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Wang EY, Pan A, Srinivas T, Loftus J, Geller G, Carrese JA, Antoine D, Fingerhood M. Patient and Physician Perspectives on Discussing Addiction Recovery and Spirituality in the Primary Care Setting. J Gen Intern Med 2024:10.1007/s11606-024-08939-9. [PMID: 39028404 DOI: 10.1007/s11606-024-08939-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Spirituality is an important component of recovery for many individuals with substance use disorder (SUD). However, few studies have compared patient and physician attitudes on spirituality in SUD recovery. OBJECTIVE This study investigates patient and physician beliefs about the role of spirituality in SUD recovery and about discussing spirituality in relationship to recovery in primary care settings. DESIGN Semi-structured interviews were conducted with primary care physicians recruited at two academic hospitals, and patients recruited from a faith-based residential therapeutic community. Interview transcripts were independently coded by two researchers and a grounded theory approach was used to generate themes that reflected participants' experiences. KEY RESULTS Interviews were conducted with 15 patients and 10 physicians. Patients had diverse views about the impact of spirituality on their SUD recovery, including positive, negative, and neutral. Patient and physician opinions on discussing spirituality in a primary care setting differed: most physicians felt positively towards this, believing that understanding their patients' spirituality helped them care for their patients as whole people. Many patients felt neutral, stating that they did not feel like these conversations were necessary for their care, and that they believed physicians preferred not to discuss spirituality in medical settings. Tolerance from both the patient and physician, open-ended questioning, and an individualized approach were identified as facilitators to effective discussions about spirituality and recovery. CONCLUSIONS Spirituality can have diverse effects on an individual's SUD recovery. Physicians endorsed the benefits of discussing spirituality in the context of their patients' recovery, while patients expressed reservations about engaging in these conversations with their physicians. This variation in perspectives highlights the need for additional research to understand the individual and structural factors that contribute to it, as well as best practices for engaging in effective, non-judgmental conversations about spirituality in recovery.
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Affiliation(s)
- Erin Y Wang
- Division of Addiction Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
| | - Annabelle Pan
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tara Srinivas
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Loftus
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gail Geller
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph A Carrese
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Denis Antoine
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Fingerhood
- Division of Addiction Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mosavizadeh SR, Bahrami M, Maghami-Mehr A, Torkan M, Mehdipoorkorani L. Explaining the Nurses' Spiritual Needs in the Oncology Department: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2024; 29:98-104. [PMID: 38333340 PMCID: PMC10849283 DOI: 10.4103/ijnmr.ijnmr_84_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 02/10/2024]
Abstract
Background It seems that improving the spiritual dimension of cancer patients can play an effective role in their mental and emotional peace. Meanwhile, oncology ward nurses are one of the most important healthcare providers that can help improve patients' relationship with God due to their more interaction and communication with patients. For this reason, this study aimed at explaining nurses' spiritual needs in an oncology ward. Materials and Methods This study was conducted based on the qualitative content analysis method. The participants included 11 nurses from the oncology ward of Seyed Al Shahada Hospital in Isfahan from 2021 to 2022. A semi-structured interview was administered to determine nurses' spiritual needs. Results Analysis of 11 interviews conducted with nurses revealed a total of four main codes, 13 sub-codes, and four sub-sub-codes. According to nurses' point of view, their spiritual needs can be classified into four dimensions as follows: communication with God, communication with oneself (intrapersonal communication), communication with others (interpersonal communication), and communication with environment. Administered interviews revealed the role of communication with God with six sub-codes as nurses' most important point of attention. Conclusions According to nurses' point of view, nurses' spiritual needs were divided into the dimensions of communication with God, communication with oneself, communication with others, and communication with environment. Therefore, it is necessary to simultaneously pay attention to oncology nurses' personal and social aspects to increase their spirituality.
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Affiliation(s)
- Seyed Rohollah Mosavizadeh
- Department of Islamic Education, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Bahrami
- Cancer Prevention Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mohammad Torkan
- The Center for Developing Interdisciplinary Research of Islamic Teaching and Health Sciences, Department of Islamic Education, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ladan Mehdipoorkorani
- Department of Medical Surgical, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Brewer LC, Bowie J, Slusser JP, Scott CG, Cooper LA, Hayes SN, Patten CA, Sims M. Religiosity/Spirituality and Cardiovascular Health: The American Heart Association Life's Simple 7 in African Americans of the Jackson Heart Study. J Am Heart Assoc 2022; 11:e024974. [PMID: 36000432 PMCID: PMC9496409 DOI: 10.1161/jaha.121.024974] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Religiosity/spirituality is a major coping mechanism for African Americans, but no prior studies have analyzed its association with the American Heart Association Life's Simple 7 (LS7) indicators in this group. Methods and Results This cross‐sectional study using Jackson Heart Study (JHS) data examined relationships between religiosity (religious attendance, private prayer, religious coping) and spirituality (theistic, nontheistic, total) with LS7 individual components (eg, physical activity, diet, smoking, blood pressure) and composite score among African Americans. Multivariable logistic regression assessed the odds of achieving intermediate/ideal (versus poor) LS7 levels adjusted for sociodemographic, behavioral, and biomedical factors. Among the 2967 participants (mean [SD] age=54.0 [12.3] years; 65.7% women), higher religious attendance was associated with increased likelihood (reported as odds ratio [95% CI]) of achieving intermediate/ideal levels of physical activity (1.16 [1.06–1.26]), diet (1.10 [1.01–1.20]), smoking (1.50 [1.34–1.68]), blood pressure (1.12 [1.01–1.24]), and LS7 composite score (1.15 [1.06–1.26]). Private prayer was associated with increased odds of achieving intermediate/ideal levels for diet (1.12 [1.03–1.22]) and smoking (1.24 [1.12–1.39]). Religious coping was associated with increased odds of achieving intermediate/ideal levels of physical activity (1.18 [1.08–1.28]), diet (1.10 [1.01–1.20]), smoking (1.32 [1.18–1.48]), and LS7 composite score (1.14 [1.04–1.24]). Total spirituality was associated with increased odds of achieving intermediate/ideal levels of physical activity (1.11 [1.02–1.21]) and smoking (1.36 [1.21–1.53]). Conclusions Higher levels of religiosity/spirituality were associated with intermediate/ideal cardiovascular health across multiple LS7 indicators. Reinforcement of religiosity/spirituality in lifestyle interventions may decrease overall cardiovascular disease risk among African Americans.
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Affiliation(s)
- LaPrincess C Brewer
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN.,Center for Health Equity and Community Engagement Research Mayo Clinic Rochester MN
| | - Janice Bowie
- Department of Health, Behavior and Society Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Joshua P Slusser
- Division of Clinical Trials and Biostatistics Mayo Clinic Rochester MN
| | | | - Lisa A Cooper
- Department of Health, Behavior and Society Johns Hopkins Bloomberg School of Public Health Baltimore MD.,Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | | | - Christi A Patten
- Center for Health Equity and Community Engagement Research Mayo Clinic Rochester MN.,Department of Psychiatry and Psychology Mayo Clinic Rochester MN
| | - Mario Sims
- Department of Medicine University of Mississippi Medical Center Jackson MS
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Hathaway DB, de Oliveira E Oliveira FHA, Mirhom M, Moreira-Almeida A, Fung WLA, Peteet JR. Teaching Spiritual and Religious Competencies to Psychiatry Residents: A Scoping and Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:300-310. [PMID: 34010864 DOI: 10.1097/acm.0000000000004167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE For many persons worldwide, mental health is inseparably linked with spirituality and religion (S&R), yet psychiatrists have repeatedly expressed doubts regarding their preparedness to address patients' spirituality or religion appropriately. In recent decades, medical educators have developed and implemented curricula for teaching S&R-related competencies to psychiatry residents. The authors reviewed the literature to understand the scope and effectiveness of these educational initiatives. METHOD The authors searched 8 databases to identify studies for a scoping review and a systematic review. The scoping review explored educational approaches (topics, methods) used in psychiatry residency programs to teach S&R-related competencies. The systematic review examined changes in psychiatry trainees' competencies and/or in patient outcomes following exposure to these educational interventions. RESULTS Twelve studies met criteria for inclusion in the scoping review. All reported providing residents with both (1) a general overview of the intersections between mental health and S&R and (2) training in relevant interviewing and assessment skills. Seven of these studies-representing an estimated 218 postgraduate psychiatry trainees and at least 84 patients-were included in the systematic review. Residents generally rated themselves as being more competent in addressing patients' S&R-related concerns following the trainings. One randomized controlled trial found that patients with severe mental illness who were treated by residents trained in S&R-related competencies attended more appointments than control patients. CONCLUSIONS S&R-related educational interventions appeared generally well tolerated and appreciated by psychiatry trainees and their patients; however, some topics (e.g., Alcoholics Anonymous) received infrequent emphasis, and some experiential teaching methodologies (e.g., attending chaplaincy rounds) were less frequently used for psychiatry residents than for medical students. The positive association between teaching S&R-related competencies to psychiatry residents and patient appointment attendance merits further study. Future trainings should supplement classroom learning with experiential approaches and incorporate objective measures of resident competence.
