RELIGIOUS AND SPIRITUAL LIVES
|Spirituality and Health at MUSC|
Religious and Spiritual Lives
|Recent Spirituality Research at MUSC|
Gallup organization has tracked US religious beliefs over the last 60 years
(Gallup, 1997) and has documented a consistent pattern of religiousness and
denomination identification. Ninety-five
percent of Americans believe in God, and 92 percent express a particular
religious denomination. Eighty-seven
percent are Christian, with 53 percent Protestant, 26 percent Catholic, and 8
percent other Christian. Two
percent are Jewish, 2 percent are Muslim, and 2 percent are other religions.
most common formal religious activity is attendance at worship services.
Over 40 percent of Americans attend worship services weekly. Other
frequent formal religious activities include scripture study classes, baptisms,
weddings and funerals. Private
religious activity is also prevalent, the most common of which is prayer.
(Levin, 1997). Several sources
indicate that 99 percent of Americans pray, and over half pray daily or more
often (Levin, 1997, Gallup, 1997). Other
frequent private activities include reading devotional materials, watching
religious programming on television, and listening to religious programming on
the radio (Taylor, 1991).
Many people who are not involved in formal religious activities have spiritual beliefs and activities that influence their attitudes and behaviors and serve as a guide for living (McBride, 1998). Having an internal or intrinsic spiritual orientation has been associated with decreased stress-related medical symptoms, regardless of whether formal religious affiliation is present (Kass et al, 1991).
One of the most important
reasons to address patients’ spiritual and religious beliefs in the health
care setting is their impact on health-related decisions and behaviors.
Sixty-one percent of Americans state that their religion is the most
important influence in their daily lives (Gallup, 1990).
Patients undergoing inpatient or outpatient medical treatment express
strong religious and spiritual orientations (Maugans, 1991, King, 1994).
One survey of 150 outpatients demonstrated that over 90 percent believed
in God, 85 percent used prayer, and 74 percent felt close to God.
A survey of inpatients at two hospitals revealed that 98 percent believed
in God and that 93 percent were very strong or somewhat strong in their beliefs.
Seventy-three percent prayed daily or more often.
Ninety-four percent agreed that spiritual health is as important as
physical health. Spiritual concerns
are almost universal among hospitalized patients.
Joint Council for Accreditation of Healthcare Organizations (JCAHO) has
recognized the influence of spirituality on hospitalized patients by requiring a
hospital chaplain or access to pastoral services in the standards for
accreditation of all hospitals (JCAHO, 1999).
According to the JCAHO, a spiritual assessment should be performed on every
patient, identifying, “at a minimum,” the patient’s denomination,
beliefs, and spiritual practices.
HEALTH BELIEFS OF RELIGIOUS GROUPS
should be aware of the more common health beliefs of religious groups in their
practice, so that they will be able to better counsel and care for their
patients. Health beliefs vary
according to culture, education, and experience.
Religious beliefs can be very strong and can be the deciding factor in
medical decisions like abortion or withdrawal of life support.
factors add to the complexity of the interaction of religious and health
beliefs, including differing beliefs between the patient and their family,
between the patient and physician, between the patient and their religious
tradition, and inconsistencies within the patient.
The family may have different views than either the patient or the
physician. While physicians presume
that medical factors should play the lead role in medical decision-making,
religious factors often play an equal or greater role.
While individuals’ beliefs do not always coincide with the principles of a specific religious code, health professionals should be aware of the major moral and religious norms that guide the medical decision-making of many patients. Physicians should be especially mindful of potentially strong religion-based health beliefs when discussing life and death issues, contraception, abortion, and euthanasia.
TAKING A SPIRITUAL HISTORY
spirituality should be assessed for several reasons: patients have views that
affect their health; many patients want their spiritual needs addressed in the
medical setting; and patients often use their faith as a resource for coping
with an illness (Gallup, 1990; King, 1994; Koenig, 1992, 1998).
Clinicians need to know whether the patient’s religious or spiritual
views may affect medical decision-making. Hospitalized
patients have expressed the desire to have their spiritual needs addressed and
some would like physicians to pray with them (Yankelovich, 1996).
Koenig and others have documented the prevalence of religious coping in
hospitalized patients, and that patients who use religious coping have less
depression and better health (Koenig, 1992; Koenig, 1998).
Case 29-3 illustrates that spiritual issues may be hidden from view but
will surface quickly once inquiry is made.
It may take little more than asking the simple question “do you have a
faith or religion that is important to you?” to open a dialogue about
spiritual or religious needs or concerns the patient may have.
a spiritual history is the process of gathering relevant information from a
patient about spiritual values, religious beliefs, spiritual needs and concerns,
and whatever gives the patient’s life and illness meaning.
