March 25th, 2014

The Next Big Patient-Centered Initiative: Spiritual Care

“Lord, I am not worthy to receive you…,” my mother says as she offers the Eucharist, a wafer of unleavened bread consecrated by a Roman Catholic priest, to a frail 80-year-old woman who lies in her hospital bed. Terminal lung cancer and pneumonia have sapped the woman of her strength, but she can still muster the ritual response.

“But only say the word,” she whispers faintly, “and my soul shall be healed.” The woman parts her dry lips and expectantly opens her mouth, where my mother places the wafer.

“Please,” my mother says gently, “let it dissolve on your tongue before you swallow.” The woman complies, a mixture of relief and contentment on her face.

This patient’s desire to have this rite performed (and thereby, as her faith tells her, enter heaven in a state of purity) was so strong that she asked her family members to seek out my mother, and she pointedly requested an early swallow evaluation in preparation.

Spirituality will play an increasing role in the patient-centered healthcare model of the future, even though many providers are unaware of this trend. It will be difficult to ignore religion in healthcare settings, given data like these:

  • 83% of surgery patients surveyed in Alabama want their surgeons to be aware of their religion and spirituality, and 64% would be more likely to trust a surgeon who takes a spiritual history of his or her patients.
  • 72% of 921 surveyed Ohioans believe that a spiritual discussion with their doctor would increase physician-patient understanding.
  • The 32% of University of Chicago Medical Center inpatients who reported having a discussion with a healthcare team member about religious and spiritual concerns were more likely than other patients to be highly satisfied with their care, whether or not they had initially desired such a discussion (41% did want the discussion initially).

The response from the healthcare profession has been mixed. In 2002, prayer was “the most commonly used complementary and alternative medical treatment in the United States,” and a full 43% of 31,044 people surveyed throughout the U.S. have reported praying for health reasons (Barnes et al. Advance Data 2004; 1). Of course, a 2007 Cochrane review on intercessory prayer showed a lack of benefit relative to standard care alone. One of the included trials assessed the benefit of prayer when the recipient was unaware of the intercessory act, a study design that some observers might consider insulting even if well-intended.

I think it’s time for the medical community to lead a patient-centered initiative rather than be dragged into one. Ezekiel Emanuel’s advocacy for end-of-life (EOL) discussions and early palliative care fell on deaf ears until the economic advantages became clear. Is it surprising, then, that the percentage of the U.S. population who believe that medical professionals should always do everything possible to save a patient’s life has doubled from 15% to 31% between 1990 and 2013? We healthcare professionals also ignored apologizing for our mistakes, a basic human courtesy, until it became a solution to the “medical liability crisis.”

Just like EOL discussions and apologizing, understanding your patient’s spiritual beliefs may one day show a quantifiable benefit. All three of these ideas center on communication — the lifeblood of social relationships. The difficulty in quantifying this resource has led to its exclusion in standard healthcare practice, and it is only being reintroduced in a piecemeal fashion.

Indeed, spiritual care is not being fully addressed even in medical fields that consider it to be important. For example, 87% and 80% of oncology nurses and doctors, respectively, surveyed at four Boston academic centers believe that spiritual care should be provided at least occasionally, but fewer than 15% of advanced cancer patients reported receiving it from either their nurses or physicians. Also worrisome is that physicians identify lack of time as the most common barrier to spiritual care, but this factor was not associated with whether the spiritual care was given — the strongest predictor was found to be previous training in spiritual care.

Let our professional organizations open up new discussions with all faiths to determine how to best pursue spiritual care for the 21st century. Let us not cede the humanistic high ground to lawyers and hospital administrators.

In reflecting on this topic, I’m reminded of a story about a beloved physician, practicing medicine in the 1960s, whose technique for always leaving his patients at ease was to start each encounter by offering and sharing a cigarette with the patient. The ritual action of smoking has a clear beginning and end, and the shared experience seems to stretch the perception of how much time has passed.

Maybe instead of a pack of cigarettes, I’ll carry a small book of prayers chosen by a consensus of faith leaders and organizations. I’ll never be capable of engaging a patient in the same way my mother does, but I certainly can say the words, “Would you like me to pray with you?”

Do you share Nick Bergfeld’s perspective on the importance of spiritual care?

3 Responses to “The Next Big Patient-Centered Initiative: Spiritual Care”

  1. Anca Negranu, Md says:

    I totaly agree!
    very often spiritual suffering is the cause for somatic symptoms or it makes them worse.

  2. Marc Goldberg, BS, MS, Phd says:

    No.Unless he includes in his book of prayers a copy of Richard Dawkin’s words as well. I believe that Medical Practitioners should embrace the spiritualism derived from the Natural World not the Supernatural one. Keep Religion out of Science and Science out of Religion. Each one is best served by the separation that is innate in their Epistemology.

  3. Mario Bonilla, Medical doctor says:

    Mario Bonilla,MD, Uruguay
    I agree convinced of the wisdom in the article. May other colleagues discover the deep of this.