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Affiliation(s)
- David B Hathaway
- D.B. Hathaway is attending physician, Department of Psychiatry, Brigham and Women's Hospital, and an instructor of psychiatry, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-7271-0018
| | - Fabrício H A de Oliveira E Oliveira
- F.H.A. de Oliveira e Oliveira is psychiatrist and a PhD student, Center for Research in Spirituality and Health (NUPES), Universidade Federal de Juiz de Fora School of Medicine, Minas Gerais, Brazil; ORCID: https://orcid.org/0000-0001-5304-2835
| | - Mena Mirhom
- M. Mirhom is co-director and a post-doctoral clinical fellow, Public Psychiatry Fellowship, Columbia University Department of Psychiatry, New York, New York; ORCID: https://orcid.org/0000-0003-0408-4056
| | - Alexander Moreira-Almeida
- A. Moreira-Almeida is associate professor of psychiatry and director, Center for Research in Spirituality and Health (NUPES), Universidade Federal de Juiz de Fora School of Medicine, Minas Gerais, Brazil; ORCID: https://orcid.org/0000-0002-9135-2532
| | - Wai Lun Alan Fung
- W.L.A. Fung is research professor, Tyndale University, faculty member, University of Toronto Faculty of Medicine, medical director, Mount Sinai Hospital Wellness Centre, and attending physician, Department of Psychiatry, Mount Sinai Hospital and North York General Hospital, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-7260-9163
| | - John R Peteet
- J.R. Peteet is associate professor of psychiatry, Harvard Medical School, site director, Fellowship in Psychosocial Oncology and Palliative Care, Dana-Faber Cancer Institute, and attending physician, Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-5362-1765
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Salazar-Collier CL, Reininger BM, Wilkinson AV, Kelder SH. Exploration of Fatalism and Religiosity by Gender and Varying Levels of Engagement Among Mexican-American Adults of a Type 2 Diabetes Management Program. Front Public Health 2021; 9:652202. [PMID: 34646799 PMCID: PMC8502957 DOI: 10.3389/fpubh.2021.652202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/30/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: Purpose of study is to explore the roles religiosity and fatalistic beliefs play in diabetes management among newly, currently, and long-term enrolled Mexican-American participants in a Type 2 diabetes mellitus (T2DM) chronic care management program. Methods: In 2017, study participants (n = 15) completed a semi-structured interview in their preferred language (English or Spanish). Sample was stratified by amount of time individual had been enrolled as a participant of the Salud y Vida program: newly, currently, or long-term. Interviews assessed religious beliefs, beliefs concerning the cause(s) of diabetes, perceived relationship between religiosity and fatalistic beliefs with T2DM management, and the appropriateness of discussing such topics with a health professional. Interview responses were analyzed using ATLAS.ti 8. Results: Themes identified included: perceived autonomy over diabetes prognosis, motivators for self-care, discussions of personal beliefs in the healthcare setting, and the church's role in diabetes management. Conclusions: Among this sample, religiosity and religious fatalism played a complex role in coping with and managing diabetes. Long-term enrolled and male participants expressed beliefs of divine control over health, and a connection between religiosity and health behavior. Long-term enrolled participants felt religious and fatalistic beliefs may be suitable and beneficial to discuss in the healthcare setting.
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Affiliation(s)
- Cindy Lynn Salazar-Collier
- Department of Public Health, College of Nursing and Health Sciences, Texas A&M International University, Laredo, TX, United States
| | - Belinda M. Reininger
- Department of Health Promotion & Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Brownsville, TX, United States
| | - Anna V. Wilkinson
- Deaprtment of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science at Houston, Austin, TX, United States
| | - Steven H. Kelder
- Deaprtment of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science at Houston, Austin, TX, United States
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Fuchs JR, Fuchs JW, Hauser JM, Coors ME. Patient Perspectives on Religiously Affiliated Care in Rural and Urban Colorado. J Prim Care Community Health 2021; 12:21501327211012158. [PMID: 33949248 PMCID: PMC8114281 DOI: 10.1177/21501327211012158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Religiously affiliated healthcare organizations play an important role in the delivery of care in the United States. There is a gap in the literature regarding patients' attitudes toward receiving care at these institutions, especially in geographically diverse populations. METHODS In this two-site pilot study, we conducted a written survey of 141 adult primary care patients at non-religiously affiliated clinics in rural and urban Colorado. Demographic information, measures of religiosity and spirituality, and opinions regarding religiously affiliated care were collected. RESULTS 73.3% and 69.6% of patients in rural and urban counties, respectively, had no preference as to the religious affiliation of their care. However, patients in the urban county (24.1%) were more likely than those in the rural county (8.3%) to prefer care that was not affiliated with any religion. CONCLUSIONS This study suggests that concerns such as proximity to care and patient/provider relationships may be more important to patients than the possible religious affiliation of a healthcare organization. This work is a first step in better understanding patients' attitudes toward religiously affiliated care in urban versus rural settings.
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Affiliation(s)
| | | | - Joshua M Hauser
- Division of Palliative Care, Northwestern University Feinberg School of Medicine and Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Marilyn E Coors
- Department of Psychiatry & The Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, Colorado, USA
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Cipriano-Steffens T, Cursio JF, Hlubocky F, Sumner M, Garnigan-Peters D, Powell J, Arndt N, Phillips L, Lassiter RH, Gilliam M, Petty LE, Pastor RSO, Malec M, Fitchett G, Polite B. Improving End of Life Cancer Outcomes Through Development and Implementation of a Spiritual Care Advocate Program. Am J Hosp Palliat Care 2021; 38:1441-1450. [PMID: 33663241 DOI: 10.1177/1049909121995413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Explored whether increased support for spiritual concerns between the healthcare team and patients through the provision of a Spiritual Care Advocate (SCA) would improve end of life outcomes in a metastatic cancer population. DESIGN Newly diagnosed metastatic cancer patients were recruited at the University of Chicago Medical Center and received spiritual support from a Spiritual Care Advocate during chemotherapy treatments. The final sample consisted of 42 patients (58% of those approached) who completed the baseline survey and had known survival status. MEASUREMENT Patients completed pre/post surveys measuring spiritual support and palliative quality of life. Baseline measurements of religious practice and externalizing religious health beliefs were also obtained. Receipt of aggressive EOL care was derived from the electronic medical record. RESULT Median age was 61 years, with 48% Black, and predominantly male (62%). Of the 42 patients, 30 (70%) had died by the time of this analysis. Perceived spiritual support from the medical team increased in 47% of those who received non-aggressive EOL care and by 40% in those who received aggressive EOL care (p=0.012). Patient perceptions of spiritual support from the medical community increased from 27% at baseline to 63% (p=0.005) after the SCA intervention. Only 20% of recipients received aggressive treatments at end of life. CONCLUSION The SCA model improved the perceived spiritual support between the healthcare team and patients. Although limited by a small sample size, the model was also associated with an improvement in EOL patients' quality of life, spiritual wellbeing, and decreased aggressive EOL care.
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Affiliation(s)
| | - John F Cursio
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Fay Hlubocky
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Marsha Sumner
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Judy Powell
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Nicole Arndt
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Lee Phillips
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | | | | | - Monica Malec
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - George Fitchett
- Department of Religion, Rush University Medical Center, Chicago, IL, USA
| | - Blase Polite
- Department of Medicine, University of Chicago, Chicago, IL, USA
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Cipriano-Steffens TM, Carilli T, Hlubocky F, Quinn M, Fitchett G, Polite B. "Let Go, Let God": A Qualitative Study Exploring Cancer Patients' Spirituality and Its Place in the Medical Setting. JOURNAL OF RELIGION AND HEALTH 2020; 59:2341-2363. [PMID: 31705446 DOI: 10.1007/s10943-019-00942-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study explored the role of God and spirituality in cancer patients to gain deeper insight into how patients use their spirituality to cope during illness, including how they see the medical team meeting their spiritual needs. From our work, some naturally emerging themes included Finding God in Cancer and Healing, Spiritual Support Desired from Medical Community, Doctor as "Gift from God"?, and Communication and the Power of Talk. Cancer patients not only acknowledged a spiritual need, but a desire for it to be addressed by their medical team as part of their treatment.
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Affiliation(s)
- Toni Marie Cipriano-Steffens
- Department of Medicine, University of Chicago, Chicago, IL, USA.
