National surveys consistently support the idea that religion and spirituality are important to most individuals in the general population. More than 90% of adults express a belief in God, and slightly more than 70% of individuals surveyed identified religion as one of the most important influences in their lives.[1] Research indicates that patients commonly rely on spirituality and religion to help them deal with serious physical illnesses, expressing a desire to have specific spiritual and religious needs and concerns acknowledged or addressed by medical staff. A survey of hospital inpatients found that 77% of patients reported that physicians should take patients' spiritual needs into consideration, and 37% wanted physicians to address religious beliefs more frequently.[2] A pilot study of 14 African American men with a history of prostate cancer found that most had discussed spirituality and religious beliefs with their physicians; they would also like their doctors and clergy to be in contact with each other.[3]

This summary will review the following topics:

• How religion and spirituality can be usefully conceptualized within the medical setting.
• The empirical evidence for the importance of religious and spiritual factors in adjustment to illness in general, and cancer in particular.
• The range of assessment approaches that may be useful in a clinical environment.
• Various models for management and intervention.
• Resources for clinical care.

Paying attention to the religious or spiritual beliefs of seriously ill patients has a long tradition within inpatient medical environments. Addressing such issues has been viewed as the domain of hospital chaplains or a patient’s own religious leader. In this context, systematic assessment has usually been limited to identifying a patient’s religious preference; responsibility for management of apparent spiritual distress has been focused on referring patients to the chaplain service.[4-6] While healthcare providers may address such concerns themselves, they are generally very ambivalent about doing so,[7] and there has been relatively little systematic investigation addressing the physician’s role. These issues, however, are being increasingly addressed in medical training.[8]

Interest in and recognition of the function of religious and spiritual coping in adjustment to serious illness, including cancer, has been growing.[9-11] New ways to assess and address religious and spiritual concerns as part of overall quality of life are being developed and tested. Limited data support the possibility that spiritual coping is one of the most powerful means by which patients draw on their own resources to deal with a serious illness such as cancer; however, patients and caregivers may be reluctant to raise religious and spiritual concerns with family members and their health care providers.[12-14] Increased spiritual well-being in a seriously ill population may be linked with lower anxiety about death.[15] Given the importance of religion and spirituality to patients, integrating systematic assessment of such needs into medical care, including outpatient care, is crucial. The development of better assessment tools will make it easier to consider which aspects of religious and spiritual coping may be important in a particular patient's adjustment to illness.

Of equal importance is the consideration of how and when to address religion and spirituality with patients and the best ways to do so in different medical environments.[16-18] Although addressing spiritual concerns is often considered an end-of-life issue, such concerns may arise at any time after diagnosis.[12] Acknowledging the importance of these concerns and addressing them, even briefly, at diagnosis may facilitate better adjustment throughout the course of treatment and create a context for richer dialogue later in the illness.

References

1. Gallup GH Jr: Religion In America 1996: Will the Vitality of the Church Be the Surprise of the 21st Century? Princeton, NJ: Princeton Religion Research Center, 1996. 
   
   
2. King DE, Bushwick B: Beliefs and attitudes of hospital inpatients about faith healing and prayer. J Fam Pract 39 (4): 349-52, 1994.  [PUBMED Abstract]
   
   
3. Bowie J, Sydnor KD, Granot M: Spirituality and care of prostate cancer patients: a pilot study. J Natl Med Assoc 95 (10): 951-4, 2003.  [PUBMED Abstract]
   
   
4. Zabora J, Blanchard CG, Smith ED, et al.: Prevalence of psychological distress among cancer patients across the disease continuum. Journal of Psychosocial Oncology 15 (2): 73-87, 1997. 
   
   
5. Fitchett G, Meyer PM, Burton LA: Spiritual care in the hospital: who requests it? Who needs it? J Pastoral Care 54 (2): 173-86, 2000 Summer.  [PUBMED Abstract]
   
   
6. Handzo G: Where do chaplains fit in the world of cancer care? J Health Care Chaplain 4 (1-2): 29-44, 1992.  [PUBMED Abstract]
   
   
7. Kristeller JL, Zumbrun CS, Schilling RF: 'I would if I could': how oncologists and oncology nurses address spiritual distress in cancer patients. Psychooncology 8 (5): 451-8, 1999 Sep-Oct.  [PUBMED Abstract]
   
   
8. Puchalski C, Romer AL: Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med 3(1): 129-137, 2000. 
   
   
9. Pargament KI: The Psychology of Religion and Coping: Theory, Research, Practice. New York, NY: Guilford Press, 1997. 
   
   
10. Koenig HG: Spirituality in Patient Care: Why, How, When, and What. Philadelphia, Pa: Templeton Foundation Press, 2002. 
    
    
11. Koenig HG, McCullough ME, Larson DB: Handbook of Religion and Health. New York, NY: Oxford University Press, 2001. 
    
    
12. Murray SA, Kendall M, Boyd K, et al.: Exploring the spiritual needs of people dying of lung cancer or heart failure: a prospective qualitative interview study of patients and their carers. Palliat Med 18 (1): 39-45, 2004.  [PUBMED Abstract]
    
    
13. McCullough ME, Hoyt WT, Larson DB, et al.: Religious involvement and mortality: a meta-analytic review. Health Psychol 19 (3): 211-22, 2000.  [PUBMED Abstract]
    
    
14. Jenkins RA, Pargament KI: Religion and spirituality as resources for coping with cancer. Journal of Psychosocial Oncology 13 (1/2): 51-74, 1995. 
    
    
15. Chibnall JT, Videen SD, Duckro PN, et al.: Psychosocial-spiritual correlates of death distress in patients with life-threatening medical conditions. Palliat Med 16 (4): 331-8, 2002.  [PUBMED Abstract]
    
    
16. Post SG, Puchalski CM, Larson DB: Physicians and patient spirituality: professional boundaries, competency, and ethics. Ann Intern Med 132 (7): 578-83, 2000.  [PUBMED Abstract]
    
    
17. Sloan RP, Bagiella E, VandeCreek L, et al.: Should physicians prescribe religious activities? N Engl J Med 342 (25): 1913-6, 2000.  [PUBMED Abstract]
    
    
18. Dagi TF: Prayer, piety and professional propriety: limits on religious expression in hospitals. J Clin Ethics 6 (3): 274-9, 1995 Fall.  [PUBMED Abstract]
    
    

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