Ƶ

Object moved to here.

Spirituality in Serious Illness and Health | Health Care Quality | JAMA | Ƶ

Ƶ

[Skip to Navigation]
Sign In
1.
Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care: reaching national and international consensus. J Palliat Med. 2014;17(6):642-656. doi:
2.
Ferngren GB. Medicine and Religion: A Historical Introduction. Johns Hopkins University Press; 2014.
3.
Pew Research Center. Religious Landscape Study. Accessed August 4, 2021.
4.
Gallup. How religious are Americans? Published December 23, 2021. Accessed February 4, 2022.
5.
Oman D. Defining religion and spirituality. In: Paloutzian RF, Park CL, eds. Handbook of the Psychology of Religion and Spirituality. Guilford Press; 2013:23-47.
6.
Hill PC, Pargament KI, Hood RW Jr, et al. Conceptualizing religion and spirituality: points of commonality, points of departure. J Theory Soc Behav. 2000;30(1):51-77. doi:
7.
Bussing A, ed. Spiritual Needs in Research and Practice: The Spiritual Needs Questionnaire as a Resource for Health and Social Care. Palgrave McMillian; 2021:1-5. doi:
8.
Puchalski C, Ferrell B, Virani R, et al. Improving the quality of spiritual care as a dimension of palliative care: the report of the Consensus Conference. J Palliat Med. 2009;12(10):885-904. doi:
9.
Institute of Medicine Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press; 2001.
10.
Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness Method User’s Manual. RAND Corp; 2001.
11.
Sterne JAC, Hernan MA, McAleenan A, Reeves BC, Higgins JPT. Assessing risk of bias in a non-randomized study. In: Higgins JPT, Thomas J, Chandler J, et al, eds. Cochrane Handbook for Systematic Reviews of Interventions Version 6.2. Cochrane; February 2021:chap 25.
12.
Murphy MK, Black NA, Lamping DL, et al. Consensus development methods, and their use in clinical guideline development. Health Technol Assess. 1998;2(3):i-iv, 1-88. doi:
13.
Malterud K. Qualitative research: standards, challenges, and guidelines. Գ. 2001;358(9280):483-488. doi:
14.
Selman L, Harding R, Gysels M, Speck P, Higginson IJ. The measurement of spirituality in palliative care and the content of tools validated cross-culturally: a systematic review. J Pain Symptom Manage. 2011;41(4):728-753. doi:
15.
Chida Y, Steptoe A, Powell LH. Religiosity/spirituality and mortality: a systematic quantitative review. Psychother Psychosom. 2009;78(2):81-90. doi:
16.
Garssen B, Visser A, Pool G. Does spirituality or religion positively affect mental health? meta-analysis of longitudinal studies. Int J Psychol Relig. 2021;31(1):4-20. doi:
17.
VanderWeele TJ. Effects of religious service attendance and religious importance on depression: examining the meta-analytic evidence. Int J Psychol Relig. 2021;31(1):21-26. doi:
18.
Mishra S, Gupta R, Bhatnagar S, et al. The COVID-19 pandemic: a new epoch and fresh challenges for cancer patients and caregivers-a descriptive cross-sectional study. Support Care Cancer. 2022;30(2):1547-1555. doi:
19.
Şahan S, Yıldız A. Determining the spiritual care requirements and death anxiety levels of patients diagnosed with COVID-19 in Turkey. J Relig Health. 2022;61(1):786-797. doi:
20.
Shiba K, Cowden RG, Gonzalez N, et al. Associations of online religious participation during COVID-19 lockdown with subsequent health and well-being among UK adults. Psychol Med. Published online February 22, 2022. doi:
21.
Balboni TA, Paulk ME, Balboni MJ, et al. Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. J Clin Oncol. 2010;28(3):445-452. doi:
22.
Johnson JR, Engelberg RA, Nielsen EL, et al. The association of spiritual care providers’ activities with family members’ satisfaction with care after a death in the ICU. Crit Care Med. 2014;42(9):1991-2000. doi:
23.
Delgado-Guay MO, Chisholm G, Williams J, Frisbee-Hume S, Ferguson AO, Bruera E. Frequency, intensity, and correlates of spiritual pain in advanced cancer patients assessed in a supportive/palliative care clinic. Palliat Support Care. 2016;14(4):341-348. doi:
24.
National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care, 4th Edition. Published 2018. Accessed July 20, 2021.
25.
Balboni TA, Balboni M, Enzinger AC, et al. Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life. Ѵ Intern Med. 2013;173(12):1109-1117. doi:
26.
Balboni TA, Vanderwerker LC, Block SD, et al. Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. J Clin Oncol. 2007;25(5):555-560. doi:
27.
Puchalski C, Romer AL. Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med. 2000;3(1):129-137. doi:
28.
Koenig HG. Religion, spirituality, and medicine: application to clinical practice. Ѵ. 2000;284(13):1708. doi:
29.
Balboni MJ, Sullivan A, Enzinger AC, et al. Nurse and physician barriers to spiritual care provision at the end of life. J Pain Symptom Manage. 2014;48(3):400-410. doi:
30.
VanderWeele TJ, Balboni TA, Koh HK. Religious service attendance and implications for clinical care, community participation, and public health. