Spiritual needs in health care
BMJ. 2004 July 17; 329(7458): 123–124.
Spiritual needs in health care
May be distinct from religious ones and are integral to palliative care
Spiritual needs change with time and circumstances. The National Institute for Clinical Excellence guidance, Supportive and Palliative Care for Adults with Cancer,
published in March 2004, acknowledges this and recommends that
healthcare teams ensure accurate and timely evaluation of spiritual
issues through regular assessment. This reflects the increasing emphasis
on spirituality as a factor contributing to wellbeing and coping
strategies.1-4
A proliferation of textbooks and book chapters with titles containing
the word “spirituality” seek to elucidate what spiritual care is, how it
might be assessed, and how needs might be met.5 However, a lack of consensus remains as to what spirituality actually is.6
Some
key words occur quite regularly in the various descriptions of
spirituality in journals and textbooks (box). In health research we
should differentiate between the terms spiritual and religious since, if
they are used interchangeably, reports of spirituality may be
describing religious practice and affiliation.7,8
These can be interrelated. Spiritual belief may or may not be
religious, but most religious people will be spiritual. A non-religious
person may still therefore have a deep spirituality and spiritual needs.
Spiritual care is not just the facilitation of an appropriate ritual
but engaging with an individual's search for existential meaning, as
reflected in the existential domain of the McGill quality of life
questionnaire.9
Variables
such as religious practice often seem easier to measure. Where
participants for research have drawn from communities where religious
practice is at high levels, these studies have shown that participating
actively in the life of the faith community seems to lead to better
health profiles. Religion also strengthens people's ability to cope with
life threatening disease,3,6,10 and its importance in predicting aspects of psychosocial need in patients with cancer has been reported.1 These studies are examining religious affiliation and behaviour even though some of them talk about spirituality.
Recently
researchers have begun to look at populations that may not be religious
but claim to have a clear spiritual belief. King et al reported that
71% of people who entered their acute hospital study had an important
spiritual belief, even though many did not express that in a religious
way.8
Other studies confirm this proportion and are beginning to show the
importance of spiritual belief in predicting clinical outcome,8 the management of death distress,11 end of life despair,2 and assessing quality of life in oncology patients.9,12
Evidence
is growing that spiritual belief and religious practice are important
predictive factors for a larger proportion of people entering health
care than previously thought. Many may benefit from support for this
aspect of their life. A need exists for user friendly and brief measures
to assess spiritual need in the absence of religious faith, so that it
may be addressed properly rather than as some general panacea which is
assumed to be good but is not individually tailored. Only in this way
may we “ensure that the spiritual elements of disease are taken into
account,” as recommended in the guidance from NICE.
References
1. McIllmurray
MB, Francis B, Harman JC, Morris SM, Soothill K, Thomas C. Psychosocial
needs in cancer patients related to religious belief. Palliat Med
2003;17: 49-54. [PubMed]
2. McClain CS, Rosenfeld B, Breitbart W. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet
2003;361: 1603-7. [PubMed]
3. Pargament KI, Koenig HG, Perez LM. The many methods of religious coping: development and initial validation of the RCOPE. J Clin Psychol
2000;56: 519-43. [PubMed]
4. Walsh K, King M, Jones L, Tookman A, Blizard R. Spiritual beliefs may affect outcome of bereavement: prospective study. BMJ
2002;324: 1551-6. [PMC free article] [PubMed]
5. Aldridge D. Spirituality, healing and medicine: return to the silence. London: Jessica Kingsley, 2000.
6. Mount BM, Lawlor W, Cassell EJ. Spirituality and health: developing a shared vocabulary. Annals RCPSC
2002;35: 303-7.
7. Speck P. Spiritual issues in palliative care. In: Doyle D, Hanks G, MacDonald M, eds. Oxford textbook of palliative medicine. Oxford: Oxford University Press, 1998: 805-16.
8. King
M, Speck P, Thomas A. The Royal Free interview for spiritual and
religious beliefs: development and validation of a self-report version. Psychol Med
2001;31: 1015-23. [PubMed]
9. Cohen
SR, Mount BM, Bruera E, Provost M, Rowe J, Tong K. Validity of McGill
quality of life questionnaire in the palliative care setting: a
multicentre Canadian study demonstrating the importance of the
existential domain. Palliat Med
1997;11: 3-20. [PubMed]
10. Feher S, Maly RC. Coping with breast cancer in later life: the role of religious faith. Psycho-Oncology
1999;8: 408-416. [PubMed]
11. Chibnall
JT, Videen SD, Duckro PN, Miller DK. Psychosocial-spiritual correlates
of death distress in patients with life-threatening medical conditions. Palliat Med
2002;16: 331-8. [PubMed]
12. Brady MJ, Peterman AH, Fitchett G, Mo M, Cella D. A case for including spirituality in quality of life measurement in oncology. Psycho-Oncology
1999;8: 417-28. [PubMed]
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