It should also include questions about how their religious and spiritual
views affect their health, whether they use religious coping, whether they have
specific spiritual concerns at the time, and whether they have a minister or
other spiritual counselor on whom to call.
Most patients (85%) believe in God and express a denominational
affiliation, but only 40% are members of a particular congregation (Gallup,
1997). Thus many hospitalized
patients do not have their own minister or spiritual counselor; for them,
chaplains are an important spiritual resource.
a spiritual history should be incorporated into the work-up of all hospital
patients and should be a part of any complete history and physical examination.
The physician should evaluate whether spirituality is important to a particular
patient and whether spiritual factors are helping or hindering the healing
process. Several clinicians have
developed tools for taking a spiritual history that aid in the process and make
the topics to cover easier to remember, including the SPIRITual history (Maugans
1991), FAITH (King, in press), and the FICA tool (Puchalski 1998).
MUSC, we teach the HOPE method of taking a spiritual history because of its ease
of use and the way it smoothly transitions from social support to spiritual
topics (Anandarajah 2000). The HOPE questions, which can be seen at on the web
were developed as a teaching tool to help medical students, residents and
practicing physicians begin the process of incorporating a spiritual assessment
into the medical interview. The first part of the mnemonic, H, addresses the
person’s basic spiritual resources, such as sources of hope, without
immediately focusing on religion or spirituality. Using this method allows for
meaningful dialogue with patients of diverse backgrounds, including those whose
spirituality lies outside the boundaries of traditional religion or those who
have been alienated in some way from their religion. It also allows those for
whom religion, God or prayer is important to volunteer this information.
The second and third letters, O and P, focus on the importance of organized religion in patients' lives and the specific aspects of their personal spirituality and practices. If patients relate meaningful experiences at this point, then the interviewer can proceed with more specific questions regarding religion and personal spirituality. If not, then one can ask open-ended follow-up questions to open the door for patients to discuss important spiritual concerns they may have.
The final letter, E, focuses on the effects of a patient's spiritual and religious beliefs on medical care and end-of-life issues. These questions help re-direct the discussion back onto clinical issues and medical-decision-making.
and other caregivers who are sensitive to the biopsychosocial needs of patients
should also consider patients’ spiritual needs.
The prominent role of religious commitment and spirituality in
patients’ private lives can have a tremendous impact on medical
decision-making and coping with serious medical illness.
Taking a spiritual history and referring patients with spiritual concerns
to chaplains or ministers are basic clinical skills that every medical provider
should learn. Inquiry into the
spiritual areas of patients’ lives, previously considered taboo, is now taught
as method of delivering more comprehensive and compassionate care at over 60
medical schools. Spiritual inquiry
is justified by the need to obtain important medical information and explore the
patient’s point of view regarding their illness, but must be done in such a
way that respects the patient’s privacy, confidentiality, and autonomy. Effectively integrating spiritual sensitivity into clinical
practice is a challenge that should be addressed by all physicians and clinical
care providers .
BIBLIOGRAPHY, AND MORE INFORMATION
G, Hight E. Spirituality and Medical Practice: Using the HOPE questions as a
practical tool for spiritual assessment. Am Fam Physician 2001;63:81-88.
Asser SM, Swan R: Child fatalities from religion-motivated medical neglect. Pediatrics 1998; 101(4): 625-9.
Baptist Faith and Message 2000 (Statement of faith by the Southern Baptist Convention.); www.sbc.net
Benson H, Dusek JA. Self-reported health, and illness and the use of conventional and unconventional medicine and mind/body healing by Christian Scientists and others. J Nerv Ment Dis 1999; 187(9): 539-548.
Desai PN: Health and Medicine in the Hindu Tradition. New York, Crossroad, 1989.
Dorff EN. The Jewish Tradition: Religious beliefs and healthcare decisions. In “Religious Beliefs and Healthcare Decisions,” 1996, Park Ridge Center, Chicago.
Dubose ER. The Jehovah’s Witness Tradition: In “Religious Beliefs and Healthcare Decisions,” 1996, Park Ridge Center, Chicago.
Ellis MR, Vinson DC, Ewigman B. Addressing spiritual concern of patients: family physicians’ attitudes and practices. Journal of Family Practice 1999; 48(2): 105-109.
Ewers GA. Four viewpoints: Churches of Christ. Austr Fam Phys 1986; 15(8):1024.
Feldman DM. Health and Medicine in the Jewish Tradition. New York; Crossroad, 1986.
Fellows, WJ. Religious East and West. New York, NY. Holt, Rinehart and Winston, 1979.
Gallup G. Religion in America 1990. The Princeton Religion Research Center, Princeton, NJ; 1990.
Gallup G. The Gallup Poll. Public Opinion 1997. Scholarly Resources, Inc. Wilmington, Delaware; 1998.
