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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

Background

The multidisciplinary Pastoral Care Team of the HUP Department of Pastoral Care began this project with three central questions:
  1. Do patients have spiritual/religious beliefs that may affect their medical decision making, especially in circumstances of grave illness?
  2. Do patients want a physician to ask whether they have such beliefs?
  3. Would such an inquiry by a physician strengthen the physician-patient relationship, especially regarding trust.
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.

Results

Among our results, we found that a majority of our population described themselves as religious (on a 5-point scale, ranging from [1]: "not religious," to [5]: "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).

Implications

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.

Publication

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.]