In the ongoing quest to improve patient satisfaction, some experts are encouraging hospitalists to look at a new angle—addressing hospitalized patients' spiritual needs.
The Beryl Institute, a global organization dedicated to improving patient experience, released a white paper on “The Critical Role of Spirituality in Patient Experience” in December 2015. It has become one of the most downloaded papers in the institute's history, said institute president Jason A. Wolf, PhD.
“There is a growing recognition that we must address the humanity in health care today,” Dr. Wolf said.
Although spiritual care—for example, the presence of chaplains—is not new to hospitals, systemic changes may be driving more demand on both the patient and clinician sides, according to Christina Puchalski, MD, MS, FACP, professor of medicine and founder and director of George Washington University's Institute for Spirituality and Health in Washington, D.C.
“Health care can be incredibly impersonal today,” she said. “It can be very mechanized with electronic health records being the place where decisions are made... People by and large can feel very lonely,” she said.
Hospitalists may be uniquely positioned to respond to that need and help patients access spiritual care because they may know their facility and its resources better than any other physician on the team, according to Dr. Wolf.
“Hospitalists can connect with an individual as a representative of that institution and recognize that the people coming to receive care are more than simply someone seeking to be healed as a body. They encompass the human being with mind, body, and spirit,” he said.
What is spiritual care?
Many people think that spiritual care means religion, but that isn't necessarily true, the experts stressed.
“It has to do with those existential questions that every religion tries to address but that even an atheist is going to ask: Why is this happening to me? What happens next? What have I done to deserve this? Some of these questions are just fundamental to the human spirit,” said Rev. Eric Hall, president and CEO of HealthCare Chaplaincy Network, which collaborated on the white paper.
Dr. Wolf said that spiritual care is often about connections. “People ultimately want to be listened to, heard, respected, and understood, in a way that is beyond just being seen as a disease or a body,” he said.
Physicians do not have to be religious or even particularly spiritual to help make sure their patients get spiritual support, said Daniel Sulmasy, MD, PhD, MACP, a professor of medicine and ethics in the department of medicine and the divinity school at the University of Chicago.
“You don't have to accept a patient's religious beliefs in order to know they are important to the patient and respond to them,” he said.
Starting the conversation
Some patients may make their interest in spirituality apparent by putting religious items, such as rosary beads, Shabbat candles, or a Koran, out in their hospital rooms, and hospitalists can use these items to open a conversation, said Dr. Sulmasy.
“I think patients are not only putting those things there for their own purposes, but they are saying something about who they are deeply, and all a clinician has to do in that setting is to recognize that [and] say, ‘Is that the Bible?’” he said. “That has an immediate effect of telling the patient that the clinician has recognized something that is of value and importance to them.”
Hospitalists can also address spirituality by sitting down next to the patient and asking how he or she is doing. “Not ‘How's your potassium doing? How's the cancer doing? How's the pain doing?’ But ‘How are you doing as a person?’ Make that connection and be open to the fact that patients may express their concerns about that in religious language,” said Dr. Sulmasy.
To address the issue more formally, Dr. Puchalski and colleagues created a validated tool for incorporating a brief spiritual screening into history-taking.
The tool follows the acronym FICA. The F stands inquiring about patients' faith and belief: Do they have beliefs that help them cope with difficult times? The I stands for asking how important that is to them: Has their spirituality influenced how they take care of themselves or make health care decisions? The C stands for a faith community: Are they part of a spiritual community, whether a religious community or a group of like-minded friends or relatives? The A stands for address and care: How can the physician address the things that the patient named?
Even with the tool, initiating such conversations can be intimidating, acknowledged Kevin Massey, MDiv, vice president for mission and spiritual care at Advocate Lutheran General Hospital in Park Ridge, Ill., and a contributor to the white paper.
As an example, he described how a physician once told him that when she was starting her career, she felt awkward asking about sexual history. She eventually overcame that as she realized it can be an important part of someone's health. Doing spiritual screenings initially gave her the same awkwardness, but as she saw how it yielded valuable insights into her patients, it became easier.
If patients do share spiritual concerns, hospitalists do not have to try to solve their problems right then, as they may not have the time or the specific skills to do so. Instead, they can say something like, “I'm so glad that you have been able to begin to share this with me. Would you mind if I told our chaplain about what you shared and asked them to come by and talk to you, because I think it may be really very helpful?” Dr. Sulmasy said.
Making that connection is worth the effort because many patients would never ask for a chaplain visit otherwise. “Sometimes, it's only the physician who can elicit those spiritual needs and make the referral,” he said.
Hospitalists may also be well placed to make other accommodations to spiritual needs. For example, he said, Muslim communities often value having many people in a patient's room to pray. A hospitalist can recognize that this is important and perhaps work to relax the restrictions on number of visitors.
Dr. Sulmasy also noted that while spirituality can be complementary to medical care, it can also pose challenges, such as an HIV patient deciding not to take his antiretroviral medication because he thinks the disease is a punishment from God. A clinician who asks a few spiritual questions may be the first person to uncover that and can then take steps to help the patient better cope with the illness, he said.
Attending to such issues is part of providing well-rounded health care, the experts agreed. “It's not about spirituality in isolation,” said Dr. Puchalski. “It's also not physical symptoms in isolation. We have to think about a whole-person interview.”