Hamel RP. The Roman Catholic tradition: Religious beliefs and health care decisions. In “Religious Traditions and Health Care Decisions,” 1996, Park Ridge Center, Chicago.
Harris-Abbott D. The Latter-day Saints: Religious beliefs and health care decisions. In “Religious Traditions and Health Care Decisions,” 1996, Park Ridge Center, Chicago.
Holifield, E B. Health & Medicine in the Methodist Tradition. In “Religious Traditions and Health Care Decisions,” 1986, Park Ridge Center, Chicago.
Jamison JE. Spirituality and medical ethics. Am J Hospice and Palliative Care May/June 1995;41-45.
Council for Accreditation of Healthcare Organizations, Standards Manual 1999.
LC, Jekel JF, Friedland G. End-of-life
decisions in HIV-positive patients: the role of spiritual beliefs.
JD, Friedman R, Lesermann, Zuttermeister PC, Benson H. Health outcomes and a new
index of spiritual experience. Journal
of the Scientific Study of Religion 1991; 30:203-211
Kass JD. Contributions of religious experience to psychological and physical well-being: research evidence and explanatory model. Care Giver Journal 1991;8:4-11.
Khan SN. The Islamic viewpoint. Austr Fam Phys 1986; 15(2):179-180.
DE, Bushwick B. Beliefs and attitudes of hospital inpatients about faith healing
and prayer. J Fam Pract 1994;
Spirituality, and Medicine: Toward the Making of a Healing Practitioner. New
York, Haworth Press, 2000
Koenig HG, George LK, Peterson BL. Religiosity and remission from depression in medically ill older patients. Am J Psychiatry 1998; 155:536-542.
Koenig HG, Cohen HJ, Blazer DG, et al. Religious coping and depression among elderly, hospitalized, medically ill men. Am J Psychiatry 1992; 149 (12): 1693-1700.
Levi JS. Jewish medical ethics. Austr Fam Phys 1986; 15(1):17-19.
JS, Taylor RJ. Age differences in
patterns and correlates of the frequency of prayer. The Gerontologist 1997; 37(1): 75-88.
MacLean D. Jehovah’s Witnesses. Austr Fam Phys 1986; 15(6):772-774.
Peel R. Health and Medicine in the Christian Science Tradition. New York; Crossroad, 1988.
Manning KM. A Catholic viewpoint. Austr Fam Phys 1986; 15(4):493-497.
Marty ME. Health and Medicine in the Lutheran Tradition. New York; Crossroad, 1986.
Matthews DA, McCullough ME, Larson DB, Koenig HG, Swyers JP, Milano MG. Religious commitment and health status. Arch Fam Med 1998; 7:118-124.
Maugans TA, Wadland WC. Religion and family medicine: a survey of physicians and patients. J Fam Pract 1991; 32:210-213.
McBride JL, Arthur G, Brooks R, Pilkington L. The relationship between patient’s spirituality and health experiences. Fam Med 1998; 30(2):122-126
McCormick RA. Health and Medicine in the Catholic Tradition. New York; Crossroad, 1987.
Morgan JL, Henley J, McCaughey D. The Anglican and Uniting Church viewpoints. Australian Family Physician 1986; 15(3): 264-265.
Nehring AK. United Church of Christ: Religious beliefs and health care decisions. In “Religious traditions and Healthcare Decisions” 1996, Park Ridge Center, Chicago.
Oats WN. Four viewpoints: The Religious Society of Friends (Quakers). Austr Fam Phys 1986; 15(8):1025.
Park Ridge Center: Religion, Sexuality, and Public Policy: Overview of World Religions, 2000: www.prchfe.org.
Puchalski CM, Larson DB. Developing curricula in spirituality and medicine. Acad Med 1998; 73 (9): 970-974.
Rahman F. Health and Medicine in the Islamic Tradition. New York; Crossroad, 1987.
Sloan RP, Bagiella E, Powell T. Religion, spirituality, and medicine. Lancet 1999; 353:664-667.
Sloan RP, Bagiella E, VandeCreek L, Hasan Y, Puolos P. Should physicians prescribe religious activities? NEJM 2000; 342 (25).
RJ, Chatters LM. Nonorganizational
religious participation among elderly black adults. J Gerontology 1991; 46(2): S103-111.
Watch Tower Bible and Tract Society. Questions From Readers. The Watchtower 2000; June 15:29-31
Waugh EH. The Islamic Tradition: religious beliefs and healthcare decisions. In “Religious traditions and Healthcare Decisions” 1996, Park Ridge Center, Chicago.
Yankelovich Partners, Inc, in Kaplan M: Ambushed by spirituality. TIME June 24,1996: 62.
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