Spirituality and Health Care

Spirituality and Spirituality and Health CareHealth CareAnita S. Kablinger MDAnita S. Kablinger MD

Associate ProfessorAssociate Professor

Psychiatry and PharmacologyPsychiatry and Pharmacology

Audience ParticipationAudience Participation What percentage of Americans says that they would What percentage of Americans says that they would

welcome a conversation with their doctor about faith?welcome a conversation with their doctor about faith? What do people pray for the most (give the top three)?What do people pray for the most (give the top three)?

Scientific evidence for the following has been rated as Scientific evidence for the following has been rated as WEAK, INADEQUATE, MODERATE or PERSUASIVE. WEAK, INADEQUATE, MODERATE or PERSUASIVE. Match the evidence to the following-Match the evidence to the following-

religion or spirituality slows the progression of cancerreligion or spirituality slows the progression of cancer religion or spirituality protects against disabilityreligion or spirituality protects against disability religion or spirituality improves recovery from acute religion or spirituality improves recovery from acute

illnessillness religion or spirituality protects against cancer mortalityreligion or spirituality protects against cancer mortality being prayed for improves physical recovery from acute being prayed for improves physical recovery from acute

illnessillness religion or spirituality protects against cardiovascular religion or spirituality protects against cardiovascular

diseasedisease church attendance promotes longer lifechurch attendance promotes longer life

DefinitionsDefinitions

ReligionReligion means to “bind together” means to “bind together” and a belief in and reverence for a and a belief in and reverence for a supernatural power regarded as supernatural power regarded as creator and governor of the creator and governor of the universe. universe.

SpiritualitySpirituality, on the other hand, is , on the other hand, is defined as a dynamic, personal, and defined as a dynamic, personal, and experiential process of belief. experiential process of belief.

Religion/Spirituality Religion/Spirituality Involvement in Medicine:Involvement in Medicine:

-JCAHO requires routine assessment of -JCAHO requires routine assessment of spirituality needsspirituality needs

-APA issued “Guidelines Regarding -APA issued “Guidelines Regarding Possible Conflict Between Psychiatry’s Religious Possible Conflict Between Psychiatry’s Religious Commitment and Psychiatry’s Practice”Commitment and Psychiatry’s Practice”

-DSM-IV includes “Religion or Spirituality -DSM-IV includes “Religion or Spirituality Problem” sectionProblem” section

-instruction in religion-spiritual issues is a -instruction in religion-spiritual issues is a curricular requirement of accredited psychiatric curricular requirement of accredited psychiatric residenciesresidencies

-APA recommends that doctors inquire -APA recommends that doctors inquire about religion and spiritual orientation of about religion and spiritual orientation of patientspatients

BackgroundBackground The percentage of those who believe in God has The percentage of those who believe in God has

changed little over the past 50 years (96% in changed little over the past 50 years (96% in 1944 and 95% in 1993). 1944 and 95% in 1993).

Eighty-nine percent of the population state that Eighty-nine percent of the population state that they pray to God on a regular basis. they pray to God on a regular basis.

Ninety-four percent of people regard their Ninety-four percent of people regard their spiritual and physical health as equally important spiritual and physical health as equally important and the majority of physicians believe spirituality and the majority of physicians believe spirituality is an important factor in health care. is an important factor in health care.

In fact, one-third of the population regards In fact, one-third of the population regards religion as the religion as the most importantmost important dimension in their dimension in their life.life.

Scientist and Clinician Beliefs: Scientist and Clinician Beliefs:

Rates of Atheism and Rates of Atheism and AgnosticismAgnosticism

U.S. PopulationU.S. Population 6%6%

American Men and Women American Men and Women of Scienceof Science: 1916 and 1996: 1916 and 199655%55%

Vermont Family PractitionersVermont Family Practitioners 36%36%PsychologistsPsychologists 28%28%PsychiatristsPsychiatrists 21%21%Bergin and Jensen, Bergin and Jensen, PsychotherapyPsychotherapy, 1990, 27:3-7., 1990, 27:3-7.Maugans and Wadland, Maugans and Wadland, Journal of Family PracticeJournal of Family Practice, , 1991, 32:210-213.1991, 32:210-213.

