Spiritual Assessment

Excerpt

The spiritual assessment is a tool to evaluate a patient's spiritual beliefs, needs, and hopes in the clinical context. The spiritual assessment helps the healthcare team member address the whole person by building a therapeutic alliance with the patient, allowing the patient to express their reasons for medical decisions, and helping elicit the patient's goals in the medical context. The term "spirituality" includes organized religion, a broad range of views on one's place in the universe, and views on one's eschatology. Studies suggest that religiosity and spirituality have a positive effect on survival.

Other studies also suggest that religious or spiritual interventions decrease depression and anxiety, increase spiritual well-being, and can have benefits in the care of patients with PTSD. Spiritual or religious intervention studies also suggest that such interventions promote health, well-being, and physical outcomes. Finally, studies suggest a benefit in reducing pain and improving quality of life. With this in mind, medical providers must attempt to understand and address the spiritual aspects of the patient's care.

Studies show that most patients are willing to discuss their spiritual beliefs with their healthcare providers. In one study conducted in the waiting room of 5 family medicine practices, 83% of patients were willing to discuss spiritual beliefs (63% depending on the situation and 20% always). The same study showed that the willingness of patients to discuss their beliefs depended on the circumstance. The 3 most common situations when a spiritual discussion was welcome were when a patient was "very seriously ill with the possibility of dying," "suffering from an ongoing, long-term, serious illness," and "just diagnosed with a serious illness," suggesting that illness severity plays a significant role in willingness to discuss spiritual beliefs. The top 3 reasons patients desired a spiritual discussion were "so that the doctor can understand how your beliefs influence how you deal with being sick," "so that the doctor can understand you better," and "so that the doctor would understand how you make decisions," suggesting that patients wish to be understood by their provider. Another cross-sectional study of one hundred forty-one primary care patients comparing rural and urban patients showed that between 38.3 and 49.1% of patients desired a clinical assessment. This same study demonstrated that patients were rarely asked about their religious or spiritual beliefs.

Another study of 456 patients from 6 academic medical center clinics found that 33% of patients would like to be asked about their religious beliefs in a routine office visit, with the number increasing to 40% for patients who were hospitalized and 70% for patients who were dying. A different study of physician spiritual and religious inquiry of one hundred sixty-two parents of children in the PICU setting found that 34% would like their physician to inquire about their spiritual/religious views. The number increased to 48% if the child was seriously ill.

Finally, another study of one hundred seventy-seven patients visiting a pulmonary clinic found that two-thirds of patients would welcome a question regarding spiritual or religious beliefs if they became gravely ill. While the percentage of patients willing to discuss spiritual beliefs varies from a significant minority to a majority of patients across studies, studies consistently show the greater the severity of illness, the more likely a patient is willing to discuss their spirituality or would like to have their provider inquire about their spirituality.