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA.
| | | | - Fay Hlubocky
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | - Michael Quinn
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - George Fitchett
- Department of Religion, Rush University Medical Center, Chicago, IL, USA
| | - Blase Polite
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
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Subrata SA. Implementation of spiritual care in patients with diabetic foot ulcers: a literature review. ACTA ACUST UNITED AC 2020; 29:S24-S32. [PMID: 32790549 DOI: 10.12968/bjon.2020.29.15.s24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lower extremity amputation is a complication of diabetic foot ulcers that can cause spiritual crisis. Integrating spiritual care into nursing practice is important to overcome this. However, studies articulating the role of nurses in spiritual care when caring for patients with diabetic foot ulcers is limited. This article aims to describe the importance of providing spiritual care for this group of patients. The interpretation of spiritual care with respect to the relationship between the patient and the family, and the role of the nurse are discussed. The findings offer a theoretical perspective on spiritual care that can be used to develop spiritual interventions, as well as prevent spiritual crises in patients with diabetic foot ulcers.
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Affiliation(s)
- Sumarno Adi Subrata
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand, Nursing Lecturer at the Department of Nursing and Wound Research Centre, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Indonesia
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Ahmad Tajuddin NAN, Suhaimi J, Ramdzan SN, Malek KA, Ismail IA, Shamsuddin NH, Abu Bakar AI, Othman S. Why women chose unassisted home birth in Malaysia: a qualitative study. BMC Pregnancy Childbirth 2020; 20:309. [PMID: 32429857 PMCID: PMC7238584 DOI: 10.1186/s12884-020-02987-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/04/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Incidences of unassisted home birthing practices have been increasing in Malaysia despite the accessibility to safe and affordable child birthing facilities. We aimed to explore the reasons for women to make such decisions. METHODS Twelve women participated in in-depth interviews. They were recruited using a snowballing approach. The interviews were supported by a topic guide which was developed based on the Theory of Planned Behaviour and previous literature. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS Women in this study described a range of birthing experiences and personal beliefs as to why they chose unassisted home birth. Four themes emerged from the interviews; i) preferred birthing experience, ii) birth is a natural process, iii) expressing autonomy and iv) faith. Such decision to birth at home unassisted was firm and steadfast despite the possible risks and complications that can occur. Giving birth is perceived to occur naturally regardless of assistance, and unassisted home birth provides the preferred environment which health facilities in Malaysia may lack. They believed that they were in control of the birth processes apart from fulfilling the spiritual beliefs. CONCLUSIONS Women may choose unassisted home birth to express their personal views and values, at the expense of the health risks. Apart from increasing mothers' awareness of the possible complications arising from unassisted home births, urgent efforts are needed to provide better birth experiences in healthcare facilities that resonate with the mothers' beliefs and values.
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Affiliation(s)
| | - Julia Suhaimi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Nurkamilla Ramdzan
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khasnur Abd Malek
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Ilham Ameera Ismail
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Nurainul Hana Shamsuddin
- Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Ahmad Ihsan Abu Bakar
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sajaratulnisah Othman
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Tajuddin NA@NA, Suhaimi J, Ramdzan SN, Malek KA, Ismail IA, Shamsuddin NH, Bakar AIA, Othman S. Why women chose unassisted home birth in Malaysia: A qualitative study.. [DOI: 10.21203/rs.2.16973/v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Abstract
Background: Incidences of unassisted home birthing practices have been increasing in Malaysia despite the accessibility to safe and affordable child birthing facilities. We aimed to explore the reasons for women to make such decisions. Methods: Twelve women participated in in-depth interviews. They were recruited using a snowballing approach. The interviews were supported by a topic guide which was developed based on the Theory of Planned Behaviour and previous literature. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.Results: Women in this study described a range of birthing experiences and personal beliefs as to why they chose unassisted home birth. Four themes emerged from the interviews; i) preferred birthing experience, ii) birth is a natural process, iii) expressing autonomy and iv) faith. Such decision to birth at home unassisted was firm and steadfast despite the possible risks and complications that can occur. Giving birth is perceived to occur naturally regardless of assistance, and unassisted home birth provides the preferred environment which health facilities in Malaysia may lack. They believed that they were in control of the birth processes apart from fulfilling the spiritual beliefs.Conclusions: Women may choose unassisted home birth to express their personal views and values, at the expense of the health risks. Apart from increasing mothers' awareness of the possible complications arising from unassisted home births, urgent efforts are needed to provide better birth experiences in healthcare facilities that resonate with the mothers’ beliefs and values.
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Tajuddin NA@NA, Suhaimi J, Ramdzan SN, Malek KA, Ismail IA, Shamsuddin NH, Bakar AIA, Othman S. Why women chose unassisted home birth in Malaysia: A qualitative study.. [DOI: 10.21203/rs.2.16973/v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Abstract
Background: Incidences of unassisted home birthing practices have been increasing in Malaysia despite the accessibility to safe and affordable child birthing facilities. We aimed to explore the reasons for women to make such decisions. Methods: Twelve women participated in in-depth interviews. They were recruited using a snowballing approach. The interviews were supported by a topic guide which was developed based on the Theory of Planned Behaviour and previous literatures. The interviews were audio recorded, transcribed verbatim and analysed using thematic analysis. Results: Women in this study described a range of birthing experiences and personal beliefs as to why they chose unassisted home birth. Four themes emerged from the interviews; i) preferred birthing experience, ii) birth is a natural process, iii) expressing autonomy and iv) faith. Such decision to birth at home unassisted was firm and strong despite the possible risks and complications that can occur. Giving birth is perceived to occur naturally regardless of assistance, and unassisted home birth provides the preferred environment which health facilities in Malaysia may lack. They believed that they were in control of the birth processes apart from fulfilling the spiritual beliefs. Conclusions: Women may choose unassisted home birth to express their personal beliefs and values, at the expense of the health risks. Apart from increasing mothers’ awareness of the possible complications arising from unassisted home births, urgent efforts are needed to provide better birth experiences in healthcare facilities that resonate with the mothers’ beliefs and values.
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Fleming DA. Commentary on "Moral Controversy and Working with Colleagues with a Shared Ethical/Moral Outlook: A National Survey of US Primary Care Physicians". South Med J 2019; 112:462. [PMID: 31375846 DOI: 10.14423/smj.0000000000001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- David A Fleming
- From the University of Missouri School of Medicine, Columbia
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Hampton M, Baydala A, Bourassa C, Mckay-McNabb K, Placsko C, Goodwill K, Mckenna B, Mcnabb P, Boekelder R. Completing the Circle: Elders Speak about End-Of-Life Care with Aboriginal Families in Canada. J Palliat Care 2018. [DOI: 10.1177/082585971002600103] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, we share words spoken by Aboriginal elders from Saskatchewan, Canada, in response to the research question, “What would you like non-Aboriginal health care providers to know when providing end-of-life care for Aboriginal families?” Our purpose in publishing these results in a written format is to place information shared by oral tradition in an academic context and to make the information accessible to other researchers. Recent theoretical work in the areas of death and dying suggests that cultural beliefs and practices are particularly influential at the end of life; however, little work describing the traditional beliefs and practices of Aboriginal peoples in Canada exists to guide culturally appropriate end-of-life care delivery. Purposive sampling procedures were used to recruit five elders from culturally diverse First Nations in southern Saskatchewan. Key informant Aboriginal elder participants were videotaped by two Aboriginal research assistants, who approached the elders at powwows. Narrative analysis of the key informant interview transcripts was conducted to identify key concepts and emerging narrative themes describing culturally appropriate end-of-life health care for Aboriginal families. Six themes were identified to organize the data into a coherent narrative: realization; gathering of community; care and comfort/transition; moments after death; grief, wake, funeral; and messages to health care providers. These themes told the story of the dying person's journey and highlighted important messages from elders to non-Aboriginal health care providers.
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Affiliation(s)
- Mary Hampton
- Professor, Luther College, University of Regina Campus, Regina, Saskatchewan, Canada S4S 0A2
| | - Angelina Baydala
- A Baydala: Department of Psychology, University of Regina; Calgary, Alberta, Canada
| | - Carrie Bourassa
- C Bourassa, K McKay-McNabb, P McNabb: First Nations University of Canada, University of Regina; Calgary, Alberta, Canada
| | - Kim Mckay-McNabb
- C Bourassa, K McKay-McNabb, P McNabb: First Nations University of Canada, University of Regina; Calgary, Alberta, Canada
| | | | - Ken Goodwill
- K Goodwill: Fort Qu'Appelle, Saskatchewan; Moose Jaw, Saskatchewan
| | | | - Pat Mcnabb
- C Bourassa, K McKay-McNabb, P McNabb: First Nations University of Canada, University of Regina; Calgary, Alberta, Canada
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Franzen AB. Influence of Physicians' Beliefs on Propensity to Include Religion/Spirituality in Patient Interactions. JOURNAL OF RELIGION AND HEALTH 2018; 57:1581-1597. [PMID: 29876717 DOI: 10.1007/s10943-018-0638-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study examines physicians' beliefs, their perceptions of whether religion impacts health outcomes, and their propensity to discuss religion/spirituality with patients. It is not uncommon for patients to want religious/spiritual conversations, but the occurrence is infrequent. This study adds to knowledge regarding which physicians include these topics. Using a nationally representative sample of physicians and a mediated bi-factor structural equation model, the author finds that "religious and spiritual" physicians connect religion and patient health more than other religious/spiritual orientations. As a result, "religious and spiritual" physicians include religion/spirituality most often (indirect path). After this variation is accounted for, "spiritual but not religious" physicians still include this content, but the "religious but not spiritual" and "neither religious nor spiritual" physicians tend to avoid talking about religiosity/spirituality with patients.