Myths about religion and Myths about religion and health care:health care:

What research does NOT show:What research does NOT show: -religious people do -religious people do notnot get sick get sick -illness is due to lack of faith-illness is due to lack of faith -spirituality is the -spirituality is the mostmost important important

factorfactor -doctors should prescribe religious -doctors should prescribe religious

activitiesactivities -other factors explain the association -other factors explain the association

between religion and spirituality and better between religion and spirituality and better health outcomeshealth outcomes

Benefits to clinicians of Benefits to clinicians of religious/spirituality focus:religious/spirituality focus:

-communicates to patient that their life -communicates to patient that their life experience is of interest and value to themexperience is of interest and value to them

-increases understanding of clinical -increases understanding of clinical condition’s association with a religious-spiritual condition’s association with a religious-spiritual problemproblem

-allows the development of a case formulation -allows the development of a case formulation of interpersonal responses and psychiatric patternsof interpersonal responses and psychiatric patterns

-identifies areas of support and community -identifies areas of support and community involvement that may be helpful adjuncts to involvement that may be helpful adjuncts to treatmenttreatment

Reasons to acknowledge Reasons to acknowledge and support a patient’s and support a patient’s

spirituality:spirituality: -people regard spiritual and physical -people regard spiritual and physical

health as equally importanthealth as equally important

-enhances coping and quality of life -enhances coping and quality of life during illnessduring illness

-enhances cultural sensitivity-enhances cultural sensitivity

-enriches the doctor/patient -enriches the doctor/patient relationshiprelationship

Barriers (reasons doctors Barriers (reasons doctors have problems assessing have problems assessing

religion/ spirituality):religion/ spirituality):

-doctors practice in biomedical model-doctors practice in biomedical model -fewer doctors regard themselves as -fewer doctors regard themselves as

religious or spiritual as compared to patientsreligious or spiritual as compared to patients -taught infrequently in medical training-taught infrequently in medical training -patients regarded as having complex or -patients regarded as having complex or

daunting needsdaunting needs -not addressed due to time constraints, -not addressed due to time constraints,

lack of confidence, and role uncertaintylack of confidence, and role uncertainty

Illness Prevention:Illness Prevention:Spirituality and Life Spirituality and Life

SatisfactionSatisfaction Study sampleStudy sample: reviewing findings from three : reviewing findings from three

national surveys totaling more than 5,600 national surveys totaling more than 5,600 older older AmericansAmericans

Study resultsStudy results: Attending religious services was : Attending religious services was linked with improved physical health or personal linked with improved physical health or personal well-being.well-being.

Other studiesOther studies: 12 other studies published since : 12 other studies published since 1980 found persons in organized religious activity 1980 found persons in organized religious activity had higher levels of life satisfaction.had higher levels of life satisfaction.

Levin JS, Chatters LM. Religion, health, and psychological well-Levin JS, Chatters LM. Religion, health, and psychological well-being in older adults: findings from three national surveys.being in older adults: findings from three national surveys. J Aging J Aging Health 1998Health 1998;10(4):504-531.;10(4):504-531.

Patient Need:Patient Need:Patient Views Regarding Patient Views Regarding

Spirituality When Seriously IllSpirituality When Seriously Ill Pulmonary Pulmonary

PatientsPatients

Consider self religious Consider self religious 51%51%

Welcome religious questions in medical history Welcome religious questions in medical history 66%66%

Not welcome religious questions Not welcome religious questions 16%16%

Physician asking about their spiritual or religiousPhysician asking about their spiritual or religiousbeliefs would increase trust in the physicianbeliefs would increase trust in the physician 66%66%

Ehman JW, Ott BB, Short TH. Ehman JW, Ott BB, Short TH. Archives of Internal Medicine Archives of Internal Medicine 19991999;;159 (15):1803-1806.159 (15):1803-1806.

