Testing Options

Exploring Religion and Spirituality with Clients in Health Care Settings

Research reports find a generally positive relation between religiosity and both physical and mental health, including reduced depression and stress, lower blood pressure, lower levels of pain, and higher likelihood of surviving cardiac surgery (Cohen et al., 2000). Providers have additional reasons to take patients’ religious and spiritual beliefs into account when patients consider these beliefs to be important to their health care decisions, and patients want to discuss them with providers in that context. In general, patients want health care providers to address their spirituality. In one study, 65% of patients felt that it was good for doctors to speak to them about their spiritual beliefs, yet only 10% said a doctor had this type of conversation with them (Puchalski, 2001). Patients may feel that trust in their physician would be strengthened, and that these discussions are warranted especially in the event of serious illness. Puchalski (2001) notes several valuable benefits to understanding a patient’s spirituality:

  • Spirituality may be a dynamic in the patient’s understanding of disease.

  • Religious convictions may affect health care decision making.

  • Spirituality may be a patient need and may be important in patient coping.

  • An understanding of the patient’s spirituality is integral to whole patient care.

The Joint Commission for Accreditation of Healthcare Organizations (JCAHO) recognizes the importance of spirituality in health care settings. JCAHO policy states: “For many patients, pastoral care and other spiritual services are an integral part of health care and daily life. The hospital is able to provide for pastoral care and other spiritual services for patients who request them.” A hospital chaplain or access to pastoral services is included within the standards for accreditation of all hospitals (JCAHO, 1999). According to the JCAHO, a spiritual assessment should be performed on every patient to identify “at a minimum” the patient’s denomination, beliefs, and spiritual practices. Genetic counselors working within hospital systems should therefore be able to identify the institutional standards and resources for pastoral care and spiritual services. Knowing about these overarching institutional resources is a first step. Genetic counselors should also consider how religion and spirituality are addressed within their genetics clinics and genetics departments. In a study of genetic counseling patients, Fick et al. showed that discussion of spirituality is more important to, and comfortable for, patients who identify themselves as “spiritual” than those who do not (2006). This study underscores the need to assess the importance of religion and spirituality with every genetic counseling client.

Genetic counselors may address religion in a limited, structured manner within the prescribed clinic intake forms and routine protocols. Asking the question, “What is your religion?” may seem straightforward, but it is not advised. This blunt question may alienate clients who are atheist, agnostic, or who follow a form of personal spirituality (Tanenbaum, 2009). Or, perhaps this scenario sounds familiar: “We ask all patients if they have any Jewish ancestry since there are certain genetic conditions that are more common when an individual is from a Jewish background.” This approach is also not advised. It confines assessment of religion to a narrow and very specific genetic risk factor that tells the counselor he/she should further investigate the family history (i.e., consider Jewish genetic diseases and/or carrier testing). This approach marginalizes the complex cultural and psychosocial information that may be present.

As an alternative to assessing religion through questionnaires or routine questions, genetic counselors can approach the discussion from a less structured general exploration of the role of religion and spirituality in the client’s health care. However, this can be an uncomfortable subject for the provider for many reasons. There may be uncertainty about whether the client’s religion would make any difference to his/her health care. Providers may avoid discussions of religion and spirituality because they fear their personal beliefs may conflict with the client’s beliefs. Lastly, health care providers may not raise the topic of religion due to the uncertain consequences and sensitive topics that may follow.

Reis et al., 2007 surveyed 127 full members of the NSGC to explore spiritual assessment practices and reactions to a spiritual assessment tool. Fewer than 8.7% of the counselors in this study assessed spirituality in more than half of their genetic counseling sessions. Anderson (2002) states: “My experience as a prenatal genetic counselor has led me to believe that most caregivers are sympathetic to the spiritual dimensions of pregnancy complications, but are uncertain how to broach the topic with their patients. Rather than risking offense, they say nothing, and patients may make the mistaken assumption that their caregivers are indifferent or hostile to their beliefs.” Therefore, it is important for genetic counselors to know about available spiritual and religious assessment tools. These tools are meant to help the provider understand the importance of religion and spirituality for the client. They also help the client appreciate the relevance of his/her religious and spiritual beliefs to the health care condition, issue or decision under discussion.

“The standard assessment of coping and support systems provides a natural lead-in to inquiry regarding spiritual resources” (Reis, 2007). Spiritual assessment complements a careful psychosocial history (Puchalski & Romer, 2000). “Spirituality and religious beliefs are embedded in culture” (Fukuyama & Sevig, 2002). “In the management of pregnancy complications, the best interests of the patients often will be embedded in spiritual issues” (Anderson, 2002). Pargament, 2007, p. 203 defines a ‘process’ of spiritual assessment, which includes setting the stage for spiritual dialogue, initial spiritual assessment, implicit spiritual assessment, and explicit spiritual assessment. Counselor knowledge about religion and spirituality, self-assessment, and communicating openness to learning and sharing with clients are key components to facilitating this process.

 

 

 

 

 

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