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Affiliation(s)
- Aaron B Franzen
- Department of Sociology and Social Work, Hope College, 41 Graves Place, Holland, MI, 49423-3617, USA.
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Polite BN, Cipriano-Steffens TM, Hlubocky FJ, Jean-Pierre P, Cheng Y, Brewer KC, Rauscher GH, Fitchett GA. Association of externalizing religious and spiritual beliefs on stage of colon cancer diagnosis among black and white multicenter urban patient populations. Cancer 2018; 124:2578-2587. [PMID: 29579340 DOI: 10.1002/cncr.31351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/25/2018] [Accepted: 02/27/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study explores whether externalizing religious and spiritual beliefs is associated with advanced-stage colon cancer at initial oncology presentation and whether this association is stronger for blacks than for whites. METHODS Patients who had newly diagnosed, invasive colon cancer were recruited at 9 sites in the Chicago metropolitan area. Eligible patients were non-Hispanic white or black, ages 30 to 79 years, and diagnosed with a primary invasive colon cancer. Patients were interviewed on prior screening and diagnosis. Social and attitudinal constructs were measured, including the God Locus of Health Control (GLHC) and Religious Problem Solving. The final response rate was 52% and included 407 patients. RESULTS The median age was 59 years (range, 30-79 years), and 51% of participants were black. Cancer stage was available for 389 (96%) patients and was divided between late stage (stages III-IV; 60%) and early stage (stages I-II; 40%). Multivariate analysis indicated that patients in the highest tertile of scores on the GLHC were more likely have an advanced stage of disease at presentation (odds ratio, 2.14; 95% confidence interval, 1.00-4.59; P = .05) compared with those in the lowest tertile. No significant interaction was identified between race and GLHC scores for stage at presentation (P = .78). CONCLUSIONS In a large sample of black and white individuals across diverse health care systems, higher scores on the GLHC predicted late disease stage at presentation. Although blacks had significantly higher GLHC scores, race was not associated with stage at presentation, nor was the association between GLHC and stage limited to blacks. Further work is needed to better understand this association and to develop interventions to better connect the religious and health care spheres. Cancer 2018;124:2578-87. © 2018 American Cancer Society.
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Affiliation(s)
- Blase N Polite
- Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Fay J Hlubocky
- Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Ying Cheng
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana
| | - Katherine C Brewer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Garth H Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - George A Fitchett
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois
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Prizer LP, Gay JL, Wilson MG, Emerson KG, Glass AP, Miyasaki JM, Perkins MM. A Mixed-Methods Approach to Understanding the Palliative Needs of Parkinson’s Patients. J Appl Gerontol 2018; 39:834-845. [DOI: 10.1177/0733464818776794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Parkinson’s disease (PD) is the second-most common age-related neurodegenerative disorder. Despite recommendations for a palliative approach, little is known about what palliative needs are unmet by standard care. This study aims to (a) identify palliative needs of PD patients, (b) determine the relationship between palliative needs and health-related quality of life (HRQoL), and (c) probe into factors affecting HRQoL. PD patients and neurologists were recruited for a survey on palliative need; a subset of patients was interviewed. Significant differences between physicians and patients were found in Physical, Psychological, Social, Financial, and Spiritual domains. Physical and Psychological needs predicted HRQoL. Primary themes across interviews included (a) lack of healthcare education and (b) need for care coordination. Secondary themes included (a) the importance of support groups, (b) the role of spirituality/religion, and (c) the narrow perceived role of the neurologist. Findings highlight the importance of coordinated individualized care.
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Boucher NA, Steinhauser KE, Johnson KS. Older, Seriously Ill Veterans’ Views on the Role of Religion and Spirituality in Health-Care Delivery. Am J Hosp Palliat Care 2018; 35:921-928. [DOI: 10.1177/1049909118767113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: To describe older Veteran’s perspectives on the current delivery of religious or spiritual (R/S) care. Methods: Semi-structured interviews with older veterans with advanced stage cancer, heart failure, or pulmonary disease to elicit views on when, how, and by whom religious and spiritual care is preferred. Results: The sample (n = 17) was largely male (94%), non-Hispanic white (52.9%), Christian (82.3%), and most had at least some college education (64.7%). Participants shared diagnoses of cancer (47%), heart failure (35.2%), or chronic obstructive pulmonary disease (17.6%). As a group, participants had moderate religiosity. Themes relevant to the study goal of improving VA care delivery are as follows: (1) process of R/S engagement, (2) timing of R/S engagement, and (3) awareness of services. Veterans discussed the need for VA providers to accommodate diverse spiritual beliefs, importance of screening for spiritual needs, inclusion of family spiritual support, need for higher visibility of services, use of nonchaplains for R/S support, and times when R/S is important. Discussion: Veterans recognize the diversity of their fellow veterans and note the opportunities and challenges in providing R/S support in the VA care setting. The findings have implications for quality improvement in VA care including efforts focused on enhanced outreach to veterans, bolstered education for staff, and more nuanced approaches to R/S support.
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Affiliation(s)
| | | | - Kimberly S. Johnson
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
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Ellington L, Billitteri J, Reblin M, Clayton MF. Spiritual Care Communication in Cancer Patients. Semin Oncol Nurs 2017; 33:517-525. [PMID: 29107530 DOI: 10.1016/j.soncn.2017.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To provide a definition of spirituality, define the scope and nature of spiritual care communication, describe how to initiate communication about, and elicit, a spiritual history, and introduce the AMEN protocol to support patient/family hopes for a miracle. DATA SOURCES Literature review. CONCLUSION Spiritual communication is important throughout cancer care. Nurses can assess and integrate patient and family caregivers' spiritual needs in clinical care by practicing self-awareness and engaging in spiritual care communication strategies. IMPLICATIONS FOR NURSING PRACTICE Spirituality is recognized as an essential component of quality care. Spiritual conversations can increase patients' satisfaction with care and improve well-being.
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Snowden A, Telfer I. Patient Reported Outcome Measure of Spiritual Care as Delivered by Chaplains. J Health Care Chaplain 2017. [PMID: 28632083 DOI: 10.1080/08854726.2017.1279935] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chaplains are employed by health organizations around the world to support patients in recognizing and addressing their spiritual needs. There is currently no generalizable measure of the impact of these interventions and so the clinical and strategic worth of chaplaincy is difficult to articulate. This article introduces the Scottish PROM, an original five-item patient reported outcome measure constructed specifically to address this gap. It describes the validation process from its conceptual grounding in the spiritual care literature through face and content validity cycles. It shows that the Scottish PROM is internally consistent and unidimensional. Responses to the Scottish PROM show strong convergent validity with responses to the Warwick and Edinburgh Mental Well-Being Scale, a generic well-being scale often used as a proxy for spiritual well-being. In summary, the Scottish PROM is fit for purpose. It measures the outcomes of spiritual care as delivered by chaplains in this study. This novel project introduces an essential and original breakthrough; the possibility of generalizable international chaplaincy research.
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Affiliation(s)
- Austyn Snowden
- a School of Health and Social Care, Edinburgh Napier University , Edinburgh , Scotland , United Kingdom
| | - Iain Telfer
- b The Royal Infirmary of Edinburgh , Edinburgh , Scotland , United Kingdom
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Robinson KA, Cheng MR, Hansen PD, Gray RJ. Religious and Spiritual Beliefs of Physicians. JOURNAL OF RELIGION AND HEALTH 2017; 56:205-225. [PMID: 27071796 DOI: 10.1007/s10943-016-0233-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of this study is to describe religious and spiritual beliefs of physicians and examine their influence on the decision to pursue medicine and daily medical practice. An anonymous survey was e-mailed to physicians at a large, multidisciplinary tertiary referral center with satellite clinics. Data were collected from January 2014 through February 2014. There were 2097 respondents (69.1 % men), and number of practicing years ranged from ≤1 to ≥30. Primary care physicians or medical specialists represented 74.1 %, 23.6 % were in surgical specialties, and 2.3 % were psychiatrists. The majority of physicians believe in God (65.2 %), and 51.2 % reported themselves as religious, 24.8 % spiritual, 12.4 % agnostic, and 11.6 % atheist. This self-designation was largely independent of specialty except for psychiatrists, who were more likely report agnosticism (P = 0.003). In total, 29.0 % reported that religious or spiritual beliefs influenced their decision to become a physician. Frequent prayer was reported by 44.7 % of physicians, but only 20.7 % reported having prayed with patients. Most physicians consider themselves religious or spiritual, but the rates of agnosticism and atheism are higher than the general population. Psychiatrists are the least religious group. Despite the influence of religion on physicians' lives and medical practice, the majority have not incorporated prayer into patient encounters.