Recovery from Surgery:Recovery from Surgery:Hip ReplacementHip Replacement

Hip fracture patients with stronger Hip fracture patients with stronger religious beliefs and practices were religious beliefs and practices were less depressed and could walk a less depressed and could walk a greater distance at discharge than greater distance at discharge than patients with lower levels of religious patients with lower levels of religious commitment.commitment.

Pressman P, et al. Pressman P, et al. Am J Psychiatry 1990Am J Psychiatry 1990;147:758-760.;147:758-760.

Those who are religious Those who are religious tend to demonstrate:tend to demonstrate:

-less cardiovascular disease -less cardiovascular disease -decrease in blood pressure and -decrease in blood pressure and

hypertensionhypertension -more health promoting behaviors-more health promoting behaviors -a decrease in depression, anxiety, -a decrease in depression, anxiety,

and suicideand suicide -less alcohol abuse or use of illicit -less alcohol abuse or use of illicit

drugsdrugs

Illness Prevention:Illness Prevention:Substance AbuseSubstance Abuse

““Individuals suffering from these Individuals suffering from these (alcohol or drug abuse) problems are (alcohol or drug abuse) problems are found to have a low level of religious found to have a low level of religious involvement . . . spiritual involvement . . . spiritual re(engagement) appears to be re(engagement) appears to be correlated with recovery.”correlated with recovery.”

Miller WR. Miller WR. AddictionAddiction 1998;93(7):979-90. 1998;93(7):979-90.

Illness Prevention: Illness Prevention: Spirituality and Marijuana UseSpirituality and Marijuana Use Survey undertaken by Harvard School of Public Health Survey undertaken by Harvard School of Public Health and University of Michigan’s Survey Research Center.and University of Michigan’s Survey Research Center.

Study SampleStudy Sample: 17,592 college students sampled from 140 U.S. : 17,592 college students sampled from 140 U.S. colleges with survey sample nationally representative of U.S. college colleges with survey sample nationally representative of U.S. college population.population.

Study ResultsStudy Results::

Increased Risk-Marijuana UseIncreased Risk-Marijuana Use

- Lower Grades – Grade “B” and below- Lower Grades – Grade “B” and below

- More time “hanging” with friends- More time “hanging” with friends

- Four-Fold Increased Risk:- Four-Fold Increased Risk: Parties Important or Very Parties Important or Very ImportantImportant

- Five-Fold Increased Risk:- Five-Fold Increased Risk: Cigarette Smoking Cigarette Smoking

- Six-Fold Increased Risk:- Six-Fold Increased Risk: Binge Drinking Binge Drinking

Bell R., et al, “The correlates of college student marijuana use: results of a US National Survey.” Bell R., et al, “The correlates of college student marijuana use: results of a US National Survey.” Addiction.Addiction. 1997; 1997; 92(5);571-581.92(5);571-581.

Illness Prevention: Illness Prevention: Spirituality and Marijuana UseSpirituality and Marijuana Use

Study Results (cont.)Study Results (cont.)::

Lowered Risk-Marijuana UseLowered Risk-Marijuana Use

- One-Half Risk:- One-Half Risk: students who viewed students who viewed Community Service as “important”Community Service as “important” to to themthem

- One-Fourth Risk:- One-Fourth Risk: Students who viewed Students who viewed Religion as ”very important”Religion as ”very important” to them to them

- Religion as important- Religion as important – – strongest predictor of marijuana use, strongest predictor of marijuana use,

even stronger in size than identification as “party even stronger in size than identification as “party animal”animal”

- After controlling for other predictor variables- After controlling for other predictor variables - - Religion as important –Religion as important –

still at still at ONE-THIRD the riskONE-THIRD the risk

““This study supports the notion that college drug use is social in nature (which)This study supports the notion that college drug use is social in nature (which)makes it resistant to change…however the findings do suggest approaches tomakes it resistant to change…however the findings do suggest approaches toprevention”prevention”

Bell R., et al, “The correlates of college student marijuana use: results of a US National Survey.” Bell R., et al, “The correlates of college student marijuana use: results of a US National Survey.” Addiction.Addiction. 1997; 1997; 92(5);571-581.92(5);571-581.

