ReviewDo patients want doctors to talk about spirituality? A systematic literature review
Introduction
Spirituality, when considered in the context of healthcare, can be understood as the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred [1]. It should not be confused with religion, which is the way some people experience spirituality, and thus a subset of human spirituality as a whole. While it is now established that spirituality is important for patient well-being in a wide variety of settings [2], [3], and that spiritual needs should be addressed in healthcare [4], the role of the physician in discussing spirituality with the patient is unclear. Traditionally the chaplain is the designated spiritual carer, but the role of the medical team in spiritual care has been increasingly promoted [5], [6]. This is a result of moves to reintroduce a biopsychosocial–spiritual model of care into medicine [7] and research suggesting that a significant proportion of patients would like their physician to enquire about their spiritual needs [8], [9]. Furthermore, evidence suggests that healthcare is enhanced when the doctor is aware of strongly held religious and spiritual (R/S) beliefs [10]. This knowledge may help the healthcare provider better understand the patient's decision-making and facilitate the process of providing acceptable treatment options [11], [12]. By ignoring R/S issues, we may be separating from patient care what may be the most important part of a person's coping mechanism, integral to their wellbeing and recovery [13].
The prospect of physicians enquiring into the R/S concerns of their patients has raised ethical concerns [14], but these have been countered by support for patient-centered care and increased awareness of the need for cultural and religious diversity amongst patients to be recognized and accommodated in the healthcare setting [15]. However, while it is accepted that many patients are interested in discussing R/S in the medical consultation, the nature of this discussion is not clear and the literature as a whole has not been integrated. This systematic review was undertaken to ascertain the patient perspective regarding the role of the doctor in the discussion of R/S during the medical consultation. To understand both the attitudes of patients and the underlying reasons for them, a mixed qualitative/quantitative synthesis was undertaken.
This review aimed to answer the following research questions from the perspective of patients:
- 1.
Do patients want their doctors to ask them about R/S?
- 2.
How would patients like their doctors to ask them about R/S?
- 3.
Do patients report that doctors currently ask them about R/S and if so, how do doctors ask?
- 4.
Do patients raise the issue of R/S in consultation, and if so, what are the barriers and facilitators, and how do doctors respond when they do?
Section snippets
Search strategy
We conducted a comprehensive systematic search of original research based on content. Preliminary searches revealed that articles addressing the issue of spirituality in healthcare were published in a broad range of journals. To ensure thoroughness, multiple databases were investigated, including journals beyond the standard biomedical literature. These were: MEDLINE, PsycINFO, CINAHL, Embase, Scopus, Web of Science, The Cochrane Library, and ATLA Religion Database. Google Scholar was used as
Character of the literature
Fifty-four studies were included in the review, 15 qualitative and 39 quantitative comprising 12,327 individual patients. (Some patients were part of the sample for more than one paper). Most, 43/54 (79.6%) studies were conducted in USA, with the majority of the remainder in industrialized countries. Study size for qualitative studies ranged from 10 to 102 subjects (median 22), and 14 to 3,141 (median 124) for quantitative studies. Over half the studies (31/54) included patients with
Discussion
Patient perceptions of R/S discussion between doctors and patients have been investigated in many contexts, which enables a more nuanced understanding of its role in healthcare. It is well established that the experience of illness and/or hospitalization is associated with increased spiritual need in many patients [29], [72]. Less clear is what constitutes spiritual care and who should provide it.
In this literature review it was found that patient views on the discussion of R/S in the medical
Conclusion
Patients desire holistic care from their doctors and strong doctor–patient relationships [52]. Physician involvement in R/S discussion enables the provision of better patient care, helps the patient cope with illness, and improves the level of understanding between patient and doctor, promoting trust [8], [35], [41]. Patient preferences regarding spiritual care are mixed. Further research is needed to clarify what constitutes R/S discussion and to help doctors identify those interested. Most
Conflict of interest statement
The authors declare no conflict of interest.
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