87.PubMedCrossRefGoogle Scholar
  46. 46.
    Matthews DA, Suchman AL, Branch WT Jr. Making “connexions”: enhancing the therapeutic potential of patient-clinician relationships. Ann Intern Med. 1993;118:973–7.PubMedGoogle Scholar
  47. 47.
    Delbanco TL. Enriching the doctor-patient relationship by inviting the patient’s perspective. Ann Intern Med. 1992;116:414–8.PubMedGoogle Scholar
  48. 48.
    Novack DH, Volk G, Drossman DA, Lipkin M. Medical interviewing and interpersonal skills teaching in U.S. medical schools. JAMA. 1993;269:2102–5.CrossRefGoogle Scholar
  49. 49.
    Conco D. Christian patients’ views of spiritual care. West J Nurs Res. 1995;17:266–76.PubMedCrossRefGoogle Scholar
  50. 50.
    Hamilton DG. Believing in patients’ beliefs: physician attunement to the spiritual dimension as a positive factor in patient healing and health. Am J Hosp Palliat Care. 1998;15:276–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Levinson W, Roter D. Physicians’ psychosocial beliefs correlate with their patient communication skills. J Gen Intern Med. 1995;10:375–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca RP. Improving physicians’ interviewing skills and reducing patients’ emotional distress: a randomized clinical trial. Arch Intern Med. 1995;155:1877–84.PubMedCrossRefGoogle Scholar
  53. 53.
    Mandziuk PA. The doctor-chaplain relationship. West J Med. 1994;160:376–7.PubMedGoogle Scholar
  54. 54.
    Giacomini MK, Cook DJ. Users’ guides to the medical literature. XXII. Qualitative research in health care. A. Are the results of the study valid? JAMA. 2000;284:357–62.PubMedCrossRefGoogle Scholar
  55. 55.
    Silverman HD. Creating a spirituality curriculum for family practice residents. Altern Ther Health Med. 1997;3:54–61.PubMedGoogle Scholar
  56. 56.
    Puchalski CM, Larson DB. Developing curricula in spirituality and medicine. [published erratum appears in Acad Med 1998 Oct;7310:1038]. Acad Med. 1998;73:970–4.PubMedCrossRefGoogle Scholar
  57. 57.
    McBride JL. The family practice residency curriculum: is there any place for spirituality and religion? Fam Med. 1999;31:685–6.PubMedGoogle Scholar
  58. 58.
    Wolkenstein AS. Spirituality in residency education: taking the next step. Fam Med. 2000;32:159–60.PubMedGoogle Scholar
  59. 59.
    Maugans TA. The SPIRITual history. Arch Fam Med. 1996;5:11–6.PubMedCrossRefGoogle Scholar
  60. 60.
    Lo B, Quill T, Tulsky J. Discussing palliative care with patients. ACP-ASIM End-of-Life Care Consensus Panel. American College of Physicians-American Society of Internal Medicine. Ann Intern Med. 1999;130:744–9.PubMedGoogle Scholar
  61. 61.
    Kuhn C. A spiritual inventory of the medically ill patient. Psychiatr Med. 1988;6:87–9.PubMedGoogle Scholar
  62. 62.
    Pargament KI, Zinnbauer BJ, Scott AB, Butter EM, Zerowin J, Stanik P. Red flags and religious coping: identifying some religious warning signs among people in crisis. J Clin Psychol. 1998;54:77–89.PubMedCrossRefGoogle Scholar
  63. 63.
    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
  64. 64.
    Park MA. A statewide assessment of attitudes, beliefs, and behaviors among blacks toward donation. J Transpl Coord. 1998;8:25–9.PubMedGoogle Scholar
  65. 65.
    Gillman J. Religious perspectives on organ donation. Crit Care Nurs Q. 1999;22:19–29.PubMedGoogle Scholar

Copyright information

© Blackwell Science Inc 2001

Authors and Affiliations

  • Randy S. Heabert
    • 1
  • Mollie W. Jenckes
    • 1
  • Daniel E. Ford
    • 1
    • 3
  • Debra R. O’Connor
    • 2
  • Lisa A. Cooper
    • 1
    • 3
  1. 1.Received from the Department of MedicineJohns Hopkins University School of MedicineUSA
  2. 2.the Department of OncologyJohns Hopkins University School of MedicineUSA
  3. 3.the Department of Health Policy and ManagementJohns Hopkins University School of Hygiene and Public HealthBaltimore

Personalised recommendations