Patient Need: Patient Need: Social Histories of Chronic Drug andSocial Histories of Chronic Drug and

Alcohol AbuseAlcohol AbuseStudy Results (cont.):Study Results (cont.):

Religious Histories: Parents and SubjectsReligious Histories: Parents and SubjectsFrequency Comparison (as ratios) for: Narcotic Abusers (NA) and Alcohol Frequency Comparison (as ratios) for: Narcotic Abusers (NA) and Alcohol Abusers (AA) to control sample:Abusers (AA) to control sample:

Religious History ItemsReligious History Items:: NA/ControlsNA/Controls AA/ControlsAA/Controls

Mother’s Religious InvolvementMother’s Religious Involvement no differenceno difference one-fifth higher one-fifth higher

Father’s Religious InvolvementFather’s Religious Involvement one-halfone-half three- three-fourths fourths

During Adolescence: During Adolescence: IncreasedIncreasedReligious InterestReligious Interest one-fourth one-fourth one-eighth one-eighth

During Adolescence: During Adolescence: DecreasedDecreasedReligious InterestReligious Interest 4 times greater 44 times greater 4½ ½

times greatertimes greater

Larson DB & Wilson WP. Religious life of alcoholics. Larson DB & Wilson WP. Religious life of alcoholics. Southern Medical JournalSouthern Medical Journal. 1980; 73(6): 723‑727.. 1980; 73(6): 723‑727. Cancellaro LA, Larson DB, Wilson WP. Religious life of narcotic addicts. Cancellaro LA, Larson DB, Wilson WP. Religious life of narcotic addicts. Southern Medical JournalSouthern Medical Journal. 1982; 75(10): . 1982; 75(10):

1166‑1168.1166‑1168.

Illness PreventionIllness PreventionSpirituality and Blood Pressure Spirituality and Blood Pressure

StatusStatus

Importance of Religion for those 55 & OlderImportance of Religion for those 55 & Older

Age Age 55* 55* Mean Systolic BPMean Systolic BP Mean Mean Diastolic BPDiastolic BP

High Importance of ReligionHigh Importance of Religion 139.7 139.7 82.6 82.6

Not High Importance Not High Importance 146.2 146.2 88.5 88.5

High VS Not High DifferenceHigh VS Not High Difference 6.5 mm Hg 6.5 mm Hg 5.9 mm Hg 5.9 mm Hg

* Adjusted for socioeconomic status and smoking* Adjusted for socioeconomic status and smoking

Larson DB, Koenig HG, Kaplan BH et al. The Impact of Religion on Man’s Larson DB, Koenig HG, Kaplan BH et al. The Impact of Religion on Man’s Blood Pressure”. Blood Pressure”. Journal of Religion & HealthJournal of Religion & Health. 1989;28(4):265-278.. 1989;28(4):265-278.

Systematic ReviewSystematic ReviewA Review of Findings Concerning A Review of Findings Concerning

Spirituality and HypertensionSpirituality and Hypertension Study ResultsStudy Results: :

For the Religious Commitment StudiesFor the Religious Commitment Studies: Of the : Of the seven seven studies found, sixstudies found, six revealed higher levels of religious revealed higher levels of religious commitment were associated with lower rates of commitment were associated with lower rates of hypertension.hypertension.

By 2000, 11 years later, Koenig, McCullough and Larson By 2000, 11 years later, Koenig, McCullough and Larson noted that “of the 16 studies that have examined the noted that “of the 16 studies that have examined the relationship between the level of religious involvement relationship between the level of religious involvement and blood pressure, 14 (88%) found lower blood and blood pressure, 14 (88%) found lower blood pressure (levels) among the more religious.”pressure (levels) among the more religious.”Levin JS, Vanderpool HY. Levin JS, Vanderpool HY. Social Science and MedicineSocial Science and Medicine 1989; 29:69-78. 1989; 29:69-78.