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Affiliation(s)
- Kristin A Robinson
- Department of Radiology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
| | | | | | - Richard J Gray
- Division of General Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
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Spirituality, Religiosity, and Health: a Comparison of Physicians' Attitudes in Brazil, India, and Indonesia. Int J Behav Med 2016; 23:63-70. [PMID: 26025629 DOI: 10.1007/s12529-015-9491-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND One of the biggest challenges in the spirituality, religiosity, and health field is to understand how patients and physicians from different cultures deal with spiritual and religious issues in clinical practice. PURPOSE The present study aims to compare physicians' perspectives on the influence of spirituality and religion (S/R) on health between Brazil, India, and Indonesia. METHOD This is a cross-sectional, cross-cultural, multi-center study carried out from 2010 to 2012, examining physicians' attitudes from two continents. Participants completed a self-rated questionnaire that collected information on sociodemographic characteristics, S/R involvement, and perspectives concerning religion, spirituality, and health. Differences between physicians' responses in each country were examined using chi-squared, ANOVA, and MANCOVA. RESULTS A total of 611 physicians (194 from Brazil, 295 from India, and 122 from Indonesia) completed the survey. Indonesian physicians were more religious and more likely to address S/R when caring for patients. Brazilian physicians were more likely to believe that S/R influenced patients' health. Brazilian and Indonesians were as likely as to believe that it is appropriate to talk and discuss S/R with patients, and more likely than Indians. No differences were found concerning attitudes toward spiritual issues. CONCLUSION Physicians from these different three countries had very different attitudes on spirituality, religiosity, and health. Ethnicity and culture can have an important influence on how spirituality is approached in medical practice. S/R curricula that train physicians how to address spirituality in clinical practice must take these differences into account.
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Rassoulian A, Seidman C, Löffler-Stastka H. Transcendence, religion and spirituality in medicine: Medical students' point of view. Medicine (Baltimore) 2016; 95:e4953. [PMID: 27661053 PMCID: PMC5044923 DOI: 10.1097/md.0000000000004953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 08/29/2016] [Accepted: 08/31/2016] [Indexed: 02/07/2023] Open
Abstract
To explore how medical students-the doctors of tomorrow-reflect upon meeting the spiritual needs of their patients, and whether they have reflected on their own religious or spiritual beliefs, or not. The study also investigates to what extent the students feel comfortable with addressing spiritual issues in their patient care, and whether they feel this is beyond their role as medical doctors.A self-administered questionnaire was developed. The survey was administered in teaching classes at the medical university of Vienna. One thousand four hundred (836 women and 564 men) students responded, laying the foundation for a thorough statistical analysis.59.5% of the students had reflected on their own belief concepts, 21.9% consider themselves religious, and 20.1% see themselves as spiritual individuals. 75.6% of the students agreed with the statement that religious conviction/spirituality might have an effect on how cancer patients cope. 85.9% would consider talking with their patients about religious/spiritual issues if patients wish to do so. 86.3% would involve chaplains if they feel it is necessary.The results of this study suggest that future doctors want to see the patient in a wider scope than the bio-psycho-social one, by including the meta-dimension of transcendence.
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Affiliation(s)
- Anahita Rassoulian
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Park CL, Sherman AC, Jim HS, Salsman JM. Religion/spirituality and health in the context of cancer: Cross-domain integration, unresolved issues, and future directions. Cancer 2015; 121:3789-94. [PMID: 26258608 PMCID: PMC4618033 DOI: 10.1002/cncr.29351] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 01/11/2015] [Accepted: 02/10/2015] [Indexed: 11/11/2022]
Abstract
This article summarizes the findings of 3 previous meta‐analytic reviews presented in this issue that evaluate associations between religiousness/spirituality (R/S) and patient‐reported outcomes across mental, physical, and social health domains. The results are synthesized, caveats in interpreting this set of analyses are discussed, directions are provided for future research, and tentative suggestions are made for clinical applications.
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Affiliation(s)
- Crystal L. Park
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Allen C. Sherman
- Behavioral Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Heather S. Jim
- Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - John M. Salsman
- Department of Medical Social Sciences, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Best M, Butow P, Olver I. Do patients want doctors to talk about spirituality? A systematic literature review. PATIENT EDUCATION AND COUNSELING 2015; 98:1320-8. [PMID: 26032908 DOI: 10.1016/j.pec.2015.04.017] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 04/21/2015] [Accepted: 04/25/2015] [Indexed: 05/05/2023]
Abstract
OBJECTIVE The aim of this systematic literature review was to ascertain the patient perspective regarding the role of the doctor in the discussion of spirituality. METHODS We conducted a systematic search in ten databases from inception to January 2015. Eligible papers reported on original research including patient reports of discussion of spirituality in a medical consultation. Papers were separated into qualitative and quantitative for the purposes of analysis and quality appraisal with QualSyst. Papers were merged for the final synthesis. RESULTS 54 studies comprising 12,327 patients were included. In the majority of studies over half the sample thought it was appropriate for the doctor to enquire about spiritual needs in at least some circumstances (range 2.1-100%, median 70.5%), but patient preferences were not straightforward. CONCLUSION While a majority of patients express interest in discussion of religion and spirituality in medical consultations, there is a mismatch in perception between patients and doctors regarding what constitutes this discussion and therefore whether it has taken place. PRACTICE IMPLICATIONS This review demonstrated that many patients have a strong interest in discussing spirituality in the medical consultation. Doctors should endeavor to identify which patients would welcome such conversations.
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Affiliation(s)
- Megan Best
- The University of Sydney NSW 2006 Australia; Greenwich Hospital Palliative Care Service, Greenwich NSW 2065 Australia.
| | | | - Ian Olver
- University of South Australia, PO Box 2471, Adelaide, SA 5001 Australia
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Rassouli M, Zamanzadeh V, Ghahramanian A, Abbaszadeh A, Alavi-Majd H, Nikanfar A. Experiences of patients with cancer and their nurses on the conditions of spiritual care and spiritual interventions in oncology units. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2015; 20:25-33. [PMID: 25709687 PMCID: PMC4325410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 08/06/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although nurses acknowledge that spiritual care is part of their role, in reality, it is performed to a lesser extent. The purpose of the present study was to explore nurses' and patients' experiences about the conditions of spiritual care and spiritual interventions in the oncology units of Tabriz. MATERIALS AND METHODS This study was conducted with a qualitative conventional content analysis approach in the oncology units of hospitals in Tabriz. Data were collected through purposive sampling by conducting unstructured interviews with 10 patients and 7 nurses and analyzed simultaneously. Robustness of data analysis was evaluated by the participants and external control. RESULTS Three categories emerged from the study: (1) "perceived barriers for providing spiritual care" including "lack of preparation for spiritual care," "time and space constraints," "unprofessional view," and "lack of support"; (2) "communication: A way for Strengthening spirituality despite the limitations" including "manifestation of spirituality in the appearances and communicative behaviors of nurses" and "communication: Transmission of spiritual energy"; and (3) "religion-related spiritual experiences" including "life events as divine will and divine exam," "death as reincarnation," "trust in God," "prayer/recourse to Holy Imams," and "acceptance of divine providence." Although nurses had little skills in assessing and responding to the patients' spiritual needs and did not have the organizational and clergymen's support in dealing with the spiritual distress of patients, they were the source of energy, joy, hope, and power for patients by showing empathy and compassion. The patients and nurses were using religious beliefs mentioned in Islam to strengthen the patients' spiritual dimension. CONCLUSIONS According to the results, integration of spiritual care in the curriculum of nursing is recommended. Patients and nurses can benefit from organizational and clergymen's support to cope with spiritual distress. Researchers should provide a framework for the development of effective spiritual interventions that are sensitive to cultural differences.
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Affiliation(s)
- Maryam Rassouli
- Department of Pediatrics, Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Zamanzadeh
- Department of Medical Surgical, Nursing and Midwifery School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghahramanian
- Department of Medical Surgical, Nursing and Midwifery School, Tabriz University of Medical Sciences, Tabriz, Iran,Address for correspondence: Dr. Akram Ghahramanian, Nursing and Midwifery School, Tabriz University of Medical Sciences, Tabriz, Iran. E-mail:
| | - Abbas Abbaszadeh
- Department of Pediatrics, Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Alavi-Majd
- Department of Biostatistics, School of Para Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Nikanfar
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Abstract
This secondary analysis of data from 200 practicing registered nurses' and student nurses' responses to 3 vignettes depicting patient spiritual distress were evaluated qualitatively and quantitatively (using the Empathic Response Scale). Findings showed wide variation in these nurses' ability to respond empathically; while some responses would be healing, others were potentially hurtful.
