Fast Fact and Concept #19: Taking a Spiritual History

Title: Fast Fact and Concept #19: Taking a Spiritual History

Author(s): Ambuel, B.; Weissman, D.

This Fact Fact and Concept reviews the components of a spiritual history--largely derived from the work of Maugans TA. The SPIRITual History. Arch Fam Med. 5:11-16, 1997.

Illness raises fundamental questions for patients--For what may I hope? Why do I suffer? Does my suffering have meaning? What happens after I die? When a physician stands with a patient as they face death, the physician inevitably plays a role in supporting the patient's inquiry into these fundamental, spiritual questions. In addition some patients have specific preferences or needs regarding medical care, death and dying that are based upon their religious beliefs. The physician often plays an important role in supporting a patient's exploration of these issues. Taking a spiritual history is one way to support the patient in this exploration.

Taking a Spiritual History

S-spiritual belief system

• Do you have a formal religious affiliation? Can you describe this?
• Do you have a spiritual life that is important to you?
• What is your clearest sense of the meaning of your life at this time?

P-personal spirituality

• Describe the beliefs and practices of your religion that you personally accept. Describe those beliefs and practices that you do not accept or follow.
• In what ways is your spirituality/religion meaningful for you?
• How is your spirituality/religion important to you in daily life?

I-integration with a spiritual community

• Do you belong to any religious or spiritual groups or communities?
• How do you participate in this group/community? What is your role?
• What importance does this group have for you?
• In what ways is this group a source of support for you?
• What types of support and help does or could this group provide for you in dealing with health issues?

R-ritualized practices and restrictions

• What specific practices do you carry out as part of your religious and spiritual life (e.g. prayer, meditation, service, etc.)
• What lifestyle activities or practices does your religion encourage, discourage or forbid?
• What meaning do these practices and restrictions have for you?
• To what extent have you followed these guidelines?

I-implications for medical care

• Are there specific elements of medical care that your religion discourages or forbids? To what extent have you followed these guidelines?
• What aspects of your religion/spirituality would you like to keep in mind as I care for you?
• What knowledge or understanding would strengthen our relationship as physician and patient?
• Are there barriers to our relationship based upon religious or spiritual issues?
• Would you like to discuss religious or spiritual implications of health care?

T-terminal events planning

• Are there particular aspects of medical care that you wish to forgo or have withheld because of your religion/spirituality?
• Are there religious or spiritual practices or rituals that you would like to have available in the hospital or at home?
• Are there religious or spiritual practices that you wish to plan for at the time of death, or following death?
• From what sources do you draw strength in order to cope with this illness?
• For what in your life do you still feel gratitude even though ill?
• When you are afraid or in pain, how do you find comfort?
• As we plan for your medical care near the end of life, in what ways will your religion and spirituality influence your decisions?

Questions for personal reflection and discussion:

• Do you feel comfortable discussing spiritual and religious issues with a patient?
• What roles are appropriate for a physician to take in this exploration?
• What roles are inappropriate for a physician to take?

References:

• Maugans TA. The SPIRITual History. Arch Fam Med. 5:11- 16, 1997.
• Ambuel, B & DE Weissman. Discussing spiritual issues and maintaining hope. In DE Weissman & B Ambuel, Improving End-of-Life Care: A Resource Guide for Physician Education, 2nd Edition. Medical College of Wisconsin, Milwaukee, 1999.
• Griffith, JL & ME Griffith. Hope in suffering/pain in health: Talking with patients about spiritual issues. Presented at The Eighteenth Forum for the Behavioral Sciences in Family Medicine, Chicago, Illinois, October, 1997.

Contact: David E. Weissman, MD, FACP Editor, Journal of Palliative Medicine Palliative Care Program Director Medical College of Wisconsin (P) 414-805-4607 (F) 414-805-4608

Copyright Notice: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Weissman, D. Fast Fact and Concepts #19: Taking a Spiritual History. July, 2000. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Creation Date: 7/2000

Format: Handouts

Purpose: Instructional Aid, Teaching

Audience(s)

Training: Fellows, 1st/2nd Year Medical Students, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice

Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery

Non-Physician: Clergy/Chaplains, General Public, Graduate Students, Lawyers, Patients/Families, Nurses, Social Workers

ACGME Competencies: Interpersonal and Communication Skills

Keyword(s): Communications skills, Death pronouncement, Discussing hospice care, Family conference, Giving bad news, Negotiating treatment goals, Personal reflection, Prognosis, Spirituality

The Fast Facts series is distributed for educational use only and does not constitute medical advice. For the most current version of Fast Facts visit the EPERC web site at www.eperc.mcw.edu. This mirror version is provided subject to copyright restrictions for educational use within the Inter-Instutional Collaborating Network on End-of-Life Care (IICN).