Koenig HG, McCullough ME, Larson DB. Koenig HG, McCullough ME, Larson DB. Handbook of Religion and HealthHandbook of Religion and Health. Oxford University Press, Inc. 2001.. Oxford University Press, Inc. 2001.

Illness Prevention:Illness Prevention:Spirituality and SmokingSpirituality and Smoking

Study sampleStudy sample: Duke Central Carolina sample of nearly 400 : Duke Central Carolina sample of nearly 400 adults over age 65adults over age 65

Study resultsStudy results: : Older adults who both attended religious services and Older adults who both attended religious services and

prayed (or read the Bible) were nine times less likely to prayed (or read the Bible) were nine times less likely to smoke.smoke.

Frequently attending services -- strongest predictor of Frequently attending services -- strongest predictor of not smoking (much stronger than prayer/Bible reading).not smoking (much stronger than prayer/Bible reading).

Koenig HG, et al. The relationship between religious activities and cigarette Koenig HG, et al. The relationship between religious activities and cigarette smoking in older adults.smoking in older adults. J Gerontol: Medical Sciences 1998 J Gerontol: Medical Sciences 1998;53A(6):M1-M9.;53A(6):M1-M9.

Bell R., et al. The correlates of college student marijuana use: Bell R., et al. The correlates of college student marijuana use: results of a U.S. national survey. Addiction 1997;92(5):571-81.results of a U.S. national survey. Addiction 1997;92(5):571-81.

Improving Treatment Improving Treatment OutcomesOutcomes

Spirituality and Elective Cardiac Spirituality and Elective Cardiac SurgerySurgery

Group Participation X Religious Strength and Comfort Group Participation X Religious Strength and Comfort Percent Who Died Post SurgeryPercent Who Died Post Surgery::

1)1) Group Participation and Strength Group Participation and Strength 3%3%and Comfort from Religionand Comfort from Religion

2)2) Group Participation ButGroup Participation But 7%7%No Strength and Comfort from ReligionNo Strength and Comfort from Religion

3)3) No Group Participation ButNo Group Participation But 8%8%Strength and Comfort from ReligionStrength and Comfort from Religion

4)4) No Group Participation andNo Group Participation and 20%20%No Strength and Comfort from ReligionNo Strength and Comfort from Religion

Oxman TE, Freeman DH and Manheimer ED. Lack of Social Participation or Religious Oxman TE, Freeman DH and Manheimer ED. Lack of Social Participation or Religious Strength or Comfort as Risk Factors For Death after Cardiac Surgery in the Elderly. Strength or Comfort as Risk Factors For Death after Cardiac Surgery in the Elderly. Psychosomatic MedicinePsychosomatic Medicine. 1995; 57:5-15.. 1995; 57:5-15.

Illness PreventionIllness PreventionSuicide and Religious Suicide and Religious

AffiliationAffiliationStudies have found that those with no Religious Studies have found that those with no Religious

Affiliation versus those with a Religious Affiliation versus those with a Religious AffiliationAffiliation::

1)1) find suicide more acceptablefind suicide more acceptable

2)2) are more likely to have suicidal ideationare more likely to have suicidal ideation

3)3) are more likely to have attempted suicideare more likely to have attempted suicide

4)4) if providers, they have more favorable if providers, they have more favorable attitudes towards physician-assisted suicideattitudes towards physician-assisted suicide

