Original Article

Patients’ Views About Discussing Spiritual Issues With Primary Care Physicians

Authors: Mark R. Ellis, MD, MSPH, James D. Campbell, Phd

Abstract

Objectives: The authors sought to explore patients’ views about discussing spiritual issues with primary care physicians, including perceived barriers to and facilitators of discussions.


Methods: The study was a qualitative, semistructured interview of 10 chronically or terminally ill patients who were deliberately selected to represent a range of demographic factors (religious background, age, sex). We coded each interview and evaluated interviews for themes through content analysis.


Results: Themes included rationale for addressing spiritual issues; prerequisites for these discussions; roles in spiritual discussions; principles of spiritual assessment; and barriers to and facilitators of spiritual discussions. Patients justified spiritual assessment on the basis of importance of spirituality in life and health. They asserted that patients must feel honored and respected by their physician to risk discussing spiritual issues. They affirmed that physicians are helpful when legitimizing their spiritual concerns. Citing physicians’ neglect of spirituality as a barrier, they affirmed that spiritual assessment in the context of other life issues facilitates spiritual discussions.


Conclusions: Patients’ willingness to discuss spiritual issues may depend on their sense of physicians’ respect for their spiritual views, attitudes about spiritual health, and qualities of openness and approachability.


Key Points


* Respondents justified spiritual assessment on the basis of the primary importance of spirituality in life, and the positive impact of a spiritual focus on patients’ health.


* Patients may need to feel honored and respected by their physician to risk bringing up spiritual issues in clinical settings.


* Patient perception that a physician is uninterested in or hostile to spiritual matters may constitute a major barrier to discussing spiritual health issues.


* Asking spiritual health questions over time, in the context of other important questions about a patient’s life, may facilitate discussions of patients’ spiritual questions and views.

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