Patient Attitudes Concerning Physician Inquiry
About Spiritual/Religious Beliefs
John W. Ehman, MDiv; Barbara B. Ott, RN, PhD; Thomas H. Short, PhD; Ralph C. Ciampa, STM; and John Hansen-Flaschen, MD
Pastoral Care Research Study Summary and Comment
By John W. Ehman and Ralph C. Ciampa
The multidisciplinary Pastoral Care Team of the HUP Department of Pastoral Care
began this project with three central questions:
We developed a study plan and an 18-item questionnaire, and received the
approval of the University's I.R.B. Next, we tested the questionnaire's
reliability by asking a group of patients to fill it out twice -- the second
time being 2-4 weeks after the first. Statistical analysis showed that the
questionnaire was indeed a reliable instrument (with correlation coefficient
of > 0.7). We then gave the questionnaire to our target population: a
consecutive group of 214 patients from the HUP Outpatient Pulmonary Clinic. The
process to this point took the Research Team approximately 20 months.
- Do patients have spiritual/religious beliefs that may affect their medical
decision making, especially in circumstances of grave illness?
- Do patients want a physician to ask whether they have such beliefs?
- Would such an inquiry by a physician strengthen the physician-patient
relationship, especially regarding trust.
Among our results, we found that a majority of our population described themselves
as religious (on a 5-point scale, ranging from : "not religious," to :
"very religious," 87% rated themselves in the range of 3-5) and 90% said that
they believed that prayer may sometimes influence recovery from illness. Regarding
our core questions, 45% of respondents indicated that they did have
spiritual/religious beliefs that would affect their decision making if they became
gravely ill, 22% had no particular opinion on the subject, and 33% said that they
did not hold such medically pertinent beliefs. However, when asked whether they
would want a physician to inquire about the possible presence of medically pertinent
spiritual/religious beliefs, 66% of all respondents indicated that they did
desire a physician's inquiry (including about half of those patients
who said that they didn't hold such spiritual/religious beliefs in the first place),
and only 18% indicated to the contrary.
Chi square analysis identified these relationships in the data to be statistically
significant (p < 0.001).
Studies have shown that physicians do not typically ask patients about
spiritual/religious beliefs that may affect medical decision making and that
may thus be appropriate to the physician-patient relationship. Our study
suggests that this potentially overlooked part of a patient's value system
may be pertinent to the process of medical decision making in a large
percentage of cases and that a physician's inquiry here may be welcomed by
many patients, even if those patients may not hold such spiritual/religious beliefs.
Our results would seem to encourage a carefully worded inquiry by physicians,
perhaps along the lines of: "Do you have any spiritual/religious beliefs that
may affect your medical decisions?" The generalizability of our results is
limited, but the data suggest that further exploration by means of our
questionnaire is warranted.
Results from this study have been published as an article, "Do Patients Want Physicians To Inquire About Their Spiritual/Religious
Beliefs If They Become Gravely Ill," in The Archives of Internal Medicine 159, no. 15
(August 9/23, 1999): 1803-6. [Click here for a list journal
articles and books that reference the study.]