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ss triple helix - Summer 2003,  Spirituality and health

Spirituality and health

Elizabeth Croton asks if doctors should enquire about their patients' spiritual beliefs?

Patients entering hospital experience a variety of emotions and utilise differing coping mechanisms to help them. One such mechanism is the presence of a personal religious faith.[1] Increasingly, it is recognised that faith and hope are valuable adjuncts to the healing process.[2,3] Yet there has not been much research on doctors' roles in patients' spiritual affairs. Research carried out in a pulmonary outpatient department indicated that 94% of patients would welcome physician enquiry into such issues but only 15% had ever had experience of this.[4] Physicians themselves report varying approaches to spiritual assessment but they affirmed that spiritual discussion should be approached with sensitivity and integrity.[5]


I carried out an 11-point interviewer-directed questionnaire survey to determine participants' religious backgrounds, practices and views regarding physician enquiry into their spiritual beliefs. South Birmingham Local Research Ethics Committee approval was obtained. Hospital inpatients on acute wards in a Birmingham teaching hospital were randomly selected (using the PAS computer database system) for inclusion into the study between August and November 2001. Patients who lacked sufficient mental capacity to answer the questions posed were excluded. No patient refused to take part.


The group of 43 patients was 53% female, 58% over 60 years of age and 98% white European. 63% said they were Christian but 56% never attended church and only 18% attended weekly. 77% believed in God, but only 56% believed in life after death. 81% had never had a doctor enquire about their religious beliefs, but 67% felt it was perfectly appropriate for doctors to do so and 44% felt that doctors should pray with patients. Only 28% felt it was inappropriate for doctors to share their own religious beliefs if asked by the patient.

The demographic data reflected the demography of the Selly Oak area of Birmingham. Compared with a recent national census, the percentage of participants declaring themselves as 'Christian' was relatively small.[6] The small sample size arose because of time constraints and delay in obtaining ethics committee approval. Consequently, I did not perform statistical analysis.


Spirituality has been defined as 'a quality that goes beyond religious affiliation, that strives for inspirations, reverence, awe, meaning and, purpose, even in those that do not believe in any god'.[7] It has been argued that all individuals have a unique personal spirituality, irrespective of religious orientation.

Traditionally, spiritual care has been perceived as a nursing role.[8] Indeed, British nurse education has long acknowledged the importance of addressing spiritual issues in patient care.[9] Interestingly through, over three quarters of nurses surveyed felt that spiritual care was best provided by a multidisciplinary team including a physician.[10]

There is little data on physicians' roles in their patients' spiritual affairs. Reasons for this are unclear. Research amongst nurses has shown a number of barriers to spiritual care provision: lack of knowledge of other religious faiths, time shortage, fear of personal prejudices.[11] It is possible that these issues apply to medical staff as well. However, a survey carried out amongst American family physicians revealed that the vast majority felt that doctors could address religious issues with patients; 37% had prayed with patients and 89% of these felt that that it had been of some help.[12]

The issue of physicians sharing their own religious faith with patients is more contentious. Concerned that doctors could abuse their authority and force personal beliefs onto vulnerable patients, there has been much debate amongst medical organisations of late.[13] The GMC have considered the matter: 'The Council has hitherto taken the view that the profession of personal opinions or faith is not of itself improper and that the Council could intervene only where there was evidence that a doctor had failed to provide an adequate standard of careā€¦it would not be right to try to prevent doctors from expressing their personal religious, political or other views to patients'.[14] In this study, half of the patients would have welcomed such discussion.


Spirituality appears to be an important issue amongst hospital inpatients. Whilst not guaranteeing recovery from illness, spiritual beliefs act as coping mechanisms for hospitalised patients through illness. Medical staff should be aware of this dimension to healthcare provision and endeavour to consider the spiritual needs of patients under their care. It is imperative that spiritual discussions between doctor and patient are broached sensitively and with the patient's consent. This study adds to the literature by suggesting that many patients feel it appropriate for doctors to share their own religious beliefs and even pray with consenting patients. I am planning another larger study and encourage other CMF members to consider doing the same.

  1. Culliford L. Spirituality and clinical care. BMJ 2002: 325;1434-35
  2. Hay D et al. Understanding the spirituality of people who don't go to church: a report on the findings of the adults' spirituality project. Nottingham: University of Nottingham, 2000
  3. Roberts JA et al. Factors influencing views of patients with gynaecological cancer about end-of-life decisions. Am J Obstetr Gynecol 1997; 176:166-72
  4. Eham JW et al. Do patients want physicians to enquire about their spiritual or religious beliefs if they become gravely ill? Arch Inter Med 1999; 159(15):1083-86
  5. Ellis JW et al. What do family physicians think about spirituality in clinical practice? J Fam Pract 2002; 51(3):249-54
  6. Office of Population, Censuses and Surveys. Census 2001 - Ethnicity and religion in England and Wales. London: OPCS, 2001
  7. Murray RB et al. Nursing Concepts for Health Promotion. London: Prentice Hall, 1989
  8. McSherry W. Nurses' perceptions of spirituality and spiritual care. Nursing Stand 1998; 13:36-40
  9. United Kingdom Central Council for Nursing, Midwifery and Health Visiting. Project 2000 - A New Preparation for Practice. London: UKCC, 1986
  10. McSherry W. Art cit
  11. Ibid
  12. Koenig HG et al. Physician perspectives of religion in the physician-older patient relationship. J Fam Pract 1989; 45:441-48
  13. Hayes D. Doctors warned against preaching to patients. Hospital Doctor 2002; 2 May:7
  14. GMC Annual Report. Doctors' use of professional standing to promote personal interests or beliefs. London: GMC, 1993:4
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