The spiritual history

The importance of a patient’s spirituality on the course of a disease and the ability to cope with that disease was mentioned last month.  The key to understanding that spirituality can be found in the Spiritual Assessment or Spiritual History.

Donald M. Friedman, MD
Donald M. Friedman, MD

Developed at The George Washington Institute for Spirituality and Health (GWish) at George Washington Medical Center in Washington, DC by Dr. Christina Puchalski and her collaborators, Drs. Daniel Sulmasy, Dale Matthews, and Joan Feno, the Spiritual History enables a physician, nurse, pastoral care provider or social worker to understand a patient’s spiritual beliefs, values, and backround and then to develop a care plan that would be appropriate for the patient’s treatment.  This can be done in a relatively short period of time, such as five minutes, an obvious advantage in the time-pressured environment of today’s medical practice.

The format of the Spiritual History is remembered by the abbreviation FICA:

F is for Faith, Belief, and Meaning

I is for Importance and Influence

C is for Community

A is for Address in Care

The questions regarding Faith, Belief, and Meaning center around whether the patient considers him/herself spiritual or religious and whether the patient has spiritual beliefs that help cope with stress.  If one does not regard him/herself as spiritual or has no spiritual beliefs, then the patient should be asked what gives his/her life meaning.  Remember that a person does not have to be religious to have spiritual beliefs.  Spiritual meaning may also be found in relationship to family, friends, work, nature, art, music, hobbies, or any activities that provide connection and comfort.  And these spiritual beliefs and values can be helpful to a patient in time of stress by providing outlets to cope with that stress or a foundation to rely on when everything else is uncertain.

Alternatively, some spiritual beliefs and outlooks may be a source of stress and complicate the illness and interfere with treatment and recovery.  For example, a patient who regards his disease as a deserved punishment might refuse beneficial treatment.  Another important benefit of the Faith, Belief, and Meaning questions is that they enable the patient to tell something about his/her life story in a relatively short period of time and indicate that the physician or other healthcare provider is interested in the patient as a person, not as just a disease.  The answers to these questions can create a therapeutic connection between the physician, nurse, chaplain, or social worker and the patient by also providing helpful understanding of the patient’s needs, coping skills, vulnerabilities, and strengths.  This in turn leads to more patient-centered care.

The importance of spiritual beliefs and practices to the patient and the influence they may have should also be explored.  Are they strong enough to be a source of strength in a time of stress?  Can they help a patient cope with an illness more effectively?  One’s spirituality can give insight into having a disease and a framework that influences how one thinks about the disease.  This can lead to a calmer approach to working toward recovery.   Also, how one maintains health and well being may be strongly influenced by the strength of one’s spirituality.  And finally, spiritual beliefs can have a significant influence on one’s medical decision making such as agreeing to and participating in medical treatment or deciding on such complex issues as end of life care and advance directives.

Whether a patient belongs to a community or not is part of the Spiritual History.  This can be a religious or spiritual community or simply a group of people who are important to the patient and for whom the patient has strong positive feelings.  Frequently, the community involved is either a church, synagogue, or mosque or it may be the patient’s family or a group of friends with whom the patient shares a common interest.  A community can be very effective in getting things done for the patient or giving emotional, loving, and caring support when it is needed.

Finally, it is important for the physician and healthcare team to address the patient’s spiritual concerns and put a plan in action that would meet the patient’s spiritual needs.  Sometimes the fact that the physician is present for the patient and acknowledges these needs can be therapeutic in itself.  If the spiritual issues are more complex and interfere with the patient’s wellness or treatment or cause spiritual distress, referral to a chaplain or spiritual counselor is certainly indicated.  Sometimes practices such as prayer, meditation, yoga, chanting, art, or music may be transformational.  But whatever the choices or plan, the patient’s spiritual beliefs and values should be respected and incorporated into the treatment plan.  It is imperative that the professionals on the healthcare team should never impose their own personal beliefs or values on the patient, but instead constantly respect those of the patient.

The concept of a Spiritual History is relatively new.  While it is a more widely taught approach in medical schools these days, the physician may not chose to use it, and the patient may hesitate to bring up spiritual issues and values because of both a belief they are not significant in medical care and a conception that the physician may not be interested anyway.  But one must be one’s own advocate in the medical world today, and a patient has the right to discuss his/her spirituality and spiritual needs and concerns.  It can give perspective on the meaning of your life, especially when faced with an illness, and encourage your physician to treat you as a whole person.

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