Patient perspectives on spirituality and the patient-physician relationship

OBJECTIVE: To identify the preferences and concerns of seriously III patien ts about discussing religious and spiritual beliefs with physicians. DESIGN. Three focus group discussions with patients who had experienced a r ecent life-threatening illness. Discussions were audiotaped, transcribed ve rbatim, and reviewed independently by two investigators to identify discret e comments for grouping into domains. A third investigator adjudicated diff erences in opinion. Comments were then independently reviewed for relevance and consistency by a health services researcher and a pastoral counselor. SETTING: Academic medical center. PARTICIPANTS: Referred sample of 22 patients hospitalized with a recent lif e-threatening illness. MEASUREMENTS AND MAIN RESULTS: Almost all of the 562 comments could be grou ped into one of five broad domains: 1) religiosity/spirituality, 2) prayer, 3) patient-physician relationship, 4) religious/spiritual conversations, a nd 5) recommendations to physicians. God, prayer, and spiritual beliefs wer e often mentioned as sources of comfort, support, and healing. All particip ants stressed the importance of physician empathy. Willingness to participa te in spiritual discussions with doctors was closely tied to the patient-ph ysician relationship. Although divided on the proper context, patients agre ed that physicians must have strong interpersonal skills for discussions to be fruitful. Physician-initiated conversation without a strong patient-phy sician relationship was viewed as inappropriate and as implying a poor prog nosis. CONCLUSION: Religion and spirituality are a source of comfort for many pati ents. Although not necessarily expecting physicians to discuss spirituality , patients want physicians to ask about coping and support mechanisms. This exploratory study suggests that if patients then disclose the importance o f spiritual: beliefs In their lives, they would like physicians to respect these values.