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McEvoy M, Schlair S, Sidlo Z, Burton W, Milan F. Assessing third-year medical students' ability to address a patient's spiritual distress using an OSCE case. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:66-70. [PMID: 24280842 DOI: 10.1097/acm.0000000000000061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To inform curricular development by assessing the ability of third-year medical students to address a patient's spiritual distress during an acute medical crisis in the context of an objective structured clinical examination (OSCE) case. METHOD During March and April 2010, 170 third-year medical students completed an eight-station videotaped OSCE at Albert Einstein College of Medicine of Yeshiva University. One of the standardized patients (SPs) was a 65-year-old man with acute chest pain who mentioned his religious affiliation and fear of dying. If prompted, he revealed his desire to speak with a chaplain. The SP assessed students' history taking, physical examination, and communication skills. In a postencounter written exercise, students reported their responses to the patient's distress via four open-ended questions. Analysis of the postencounter notes was conducted by three coders for emergent themes. Clinical skills performance was compared between students who reported making chaplain referral and those who did not. RESULTS A total of 108 students (64%) reported making a chaplain referral; 4 (2%) directly addressed the patient's religious/spiritual beliefs. Students' clinical performance scores showed no significant association with whether they made a chaplain referral. CONCLUSIONS Findings suggest that the majority of medical students without robust training in addressing patients' spiritual needs can make a chaplain referral when faced with a patient in spiritual crisis. Yet, few students explicitly engaged the patient in a discussion of his beliefs. Thus, future studies are needed to develop more precise assessment measures that can inform development in spirituality and medicine curricula.
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Affiliation(s)
- Mimi McEvoy
- Ms. McEvoy is associate professor of family and social medicine and assistant professor of pediatrics, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York. Dr. Schlair is assistant professor, Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine of Yeshiva University, Bronx, New York. Dr. Sidlo is a fourth-year medical student, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York. Dr. Burton is associate professor, Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York. Dr. Milan is professor of clinical medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York
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Abghari MS, Takemoto R, Sadiq A, Karia R, Phillips D, Egol KA. Patient perceptions and preferences when choosing an orthopaedic surgeon. THE IOWA ORTHOPAEDIC JOURNAL 2014; 34:204-208. [PMID: 25328483 PMCID: PMC4127729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Information regarding patient preferences is important to develop more diversity in healthcare providers. To our knowledge, no information exists regarding how patients choose their orthopaedic surgeon. The purpose of this study is to determine which demographic factors, if any, affect patient preferences when choosing an orthopaedic surgeon. METHODS Five hundred new patients presenting to a large, urban, academic orthopaedic clinic from May 2011 to May 2013 were prospectively asked to participate in this study. Patients were asked to complete a survey designed with the help of the Division of Population Health that focused on demographic, professional and physical attributes of theoretical surgeons. Specifically, patient preference of surgeon age, gender, race, religion, importance of education prestige, training program prestige and number of medical publications were evaluated. Patients were then stratified by age, gender, race, religion, educational level and income level to assess whether their own demographics were related to their preferences. The data was then analyzed to determine whether correlations existed between patient preferences and their own demographics. RESULTS Five hundred patients agreed to participate in the study. There were 195 (39.0%) males and 281 (56.2%) females with an average age of 40.8 years (SD=20.5), 24 patients (4.8%) did not respond to the question. Two hundred and twelve (42.4%) patients were Caucasian, 116 (23.2%) were Hispanic, 53 (10.6%) were African American, 44 (8.8%) were Asian, 32 (6.4%) were listed as other and 43 (8.6%) did not answer. 78.0% of patients had no preference for their surgeon's gender, but for those who did, both men and woman preferred male surgeons (weak positive correlation, not statistically significant, r=0.096, p=0.373). The majority of patients (84.8%) had no preference for the race of their surgeon, but those that had a preference tended to prefer surgeons of their own ethnicity (p<0.001). With increasing patient education level, medical school, residency and fellowship training prestige had more importance as a selection criterion. Increasing patient education level also demonstrated a corresponding importance given to physician education and training as categorized by the perception of residency training program prestige (p=0.04). A majority of patients (84.0%) had no preference for their surgeon's religion, but for those who did there was a strong correlation (r=0.65), between the patients' own religion and that of the physician (p<0.001). There was universal agreement in perception that neither physician age nor years in practice made any difference as selection criteria when choosing an orthopaedic surgeon (p>0.05). Finally patient income level had no effect on specific criteria when choosing a surgeon. CONCLUSION The vast majority of patients surveyed had no preference in age, gender, race, or religion of their potential surgeon. However, patients who had preferences in these categories tended to choose surgeons of the same age, race and religion. These findings neither support or refute the need for diverse health care providers in the field of orthopaedics.
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Affiliation(s)
| | | | | | - Raj Karia
- Hospital for Joint DiseasesNYU Langone Medical CenterNew York, N.Y.
| | - Donna Phillips
- Hospital for Joint DiseasesNYU Langone Medical CenterNew York, N.Y.
| | - Kenneth A Egol
- Hospital for Joint DiseasesNYU Langone Medical CenterNew York, N.Y.
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Spiritual support of cancer patients and the role of the doctor. Support Care Cancer 2013; 22:1333-9. [DOI: 10.1007/s00520-013-2091-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 12/05/2013] [Indexed: 01/01/2023]
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King SDW, Dimmers MA, Langer S, Murphy PE. Doctors' attentiveness to the spirituality/religion of their patients in pediatric and oncology settings in the Northwest USA. J Health Care Chaplain 2013; 19:140-64. [PMID: 24070435 DOI: 10.1080/08854726.2013.829692] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research indicates that spirituality/religion is important to many patients and they want this to be an integrated component of their care. This study's aim was to better understand doctors' attentiveness to patients'/families' spiritual/religious concerns and the contributing factors for this in the Northwest USA as well as doctor's attitudes about referrals to chaplains. Study participants included 108 pediatricians and oncologists who completed an online self-report questionnaire regarding their beliefs about the health relevance of patients' spirituality/religion and their attentiveness to this. Few doctors routinely addressed this concern. Doctors who were Christian, did not expect negative reactions to inquiring, and were knowledgeable regarding chaplains were more likely to address spirituality/religion. Doctors who felt less adequate in addressing spirituality/religion and were concerned about patients negative reactions were less likely to value referral to chaplains. On the other hand, those who had an understanding regarding chaplains were more likely to support referral.
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Lucchetti G, de Oliveira LR, Koenig HG, Leite JR, Lucchetti ALG. Medical students, spirituality and religiosity--results from the multicenter study SBRAME. BMC MEDICAL EDUCATION 2013; 13:162. [PMID: 24314327 PMCID: PMC4029451 DOI: 10.1186/1472-6920-13-162] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 12/02/2013] [Indexed: 05/15/2023]
Abstract
BACKGROUND To evaluate the relationship between spirituality/religiosity (S/R) and the attitudes, beliefs and experiences of medical students in Brazil with respect to S/R in their undergraduate training and clinical practice. METHODS SBRAME (Spirituality and Brazilian Medical Education) is a multicenter study involving 12 Brazilian medical schools with 5950 medical students (MS). Participants completed a questionnaire that collected information on socio-demographic data and S/R in their undergraduate training and practice. RESULTS Of all MS, 3630 participated in the survey (61.0%). The sample was 53.8% women and the mean age was 22.5 years. The majority of MS believed that spirituality has an impact on patients' health (71.2%) and that this impact was positive (68.2%). The majority also wanted to address S/R in their clinical practice (58.0%) and considered it relevant (75.3%), although nearly one-half (48.7%) felt unprepared to do so. Concerning their training, most MS reported that they had never participated in a "spirituality and health" activity (81.0%) and that their medical instructors had never or rarely addressed this issue (78.3%). The majority also believed that they should be prepared to address spiritual issues related to the health of their patients (61.6%) and that this content should be included in the medical curriculum (62.6%). CONCLUSION There is a large gap between MS attitudes and expectations and the S/R training that they are receiving during their undergraduate training. The majority of MS surveyed believe that patients should have their beliefs addressed and that these beliefs could have important effects on their health and the doctor-patient relationship. These results should stimulate discussion about the place that S/R training should have in the medical curriculum.
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Affiliation(s)
- Giancarlo Lucchetti
- Federal University of Juiz de Fora, Juiz de Fora, Brazil
- Brazilian Medical Spiritist Association, Rua Dona Elisa, 150 apto 153B, São Paulo, Brazil
| | | | - Harold G Koenig
- Duke University Medical Center, Durham, North Carolina, USA
- King Abdulaziz University, Jeddah, Saudi Arabia
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Ellis MR, Thomlinson P, Gemmill C, Harris W. The spiritual needs and resources of hospitalized primary care patients. JOURNAL OF RELIGION AND HEALTH 2013; 52:1306-1318. [PMID: 22311475 DOI: 10.1007/s10943-012-9575-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Previous studies have recognized the importance of hospitalized primary care patients' spiritual issues and needs. The sources patients consult to address these spiritual issues, including the role of their attending physician, have been largely unstudied. We sought to study patients' internal and external resources for addressing spiritual questions, while also exploring the physician's role in providing spiritual care. Our multicenter observational study evaluated 326 inpatients admitted to primary care physicians in four midwestern hospitals. We assessed how frequently these patients identified spiritual concerns during their hospitalization, the manner in which spiritual questions were addressed, patients' desires for spiritual interaction, and patient outcome measures associated with spiritual care. Nearly 30% of respondents (referred to as "R/S respondents") reported religious struggle or spiritual issues associated specifically with their hospitalization. Eight-three percent utilized internal religious coping for dealing with spiritual issues. Chaplains, clergy, or church members visited 54% of R/S respondents; 94% found those visits helpful. Family provided spiritual support to 45% of R/S respondents. Eight percent of R/S respondents desired, but only one patient actually received, spiritual interaction with their physician, even though 64% of these patients' physicians agreed that doctors should address spiritual issues with their patients. We conclude that inpatients quite commonly utilize internal resources and quite rarely utilize physicians for addressing their spiritual issues. Spiritual caregiving is well received and is primarily accomplished by professionals, dedicated laypersons, or family members. A significantly higher percentage of R/S patients desire spiritual interaction with their physician than those who actually receive it.