Illness Prevention: Illness Prevention: Mothers’ Religion and Depression in Mothers’ Religion and Depression in

their Childrentheir Children Study sampleStudy sample: 60 mothers and their 151 children who : 60 mothers and their 151 children who

were followed up 10 years laterwere followed up 10 years later

Study resultsStudy results: If mothers viewed religion as highly : If mothers viewed religion as highly important:important: daughters (not sons) 60% less likely to have had daughters (not sons) 60% less likely to have had

major depressive disordermajor depressive disorder mothers themselves 80% less likely to have had mothers themselves 80% less likely to have had

major depressive episode during 10 year follow-upmajor depressive episode during 10 year follow-up

Miller, L., et al. Religiosity and depression: ten-year follow-up of Miller, L., et al. Religiosity and depression: ten-year follow-up of depressed mothers and offspring.depressed mothers and offspring. J Am Acad Child Adolesc Psychiatry J Am Acad Child Adolesc Psychiatry 19971997;36(10):1416-25.;36(10):1416-25.

““Bottom Line” of Bottom Line” of Prevention:Prevention:

Living LongerLiving Longer

““Respect for God is the beginning of Respect for God is the beginning of wisdom; and the knowledge of the wisdom; and the knowledge of the sacred is understanding.sacred is understanding.

By wisdom your days will be By wisdom your days will be MULTIPLIED and the years of MULTIPLIED and the years of your life will be INCREASED.”your life will be INCREASED.”

Proverbs 9:10-11Proverbs 9:10-11

Illness Prevention: Illness Prevention: Living LongerLiving Longer

Study sampleStudy sample: national sample of 21,000 U.S. adults : national sample of 21,000 U.S. adults with 10-year follow-up. 1987 National Health with 10-year follow-up. 1987 National Health Interview Survey with 1997 NCHS Multiple Cause of Interview Survey with 1997 NCHS Multiple Cause of Death FileDeath File

Study resultsStudy results: : 1.1. ““Life expectancy gap between those who attend Life expectancy gap between those who attend

more than once a week and those who never attend more than once a week and those who never attend is over 7 years.” is over 7 years.”

2.2. For Blacks, the life expectancy gap is 14 years.For Blacks, the life expectancy gap is 14 years.

Hummer RA, et al. Religious involvement and U.S. adult mortality.Hummer RA, et al. Religious involvement and U.S. adult mortality. Demography 1999Demography 1999;36(2)273-85.;36(2)273-85.

U.S. Life Expectancy at Age U.S. Life Expectancy at Age 2020

by Religious Attendanceby Religious Attendance

65

75

85

Never <1/wk-1/wk >1/wk

Blacks

Whites

Frequency of Attendance

Average A

ge at Death

(n=21,204)

Hummer et al (1999). Demography 36:273-285

Stages of death and dying – Stages of death and dying – Elizabeth Kubler-RossElizabeth Kubler-Ross

talked to 400 dying patientstalked to 400 dying patients knew they were dying even if not toldknew they were dying even if not told they need to talk about itthey need to talk about it need to maintain hope, even if not hope need to maintain hope, even if not hope

of a cureof a cure

5 stages that most dying people go through 5 stages that most dying people go through from the time they learn they are dying to from the time they learn they are dying to actual death:actual death:

DenialDenial AngerAnger BargainingBargaining DepressionDepression AcceptanceAcceptance She also described unfinished tasks of the dying She also described unfinished tasks of the dying

including: reconciliations, resolution of conflicts, including: reconciliations, resolution of conflicts, and the pursuit of specific remaining goals.and the pursuit of specific remaining goals.

Breaking the news of Breaking the news of impending death:impending death:

physician should be presentphysician should be present spouse should be present if possiblespouse should be present if possible relatives need comfort, as does the patientrelatives need comfort, as does the patient use simple words, even with educated patientsuse simple words, even with educated patients show compassion and support, do not be abrupt or show compassion and support, do not be abrupt or

bluntblunt guessing how long a patient has to live is often guessing how long a patient has to live is often

inaccurate and unadvisableinaccurate and unadvisable encourage and answer questionsencourage and answer questions truth is not the enemy of hopetruth is not the enemy of hope communicate willingness to see patient through death communicate willingness to see patient through death explain the situation and introduce the next stepexplain the situation and introduce the next step

