Recognizing Patient Spirituality Could Improve Quality of Care

When it comes to quality and medicine, we're often comfortable discussing many subjects, such as the latest technologies, the newest journal findings, recent legislation, or even revised payment strategies. However, if we move the subject to the human aspect—examining patient spiritual needs—the comfort zone seems to shrink.

We may have our own set of personal beliefs, but sometimes addressing a patient's spiritual needs as part of his or her care may appear out of place or inappropriate. However, two new studies find that recognizing that spirituality may be an important part of providing quality care.

In the first study, researchers at Dana Farber Cancer Institute in Boston found support of terminally ill cancer patients' spiritual needs by medical teams was associated with greater quality of life—even during the last remaining days.

Recent research has shown that religion and spirituality many times are prime sources of comfort and support for patients confronting advanced disease, according to the study's senior author, Tracy Balboni, MD, MPH, a radiation oncologist at Dana Farber.

"Our findings indicate that patients whose spiritual needs are supported by their medical team—including doctors, nurses and chaplains—have better quality of life near death and receive less aggressive medical care at the end of life," she said.

The study, which appears on the current online version of the Journal of Clinical Oncology, involved 343 incurable cancer patients at hospital and cancer centers nationwide. Participants were interviewed about how they coped with their illnesses, the degree to which their spiritual needs were met by medical teams, and their preferences regarding end of life treatment. Each patient's course of care were tracked during the remainder of his or her life.

Patients whose spiritual needs were supported by the medical team were likely to move to hospice care at the end of life, the researchers noted. Also, spiritual support among those patients who relied on their religious beliefs to cope with their illnesses reduced their risks of receiving aggressive medical treatments at the end of their lives.

Support of patients' spiritual needs by the medical team also was associated with better patient well being toward the end of life: scores averaged 28% higher among those receiving spiritual support.

In a separate study from Rice University, Houston, and Brandeis University, Waltham, MA, it was found that while more physicians say religion and spirituality help some patients and their families cope with serious illness, it was often the families and patients—not the physicians—who raised the issue of prayer.

This study, which appears in the current issue of Southern Medical Journal, suggests that medical education could be enhanced by courses that address the topic of prayer—but which go beyond just praying.

"We know that prayer in physician patient interactions is attracting more attention," said coauthor Wendy Cadge, a sociologist at Brandeis University. "Most research in this area focuses on whether physicians and patients think prayer is relevant. But, in this study, we wanted to find out when and how prayer comes up in the clinic, and how physicians respond."

The study found that pediatricians usually respond to requests for prayer in one of four ways:

• They participate in the prayers.
• They accommodate the prayers, but don't participate.
• They reframe the prayers.
• They direct the families and patients to religious and spiritual resources, such as hospital chaplains.

A few physicians did join in prayers with families and/or participated in religious rituals, such as baptism or being at the bedside. Others said they accommodated prayers, but didn't actively participate in them.

Another group of pediatricians reframed the prayer requests in ways they thought were more realistic and appropriate, Cadge said. The fourth group of physicians responded to requests for prayer by referring patients and families to other resources, such as the family's religious leaders or hospital chaplains.

Overall, the study showed that the situations that lead to requests and physicians' behaviors in response are far more complex "than simply praying or not praying," said Cadge.

In the long run, both these studies seem to show that while responding to spirituality seems to be a personal issue, there may be more there in adding it to the arsenal of providing quality care—and maybe we shouldn't be so shy to talk about it.