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Affiliation(s)
- Mark R Ellis
- Cox Family Medicine Associates, 3850 S. National Ave., Ste 520, Springfield, MO, 65807, USA,
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Vermandere M, Bertheloot K, Buyse H, Deraeve P, De Roover S, Strubbe L, Van Immerseel I, Vermandere S, Voss M, Aertgeerts B. Implementation of the ars moriendi model in palliative home care: A pilot study. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x12y.0000000048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Berg GM, Crowe RE, Budke G, Norman J, Swick V, Nyberg S, Lee F. Kansas physician assistants' attitudes and beliefs regarding spirituality and religiosity in patient care. JOURNAL OF RELIGION AND HEALTH 2013; 52:864-876. [PMID: 21922428 DOI: 10.1007/s10943-011-9532-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Research indicates patients want to discuss spirituality/religious (S/R) beliefs with their healthcare provider. This was a cross-sectional study of Kansas physician assistants (PA) regarding S/R in patient care. Surveys included questions about personal S/R beliefs and attitudes about S/R in patient care. Self-reported religious respondents agreed (92%) they should be aware of patient S/R; 82% agreed they should address it. Agreement with incorporating S/R increased significantly based on patient acuity. This research indicates Kansas PAs' personal S/R beliefs influence their attitudes toward awareness and addressing patient S/R.
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Affiliation(s)
- Gina M Berg
- Wesley Medical Center, Trauma Services, Wichita, KS 67214, USA.
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Lucchetti G, Bassi RM, Lucchetti ALG. Taking Spiritual History in Clinical Practice: A Systematic Review of Instruments. Explore (NY) 2013; 9:159-70. [DOI: 10.1016/j.explore.2013.02.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Indexed: 11/28/2022]
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Karches KE, Chung GS, Arora V, Meltzer DO, Curlin FA. Religiosity, spirituality, and end-of-life planning: a single-site survey of medical inpatients. J Pain Symptom Manage 2012; 44:843-51. [PMID: 22727947 PMCID: PMC3459155 DOI: 10.1016/j.jpainsymman.2011.12.277] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 12/03/2011] [Accepted: 12/14/2011] [Indexed: 11/25/2022]
Abstract
CONTEXT Prior studies suggest that terminally ill patients who use religious coping are less likely to have advance directives and more likely to opt for heroic end-of-life measures. Yet, no study to date has examined whether end-of-life practices are associated with measures of religiosity and spirituality. OBJECTIVES To assess the relationship between general measures of patient religiosity and spirituality and patients' preferences for care at the end of life. METHODS We examined data from the University of Chicago Hospitalist Study, which gathers sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center. Primary outcomes were whether the patient had an advance directive, a do-not-resuscitate (DNR) order, a durable power of attorney for health care, and an informally designated decision maker. Primary predictors were religious attendance, intrinsic religiosity, and self-rated spirituality. RESULTS The sample population (n=8308) was predominantly African American (73%) and female (60%). In this population, 1.5% had advance directives and 10.4% had DNR orders. Half (51%) of the patients had specified a decision maker. White patients were more likely than African American patients to have an advance directive (odds ratio [OR] 2.1; 95% CI 1.1-4.0) and a DNR order (OR 1.7; 95% CI 1.0-2.9). Patients reporting high intrinsic religiosity were more likely to have specified a decision maker than those reporting low intrinsic religiosity (OR 1.3; 95% CI 1.1-1.6). The same was true for those with high compared with low spirituality (OR 1.3; 95% CI 1.1-1.5). Religious characteristics were not significantly associated with having an advance directive or DNR order. CONCLUSION Among general medicine inpatients at an urban academic medical center, those who were highly religious and/or spiritual were more likely to have a designated decision maker to help with end-of-life decisions but did not differ from other patients in their likelihood of having an advance directive or DNR order.
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Affiliation(s)
- Kyle E Karches
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois 60637-5415, USA.
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Cordella M. Negotiating religious beliefs in a medical setting. JOURNAL OF RELIGION AND HEALTH 2012; 51:837-853. [PMID: 20838895 DOI: 10.1007/s10943-010-9393-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This manuscript studies in detail, following a discourse analytical approach, medical consultations in which a patient's religious belief does not allow blood transfusion to be administered. The patient is a young Jehovah's Witness suffering myeloid leukaemia who is being treated in a Catholic cancer hospital where the practice of blood transfusion forms part of the standard protocol to treat the disease. The consultations under analysis take place in a Chilean cancer clinic where mainly the oncologist and a Jehovah's Witness Representative (JWR) present discuss and negotiate expert information on the substitute methods to be used. The exchange dynamics of the consultations differ from the usual visits where the medical knowledge and expertise is primarily in the hands of the medical practitioner. In these encounters, the JWR shares vital information with the oncologist providing the basis of the treatment to be used. This shifting of the balance of power-which could have been a cause of tension in the visit and a contributing factor in the disruption of communication-has instead brought light to the encounter where the negotiated treatment has been achieved with relative ease. The patient's future is in the hands of the oncologist and the JWR, and their successful negotiation of treatment has made it possible to cater for the particular needs of a JW patient. Sharing different medical practices has not been an obstacle, but an opportunity to find out ways to deliver equity access and well-informed practices to a non-conventional patient.
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Affiliation(s)
- Marisa Cordella
- School of Languages, Cultures and Linguistics, Faculty of Arts Monash University, Building 11, Clayton Campus, Clayton, VIC, 3800, Australia.
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Polzer Casarez RL, Engebretson JC. Ethical issues of incorporating spiritual care into clinical practice. J Clin Nurs 2012; 21:2099-107. [DOI: 10.1111/j.1365-2702.2012.04168.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cobb M, Dowrick C, Lloyd-Williams M. What can we learn about the spiritual needs of palliative care patients from the research literature? J Pain Symptom Manage 2012; 43:1105-19. [PMID: 22575720 DOI: 10.1016/j.jpainsymman.2011.06.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 06/22/2011] [Accepted: 06/26/2011] [Indexed: 12/12/2022]
Abstract
CONTEXT Spirituality is a distinctive subject within palliative care practice and literature, but research to date is relatively undeveloped in this field and studies often throw more light on conceptual and methodological issues than producing reliable data for clinical practice. OBJECTIVES To determine what is known about the spiritual needs of palliative care patients from the evidence presented in published research. METHODS Specialist online databases were interrogated for primary empirical studies of patients with a chronic disease unresponsive to curative treatment. Studies that only used a proxy for the patient or reported expert opinion were excluded. Each study was critically appraised for quality and the strength of its evidence to determine if any data could be pooled. RESULTS Thirty-five studies were identified, equating to a total of 1374 patients. Study populations were typically people with advanced-stage cancer, older than 60 years, who were English speaking, and with a Christian or Jewish religious affiliation, reflecting the predominance of Anglo-American studies. Studies fell into two groups: those that investigated the nature of spiritual experience and those that examined the relationship of spirituality with other phenomena. The evidence was insufficiently homogeneous to pool. CONCLUSION Relevant accounts of what spirituality means for palliative care patients and evidence of how it operates in the lives of people with life-limiting disease can be derived from research. Studies to date are limited by reductive representations of spirituality and the conduct of research by health professionals within health care communities demarcated from disciplines and interpretive traditions of spirituality.
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Affiliation(s)
- Mark Cobb
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK.
