Religion and Spirituality in Primary Care
Religious commitment is intrinsically connected to cultural, mental, spiritual, and societal aspects of wellness, and, thus, should be better recognized by the medical community, whose goal is to provide culturally competent, relationship-centered healthcare. As physicians strive to provide care that is culturally competent and patient-centered, they must be careful to take into account their patients’ deepest human commitments.
This is a summarized version of the full in-depth article on Relias Media.
AUTHORS
Kristin M. Collier, MD, FACP, Clinical Assistant Professor, Internal Medicine; Associate Program Director, Internal Medicine
Residency Program; Director, University of Michigan Medical School Program on Health, Spirituality, and Religion, University of Michigan, Ann Arbor, MI
Cornelius A. James, MD, Clinical Assistant Professor, Michigan Medicine Internal Medicine and Pediatrics, Ann Arbor, MI
PEER REVIEWER
Peter Bath, DMin, Vice President, Missions and Ministry, Kettering Health Network, Huber Heights, OH
Introduction
Religion and spirituality play a significant role in many patients’ lives, influencing their perceptions of health, illness, and care. As healthcare evolves to become more culturally competent and patient-centered, it is crucial for medical providers to consider these dimensions in their care. The Association of American Medical Colleges (AAMC) highlighted this in its 1999 report, urging medical schools to educate students on the importance of spirituality and cultural beliefs in patient care. Religion has historically been linked to healing, with religious organizations founding some of the earliest hospitals in the U.S. Despite this long-standing connection, modern Western medicine often separates the spiritual from the physical, leading to gaps in addressing the holistic needs of patients.
Historical Context and Evolving Perspectives
Spirituality’s role in healthcare has been recognized for centuries, from the establishment of hospitals by religious groups to formal associations between medical societies and religious organizations, such as the American Medical Association’s (AMA) Committee on Medicine and Religion (CMR) in the 1960s and 70s. However, these efforts diminished over time, largely due to internal debates within the medical community. Recently, calls for a more holistic approach to healthcare, one that includes spirituality, have resurfaced, particularly in palliative care and chronic disease management.
The Biopsychosocial-Spiritual Model of Care
George Engle's 1977 biopsychosocial model broadened the scope of care by integrating physical, psychological, and social factors. However, this model did not fully address the spiritual dimensions of health. Cicely Saunders, founder of the modern hospice movement, introduced the concept of "total pain," recognizing that suffering involves physical, psychological, social, and spiritual components. This led to the development of the biopsychosocial-spiritual model, which the World Health Organization (WHO) embraced in its 1999 definition of health as a state of "complete physical, mental, spiritual, and social well-being."
Spirituality’s Impact on Health Outcomes
Religion and spirituality are not only prevalent but have measurable effects on health outcomes. Studies show that regular attendance of religious services is associated with lower risks of all-cause mortality, cardiovascular disease, and cancer. Spiritual practices, such as prayer, have been shown to positively impact mental health by reducing depressive symptoms, anxiety, and suicide risk. Furthermore, in conditions like heart failure and HIV, spiritual well-being correlates with better patient outcomes, such as lower mortality risk and improved quality of life.
Addressing Spiritual and Religious Needs in Healthcare
Despite evidence supporting the role of spirituality in health, healthcare providers often fail to address patients' spiritual needs. Research shows that many patients desire their healthcare providers to inquire about their religious beliefs, particularly during serious illness or end-of-life care. However, many physicians report feeling inadequately trained to handle these conversations.
Several validated tools can help physicians assess spiritual needs, including the FICA tool, which explores Faith, Importance, Community, and Addressing care preferences. The HOPE and SPIRITual tools offer alternative approaches for quick spiritual assessments. Despite these resources, barriers such as time constraints, lack of training, and discomfort with discussing religion prevent many providers from engaging with patients' spiritual concerns.
The Role of Chaplains in Patient Care
Chaplains play a vital role in addressing spiritual distress, particularly in hospital settings. Certified chaplains are trained to provide spiritual care to patients from various religious and philosophical backgrounds. While many physicians believe chaplains are only needed for end-of-life care, chaplains can assist at any stage of illness. Studies show that patients who receive chaplain visits report higher satisfaction with their care, emphasizing the importance of integrating chaplaincy into routine healthcare.
The Importance of Prayer in Patient Care
Prayer is a common coping mechanism for many patients facing illness, with a majority of U.S. adults reporting daily prayer. Some patients may request their physicians to pray with them. Although it is a personal decision for healthcare providers, leading or joining in prayer can be appropriate if initiated by the patient. When participating, providers are encouraged to use nondenominational language to respect the diversity of beliefs.
Religious Accommodation in Healthcare
Respecting patients' religious practices in healthcare settings is essential for culturally competent care. This includes accommodating dietary restrictions, providing space and time for prayer, and integrating religious beliefs into medical decision-making when appropriate. The Joint Commission mandates hospitals to respect patients' cultural and religious values, emphasizing the need for healthcare providers to facilitate these accommodations.
Barriers to Providing Spiritual Care
Despite the clear benefits of addressing spiritual needs, barriers remain. These include a lack of time, inadequate training, and insufficient chaplaincy support in outpatient settings. Most electronic health records (EHRs) do not prompt providers to take a spiritual history, and many healthcare professionals are unsure how to contact chaplains or what services they offer. Furthermore, discomfort with differing religious beliefs can prevent providers from addressing spiritual needs effectively.
Summary
To deliver truly patient-centered care, physicians must consider the spiritual dimensions of their patients’ health. This requires training in spiritual history-taking, increased resources for spiritual care, and an openness to addressing religious concerns. By incorporating spirituality into healthcare, providers can offer more comprehensive, compassionate care that aligns with patients’ deeply held beliefs and values. Overcoming the barriers to spiritual care will require ongoing efforts in medical education, interdisciplinary collaboration, and advocacy for the inclusion of spirituality in healthcare settings.
Read the full in-depth article on Relias Media
We discuss religion, spirituality, and healthcare in more detail and include detailed charts and tables in our full write-up on Relias Media.