Principles of Family Medicine“Spirituality and Clinical Care”

Victor Sierpina, M.D.

Michael M. Olson, Ph.D.

Overview of Seminar Introduction

Controversies and Consensus

Clinical Cases Interns small group session/discussion Break (10 minutes) Evidence-base for impact of

spirituality/religion on health care outcomes Spiritual History Models Practice

Religion – Spirituality Defined

Controversy and Consensus

Consensus IntertwinedPrescribing/Proselytizing Pt. Initiated prayerTaking spiritual hx./talking about issues

is delicate, not indicated in all visits.Collaboration neededDecisions made by pt./fam./dct.Ethics, power, boundaries, all

challenges

Clinical Experience/Vignettes*

*Olson, M. M., Dollahite, D. C., & White, M. B. (2002). Involved fathering of children with special needs: Relationships and religion as resources. Journal of Religion, Health, and Disabilities 6 (1), 47-73.

Research

U.S. Beliefs: Faith, Prayer, & Health79% Believe spiritual faith can help one

recover from illness, injury, or disease

56% Believe their faith helped them recoverfrom illness, injury, or disease

63% Believe doctors should talk to patientsabout their spiritual faith

Only 10% of doctors have done so

USA Weekend, April 5-7, 1996.

More Statistics

9 out of 10 adult Americans pray.96% of Americans currently believe in a

God or a universal Spirit, and the majority of Americans feel that religion is an important component in their lives (Kudlac, 1991; McAllister, 1998; Thoresen, 1998)

Physicians’ view of top 5 barriers to addressing patient spiritual concerns:

Lack of time 71%

Lack of training 59%

Uncertainty identifying spiritual needs 56%

Concern projecting own beliefs 53%

Uncertainty managing pts. spiritual issues 49%

Ellis MR, et al. Addressing spiritual concerns of patients’ family physicians’ attitudes and practices. Journal of Fam Pract 1999;48(2):105-9.

Family Physician’s View of Spirituality

National survey of family physicians

Felt somewhat close to God 77%Attend religious services monthly 74%

Pray, spend time in spiritual practice daily 35%

Did not believe in God, higher power, force 5%

Daaleman TP, Frey B. Spiritual and religious beliefs and practices of family physicians: a national survey. J Fam Pract 1999; 48(2):98-104.

Evidence-based Practice

Koenig, H. G., McCullough, M. E., & Larson, M.D. (2001). Handbook of Religion and Health. Oxford Press.

Mayo Clinic Proceedings. 2001; 76: 1225-1235. – Critical review of the research literature (published studies, meta-analyses, systematic reviews, and subject reviews)

Religious Involvement, Spirituality, and HealthDecreased mortalityDecreased cardiovascular diseaseDecreased hypertensionHealth promoting behaviorsTerminally ill patients

Religious Involvement, Spirituality, and HealthDepressionAnxietySubstance Abuse

Negative Influences of Religion/Spirituality on Health ( - ) correlation in appx. 5% of studies:

RX Timely medical care Blood Immunizations Refusing pre-natal care Replacing MHC w/ Religion

Effect on Attitudes, Cognitive Thought Processes, BehaviorCan promote rigid thinking, over-

dependence on laws and rules, and disregard for personal individuality and autonomy.

Excessive reliance on religious rituals or counsel may delay seeking necessary treatment for health problems

Spiritual History Models

Practice:1. Pair up with person next to you and choose one of the spiritual history models you prefer to use. Practice assessment.2. Responder: Either use your own life/experience or that of someone you know well enough that you could respond with sufficient information to be meaningful.After you’ve finished switch roles and practice again.