{"id":42312,"date":"2014-03-25T15:26:35","date_gmt":"2014-03-25T19:26:35","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&#038;p=42312"},"modified":"2014-03-28T00:29:38","modified_gmt":"2014-03-28T04:29:38","slug":"the-next-big-patient-centered-initiative-spiritual-care","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2014\/03\/25\/the-next-big-patient-centered-initiative-spiritual-care\/","title":{"rendered":"The Next Big Patient-Centered Initiative: Spiritual Care"},"content":{"rendered":"<p><!--[if gte mso 9]><xml>\n<o:officedocumentsettings>\n<o:relyonvml><\/o:relyonvml>\n<o:allowpng><\/o:allowpng>\n<\/o:officedocumentsettings>\n<\/xml>< ![endif]--><\/p>\n<p><!--[if gte mso 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class=\"MsoNormal\">\u201cLord, I am not worthy to receive you\u2026,\u201d my mother says as she offers the Eucharist, a wafer of unleavened bread consecrated by a Roman Catholic priest, to a frail 80-year-old woman who lies in her hospital bed. Terminal lung cancer and pneumonia have sapped the woman of her strength, but she can still muster the ritual response.<\/p>\n<p class=\"MsoNormal\">\u201cBut only say the word,\u201d she whispers faintly, \u201cand my soul shall be healed.\u201d The woman parts her dry lips and expectantly opens her mouth, where my mother places the wafer.<\/p>\n<p class=\"MsoNormal\">\u201cPlease,\u201d my mother says gently, \u201clet it dissolve on your tongue before you swallow.\u201d The woman complies, a mixture of relief and contentment on her face.<\/p>\n<p class=\"MsoNormal\">This patient\u2019s desire to have this rite performed (and thereby, as her faith tells her, enter heaven in a state of purity) was so strong that she asked her family members to seek out my mother, and she pointedly requested an early swallow evaluation in preparation.<\/p>\n<p class=\"MsoNormal\">Spirituality will play an increasing role in the patient-centered healthcare model of the future, even though many providers are unaware of this trend. It will be difficult to ignore religion in healthcare settings, given data like these:<\/p>\n<ul>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21292214\">83% of surgery patients surveyed in Alabama<\/a> want their surgeons to be aware of their religion and spirituality, and 64% would be more likely to trust a surgeon who takes a spiritual history of his or her patients.<\/li>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15335136\">72% of 921 surveyed Ohioans<\/a> believe that a spiritual discussion with their doctor would increase physician-patient understanding.<\/li>\n<li>The <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21720904\">32% of University of Chicago Medical Center inpatients<\/a> who reported having a discussion with a healthcare team member about religious and spiritual concerns were more likely than other patients to be highly satisfied with their care, whether or not they had initially desired such a discussion (41% did want the discussion initially).<\/li>\n<\/ul>\n<p class=\"MsoNormal\">The response from the healthcare profession has been mixed. In 2002, prayer was \u201cthe most commonly used complementary and alternative medical treatment in the United States,\u201d and a full 43% of 31,044 people surveyed throughout the U.S. have reported praying for health reasons (<span class=\"sb-authors\">Barnes\u00a0et al<\/span><span class=\"sb-contribution\">. <em>Advance Data <\/em><\/span><em><\/em><span class=\"sb-date\">2004;<\/span><span class=\"sb-pages\"> 1<\/span>). Of course, a 2007 <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10796350\">Cochrane review on intercessory prayer<\/a> showed a lack of benefit relative to standard care alone. One of the included trials assessed the benefit of prayer when the recipient was unaware of the intercessory act, a study design that some observers might consider insulting even if well-intended.<\/p>\n<p class=\"MsoNormal\">I think it\u2019s time for the medical community to lead a patient-centered initiative rather than be dragged into one. Ezekiel Emanuel\u2019s advocacy for end-of-life (EOL) discussions and early palliative care fell on deaf ears until the economic advantages became clear. Is it surprising, then, that the percentage of the U.S. population who believe that medical professionals should always do everything possible to save a patient\u2019s life has <a href=\"http:\/\/www.pewforum.org\/2013\/11\/21\/views-on-end-of-life-medical-treatments\/\">doubled from 15% to 31%<\/a> between 1990 and 2013? We healthcare professionals also ignored apologizing for our mistakes, a basic human courtesy, until it became <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16776389\">a solution to the \u201cmedical liability crisis.\u201d<\/a><\/p>\n<p class=\"MsoNormal\">Just like EOL discussions and apologizing, understanding your patient\u2019s spiritual beliefs may one day show a quantifiable benefit. All three of these ideas center on communication \u2014 the lifeblood of social relationships. The difficulty in quantifying this resource has led to its exclusion in standard healthcare practice, and it is only being reintroduced in a piecemeal fashion.<\/p>\n<p class=\"MsoNormal\">Indeed, spiritual care is not being fully addressed even in medical fields that consider it to be important. For example, 87% and 80% of oncology nurses and doctors, respectively, <a>surveyed at four Boston academic centers<\/a> believe that spiritual care should be provided at least occasionally, but fewer than 15% of advanced cancer patients reported receiving it from either their nurses or physicians. Also worrisome is that physicians identify lack of time as the most common barrier to spiritual care, but this factor was <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24480531\">not associated with whether the spiritual care<\/a> was given \u2014 the strongest predictor was found to be previous training in spiritual care.<\/p>\n<p class=\"MsoNormal\">Let our professional organizations open up new discussions with all faiths to determine how to best pursue spiritual care for the 21st century. Let us not cede the humanistic high ground to lawyers and hospital administrators.<\/p>\n<p class=\"MsoNormal\">In reflecting on this topic, I\u2019m reminded of a story about a beloved physician, practicing medicine in the 1960s, whose technique for always leaving his patients at ease was to start each encounter by offering and sharing a cigarette with the patient. The ritual action of smoking has a clear beginning and end, and the shared experience seems to stretch the perception of how much time has passed.<\/p>\n<p class=\"MsoNormal\">Maybe instead of a pack of cigarettes, I\u2019ll carry a small book of prayers chosen by a consensus of faith leaders and organizations. I\u2019ll never be capable of engaging a patient in the same way my mother does, but I certainly can say the words, \u201cWould you like me to pray with you?\u201d<\/p>\n<p class=\"MsoNormal\"><b style=\"mso-bidi-font-weight: normal;\">Do you share Nick Bergfeld\u2019s perspective on the importance of spiritual care?<\/b><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Medical student Nick Bergfeld shares his thoughts about a need that many patients have but that medical practice largely neglects.<\/p>\n","protected":false},"author":844,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[643,1231,2211,2210],"class_list":["post-42312","post","type-post","status-publish","format-standard","hentry","category-general","tag-end-of-life-care","tag-patient-centered-care","tag-religion","tag-spirituality"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/42312","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/844"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=42312"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/42312\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=42312"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=42312"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=42312"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}