Annals of Long Term Care

This article is the third in a series on palliative care in the LTC setting. Part I appeared in the April issue, and Part II appeared in the May issue of the Journal.

Spirituality and religion have been intertwined with medical care throughout history. In the past few decades, increasing emphasis has been placed on the interaction of patients’ belief systems and impact on their physical and mental health. Tools to access spirituality, religious beliefs, and value systems have been developed to help physicians integrate these domains into the realm of medical care. A Consensus Conference sponsored by the Archstone Foundation recently published a report with recommendations for integrating spiritual care and improving palliative care. This brief review offers a step-wise implementation of these recommendations in long-term care. (Annals of Long-Term Care: Clinical Care and Aging 2010;18[7]:28-31)

There was a time in history when medicine and spirituality were one. Before science could help us explain and address illness, our ancestors turned to religion or spirituality for the ultimate answers. Despite the many scientific advances, there remain many unanswerable questions. Physicians are left with the query, “What role does religion and spirituality play in my practice of medicine?”

The accepted definition of spirituality is the personal search for meaning, purpose, and truth in one’s life, while religion is the organized set of beliefs and values one practices.^1-4 If one accepts the premise that all long-term care (LTC) is palliative care, whether there is a designation of terminal illness or not, then spirituality and religion are not just the awakened or intensified concerns of end of life, but a dynamic aspect of everyday life of all patients.⁵

As we age, the meaning or purpose of one’s life takes on developmental importance. Erik Erikson described that in late life one must review life and balance between Integrity and Despair.⁶ From this balance springs the developmental strength of Wisdom. A physician is in a unique position to foster this developmental strength as the patient identifies meaning, purpose, and intrinsic supports available.

The literature has supported that religious beliefs are important to aging individuals, and to medical care in general.^7-10 There are case reports of intense belief systems and seemingly miraculous cures.¹¹ Studies have determined that psychological well-being and depression associated with medical illness may be affected by intrinsic religious beliefs.^12,13 Recent studies continue to demonstrate the importance of religious beliefs in nursing home residents.^14,15

Physicians have been given guidance in spiritual care in medicine, to understand why spirituality is important¹⁶ and to address the need for initiating the conversation of spirituality at the end of life.^17,18 There is increasing regulatory influence recognizing the importance of assessments.¹⁹ To place this in context in this age of expediency, does spirituality and religion need to be included in physicians’ history-taking? As physicians are urged to view pain as a vital sign, are spirituality/religious beliefs also a vital sign?

The lay literature has addressed the growing interest in religion and spirituality. A Time magazine article discussed at length the “biology of belief” and described the study of religion and medicine as a “growth market.”²⁰ A forum of two physicians and a well-known academic hospital chaplain debated the role of the physician in obtaining or using a spiritual history.²¹ When is it appropriate for the physician to use one of the many spiritual history tools? Who is the correct person to complete the spiritual history?