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Source: Ehman JW, et al. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Arch Intern Med 1999;159:1803-1806.
To examine patient acceptance of asking "Do you have spiritual or religious beliefs that would influence your medical decisions if you become gravely ill?" in the medical history, we conducted a self-administered questionnaire study of 177 ambulatory adult outpatients visiting a pulmonary faculty office practice at a university teaching hospital in 1997. Respondents were 63% white and female, 75% Christian, and had a mean age 52 +/- 16 years.
Ninety percent of respondents believed that prayer may sometimes influence recovery from an illness, and 51% of respondents described themselves as religious. Almost half of respondents (45%) reported that religious beliefs would influence their medical decisions if they became gravely ill; 94% of these individuals agreed or strongly agreed that physicians should ask them whether they have such beliefs, and 45% of the respondents who denied having such beliefs also agreed that physicians should ask about them. Altogether, two thirds of all respondents indicated that they would welcome the study question in a medical history; 16% reported that they would not. Only 15% of the study group recalled having been asked whether spiritual or religious beliefs would influence their medical decisions. Another 15% identified themselves as currently gravely ill.
We conclude that many adult outpatients would welcome a carefully worded inquiry about their spiritual or religious beliefs in the event that they become gravely ill.
As the authors point out, this provocative study from University of Pennsylvania investigators contradicts in part the findings of three earlier studies published in the family medicine literature. Previous investigators asked about the discussion of religious issues in the medical office. The current investigators framed the question in terms of medical decision making and personal values.
The limitations of this study are many—selection bias, lack of follow-up, setting specificity—but its chief benefit is its effort to make explicit the spiritual issues underlying decision making. Clearly, spiritual and religious issues matter deeply to patients: When to use what we learn about spiritual and religious beliefs, and whether and how to put into practice efforts to pray with patients are "how-to" questions that can be carefully asked.
Presenting the question quoted above in a careful, nonjudgmental manner to patients who are chronically ill can do no harm, and will probably help. Integrate it into the Social History part of an initial assessment.