What Do Family Physicians Think About Spirituality In Clinical Practice?

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Original Research

What Do Family Physicians Think About Spirituality In Clinical Practice?

J Fam Pract. 2002 March;51(3):249-254

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References

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Methods

We conducted semistructured interviews¹⁵ with 13 family physicians. Participants assessed their frequency of addressing patients’ spiritual issues and provided demographic information and practice characteristics. Interview topics included spirituality in the doctor-patient relationship, the practice of addressing spiritual issues, and perceived facilitators and barriers to discussing spiritual issues. Interviews were conducted by one of the authors (either A.D.B. or D.H.) or by a research assistant trained in qualitative investigation techniques. Interviews averaged 45 minutes in duration.

To guard against bias in advocating a particular stance toward spiritual assessment, we stressed to respondents that we wanted their honest observations and confirmed their statements throughout the interview. Before analyzing the data, we noted our preconceptions toward spiritual assessment. We consciously sought to avoid these biases while reviewing the data.¹⁶ To further reduce the likelihood of bias, we selected a research team whose members represented multiple academic disciplines and religious backgrounds.

Qualitative research aims to uncover new information and perspectives rather than to draw definitive conclusions from a representative study sample.¹⁷ Study participants were deliberately selected¹⁸ to represent a range of demographic factors (sex, age, religious background), practice types (academic or community practice; urban and rural), and practice regarding physicians’ role in addressing patients’ spiritual issues.

All study participants were board-certified family physicians in Missouri. Three participants were white women; 10 were white men. They ranged in age from 37 to 63 years. Three were in full-time community practice; all others were medical school or residency faculty. All but 1 faculty member reported previous community practice experience. Two participants practice in rural locations; 2 in community health centers; 1 in a metropolitan community practice; 4 in metropolitan community-based residency clinics; and 4 in a metropolitan university-based residency clinic. Subjects’ religious affiliations were Jewish (1), Christian (6), “Unitarian Universalist with Muslim leanings” (1), “Unitarian Universalist with Buddhist leanings” (1), “Unitarian” (2), “none” (1), and agnostic (1).

Interviews took place in participants’ offices. We informed them of the use of audiotapes during the telephone recruitment and obtained verbal consent before audiotaping. An Institutional Review Board approved our study.

Study staff transcribed the interviews verbatim. Investigators verified interview content through comparison with interviewers’ notes and entered the text into Ethnograph,¹⁹ a computer database program designed to organize textual material. Investigators used an iterative process to make an initial template for organizing and coding data.²⁰ Our multiple readings of interviews led to further code revisions until consensus was reached regarding salient issues or themes.^21,22 We solicited respondents’ views of the validity of the final codes and themes and of the accuracy of illustrative quotations.

Results

Six respondents reported regularly addressing spiritual issues with patients. One respondent reported an intermediate level of involvement; 6 reported that they do not regularly address spiritual issues. One physician was opposed to physicians’ addressing spiritual issues with patients.

The themes that emerged from the coded interviews were associated with 5 issues: (1) the appropriate role for physicians in addressing spiritual concerns; (2) situations in which physicians focus on spiritual issues (the nature and setting of these discussions); (3) how physicians address spiritual issues; (4) barriers to addressing spiritual issues; and (5) facilitators of spiritual assessment.

Physician’s role

Physicians who regularly discussed spirituality believed that the scientific evidence linking spirituality and positive health outcomes justified their actions. One study participant stated, “Every physician ought to be dealing with [patients’] spiritual issues. [For example,] how can you justify not talking about spirituality to a patient with depression when you can prove scientifically that strengthening faith commitment helps them? It really comes down to a quality of care issue.”

Some respondents believed that the primacy of spirituality in life provided a justification for addressing spiritual issues with patients. As one stated, “These values . . . get at the core of who you are. I would hope that I would be respectful and supportive” [whether or not I was a physician].

The respondents universally viewed themselves as supportive resources for patients through listening, validating spiritual beliefs, and remaining with patients during times of need. One expressed that healing occurs as physicians and patients connect as people, stating, “I don’t have to be a spiritual master. I can be a human being, trying to connect with another human being. That is a healing experience.”

Although several participants seldom addressed spiritual matters, only one strongly opposed the initiation of such discussions, out of concern about role definition and invasion of patients’ privacy. This participant felt that spiritual matters were “no more in the physician’s domain than questions regarding patients’ finances or their most evil thoughts.”