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Taylor D, Mulekar MS, Luterman A, Meyer FN, Richards WO, Rodning CB. Spirituality within the patient-surgeon relationship. JOURNAL OF SURGICAL EDUCATION 2011; 68:36-43. [PMID: 21292214 DOI: 10.1016/j.jsurg.2010.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 07/09/2010] [Accepted: 08/26/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To assess the attitudes of general and orthopaedic surgical outpatients regarding inquiry into their religious beliefs, spiritual practices, and personal faith. DESIGN Prospective, voluntary, self-administered, and anonymously-completed questionnaire, regarding religious beliefs, spiritual practices, and personal faith, March-August, 2009. SETTING General and orthopaedic surgical outpatient settings, Health Services Foundation, College of Medicine, University of South Alabama, a tertiary care academic medical center in Mobile, Alabama. PARTICIPANTS All patients referred for evaluation and management of general and orthopaedic surgical conditions, pre- and postoperatively, were approached. METHODOLOGY The questionnaire solicited data regarding patient: (1) demographics; (2) religious beliefs, spiritual practices, and personal faith; and (3) opinions regarding inquiry into those subjects by their surgeon. The latter opinions were stratified on a 5-point Likert scale ranging from "strongly disagree" to "strongly agree." Statistical analysis was conducted using software JMP(®) 8 Statistical Discovery Software (S.A.S. Institute Inc., Cary, North Carolina) and a 5% probability level was used to determine significance of results. RESULTS Eighty-three percent (83%) of respondents agreed or strongly agreed that surgeons should be aware of their patients' religiosity and spirituality; 63% concurred that surgeons should take a spiritual history; and 64% indicated that their trust in their surgeon would increase if they did so. Nevertheless, 17%, 37%, and 36% disagreed or strongly disagreed with those perspectives, respectively. CONCLUSIONS By inference to the best explanation of the results, we would argue that religiosity and spirituality are inherent perspectives of patient-surgeon relationships. Consequently, those perspectives are germane to the therapeutic milieu. Therefore, discerning each patient's perspective in those regards is warranted in the context of an integrative and holistic patient-surgeon relationship, the intent of which is to restore a patient to health and well-being.
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Affiliation(s)
- Dan Taylor
- Department of General Surgery, College of Medicine and Medical Center, University of South Alabama, Mobile, Alabama, USA
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Hilbers J, Haynes AS, Kivikko JG. Spirituality and health: an exploratory study of hospital patients' perspectives. AUST HEALTH REV 2010; 34:3-10. [DOI: 10.1071/ah09655] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 02/24/2009] [Indexed: 11/23/2022]
Abstract
The relationship between spirituality/religion and health is receiving increasing academic interest, but few studies have explored the experience of Australians. This paper presents data from an exploratory survey of patients and families in a public teaching hospital in Sydney. The findings show that the majority of hospital service users: •believe there are links between spirituality/religion and health; •believe that rituals and customs can help people when they are sick/suffering; •have valued practices associated with their beliefs; •feel it is helpful for health staff to know their patients’ beliefs; •are willing to be asked about their beliefs; or •want hospital staff to respect and support the beliefs and practices of all patients. Spirituality and religion, and the beliefs and practices associated with them, were found to be eclectic, individualised and evolving in response to life events such as loss and health crises. This paper concludes that a person-centred framework of health practice includes attention to the religious/spiritual dimension of patients and their families. What is known about the topic?There is a rapidly developing body of research that demonstrates an increasing awareness of the important links between religion and health, but is limited in Australian application. What does this paper add?This paper provides contextually relevant qualitative and quantitative data on patient perspectives, including how patients wish to be treated by health staff in relation to their beliefs and practices. The Australian perspective also provides a valuable counterpoint to US-dominated research in the global community. What are the implications for practitioners?The research findings indicate that practitioners need to recognise and respond to the role of religious and spiritual beliefs and practices in patients’ health journeys. The discussion suggests some practical ways of doing this which sit comfortably within the patient-centred approach.
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Seccareccia D, Brown JB. Impact of Spirituality on Palliative Care Physicians: Personally and Professionally. J Palliat Med 2009; 12:805-9. [DOI: 10.1089/jpm.2009.0038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dori Seccareccia
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Canada
| | - Judith Belle Brown
- Department of Family Medicine, University of Western Ontario, London, Ontario, Canada
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Taylor EJ, Mamier I, Bahjri K, Anton T, Petersen F. Efficacy of a self-study programme to teach spiritual care. J Clin Nurs 2008; 18:1131-40. [PMID: 19207790 DOI: 10.1111/j.1365-2702.2008.02526.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVES This study investigated the efficacy of a self study programme designed to teach nurses about how to talk with patients about spirituality, and to identify factors predicting this learning. Furthermore, the study investigated whether there were differences in learning between students and practicing clinicians, and between those in a religious or non-religious institution. BACKGROUND Although USA and UK accrediting bodies mandate nurses learn how to assess and support patient spiritual health, there is a paucity of evidence to guide educators regarding how to teach spiritual care to nurses. Indeed, it is unknown if aspects of spiritual care can be taught using formal approaches. DESIGN A pretest-posttest pre-experimental design was used to study how attitude toward spiritual care, ability to create empathic verbal responses to expressed spiritual pain, personal spiritual experience, and knowledge about communication for spiritual caregiving changed from before to after programme completion. METHODS Study participants, 201 nursing students and RNs, independently completed the mailed self-study programme (i.e. workbook with supplemental DVD) and self-report study instruments (i.e. Daily Spiritual Experience Scale, Spiritual Care Perspective Scale-Revised, Response Empathy Scale, Communicating for Spiritual Care Test, and Information about You form). RESULTS Significant differences were seen between the before and after scores measuring attitude, ability, spiritual experience, and knowledge. An interaction effect of time between students and registered nurses for both spiritual care attitude and personal spiritual experience was observed. CONCLUSIONS Findings suggest learning occurred for both students and RNs, regardless of whether they were at a religious institution or not. Relevance to clinical practice. These data indicate that this self-study programme was an effective approach to teach nurses about how to converse with patients about spirituality.
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Pembroke NF. Appropriate spiritual care by physicians: a theological perspective. JOURNAL OF RELIGION AND HEALTH 2008; 47:549-559. [PMID: 19093681 DOI: 10.1007/s10943-008-9183-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
It is argued that when spiritual care by physicians is linked to the empirical research indicating the salutary effect on health of religious beliefs and practices an unintended degradation of religion is involved. It is contended that it is much more desirable to see support for the patient's spirituality as part of holistic care. A proposal for appropriate spiritual care by physicians is offered.
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Affiliation(s)
- Neil Francis Pembroke
- The School of History, Philosophy, Religion, and Classics, The University of Queensland, Forgan Smith Building, St. Lucia, Brisbane, QLD 4072, Australia.
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Pembroke NF, Pembroke JJ. The spirituality of presence in midwifery care. Midwifery 2008; 24:321-7. [PMID: 17275972 DOI: 10.1016/j.midw.2006.10.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 09/13/2006] [Accepted: 10/19/2006] [Indexed: 11/28/2022]
Abstract
The quality of the relationship between the midwife and the woman is widely acknowledged to be of vital importance in pregnancy and childbirth. The authors argue that presence is the spiritual strength that enables midwives to fully actualise their relational capacity. Presence describes a special way of being there or being with the other person. In order to develop its meaning fully, reference is made to the concepts of responsibility (Martin Buber) and availability (Gabriel Marcel). Responsibility indicates a deep capacity to respond to the needs people have to be heard, understood, respected, and, when it is required, helped and supported. Availability refers to the willingness of a person to give of herself for the sake of others. The aim of this paper is to offer a fresh perspective on the nature of caring midwifery through the use of these unique perspectives on genuine presence. The research method used is an integration of the philosophical reflections with relevant personal reports from women. These reports have been gathered from the research of others.
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Affiliation(s)
- Neil F Pembroke
- School of History, Philosophy, Religion, and Classics, Forgan Smith Building, University of Queensland, St. Lucia, 4072, Australia.
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Patients’ Perception of Physician-Initiated Prayer Prior to Elective Ophthalmologic Surgery. South Med J 2008; 101:138-41. [DOI: 10.1097/smj.0b013e3181612128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hughes Halbert C, Barg FK, Weathers B, Delmoor E, Coyne J, Wileyto EP, Arocho J, Mahler B, Malkowicz SB. Differences in cultural beliefs and values among African American and European American men with prostate cancer. Cancer Control 2007; 14:277-84. [PMID: 17615534 DOI: 10.1177/107327480701400311] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although cultural values are increasingly being recognized as important determinants of psychological and behavioral outcomes following cancer diagnosis and treatment, empirical data are not available on cultural values among men. This study evaluated differences in cultural values related to religiosity, temporal orientation, and collectivism among African American and European American men. METHODS Participants were 119 African American and European American men who were newly diagnosed with early-stage and locally advanced prostate cancer. Cultural values were evaluated by self-report using standardized instruments during a structured telephone interview. RESULTS After controlling for sociodemographic characteristics, African American men reported significantly greater levels of religiosity (Beta = 24.44, P < .001) compared with European American men. African American men (Beta = 6.30, P < .01) also reported significantly greater levels of future temporal orientation. In addition, men with more aggressive disease (eg, higher Gleason scores) (Beta = 5.11, P < .01) and those who were pending treatment (Beta = -6.42, P < .01) reported significantly greater levels of future temporal orientation. CONCLUSIONS These findings demonstrate that while ethnicity is associated with some cultural values, clinical experiences with prostate cancer may also be important. This underscores the importance of evaluating the effects of both ethnicity and clinical factors in research on the influence of cultural values on cancer prevention and control.
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