Greatest fears of a dying Greatest fears of a dying person:person:

abandonmentabandonment painpain shortness of breath shortness of breath

The Forgotten Factor:The Forgotten Factor:Systematic Reviews of the Systematic Reviews of the

FindingsFindings

Of studies examining religious commitment Of studies examining religious commitment

variables in clinical research:variables in clinical research:

FamilyFamily FrequencyFrequencyPsychiatryPsychiatry MedicineMedicineof of

WorshipWorship

Clinical harmClinical harm --ALL less than 5%----ALL less than 5%--

Clinical benefitClinical benefit -- ALL greater than 80%---- ALL greater than 80%--

Questions That Can Be Used to Questions That Can Be Used to Facilitate Clinical Discussions Facilitate Clinical Discussions

About Patient SpiritualityAbout Patient Spirituality

From “SPIRITual History:”From “SPIRITual History:”1.1. What does your spirituality/religion mean to you?What does your spirituality/religion mean to you?2.2. What aspects of your religion/spirituality would you What aspects of your religion/spirituality would you

like me to keep in mind as I care for you?like me to keep in mind as I care for you?3.3. Would you like to discuss the religious or spiritual Would you like to discuss the religious or spiritual

implications of your health care?implications of your health care?4.4. As we plan for your care near the end of life, how As we plan for your care near the end of life, how

does your faith impact on your decisions?does your faith impact on your decisions?

Maugans TA. The SPIRITual history. Maugans TA. The SPIRITual history. Arch Fam Med 1996Arch Fam Med 1996; 5:11-6.; 5:11-6.

1.1. How close do you feel to God or a higher power?How close do you feel to God or a higher power?2.2. Have you ever had an experience that convinced Have you ever had an experience that convinced

you that God or a higher power exists?you that God or a higher power exists?3.3. How strongly religious (or spiritually oriented) How strongly religious (or spiritually oriented)

do you consider yourself to be? do you consider yourself to be?

McBride JL, et al. The relationship between a patient’s spirituality McBride JL, et al. The relationship between a patient’s spirituality and health experiences.and health experiences. Fam Med 1998 Fam Med 1998; 30(2):122-6.; 30(2):122-6.

Kass JD, et al. Health outcomes and a new index of spiritual Kass JD, et al. Health outcomes and a new index of spiritual experience. experience. J Scientific Study of Religion 1991J Scientific Study of Religion 1991; 30:203-11.; 30:203-11.

Questions That Can Be Used to Questions That Can Be Used to Facilitate Clinical Discussions Facilitate Clinical Discussions

About Patient SpiritualityAbout Patient Spirituality

Taking a spiritual Taking a spiritual history. . .history. . .

S Spiritual Belief SystemS Spiritual Belief System P Personal SpiritualityP Personal Spirituality I Integration in a Spiritual CommunityI Integration in a Spiritual Community R Ritualized Practices and RestrictionsR Ritualized Practices and Restrictions I Implications for Health CareI Implications for Health Care T Terminal Events Planning (advance T Terminal Events Planning (advance

directives, DNR wishes, DPOA etc..)directives, DNR wishes, DPOA etc..)

Research tells us:Research tells us:

-patients want clinicians to consider spiritual -patients want clinicians to consider spiritual issuesissues

-religious commitments are associated with -religious commitments are associated with health enhancing behaviors and attitudes influence health enhancing behaviors and attitudes influence preventative practices in all aspects of medicinepreventative practices in all aspects of medicine

-incorporating spiritual concepts in some areas -incorporating spiritual concepts in some areas of treatment enhances their relevance for patientsof treatment enhances their relevance for patients

-using religion-oriented treatments for religious -using religion-oriented treatments for religious patients may be effective for treating some patients may be effective for treating some psychiatric disorderspsychiatric disorders

-recovery from episodes of major mental illness -recovery from episodes of major mental illness may be associated with religious involvementmay be associated with religious involvement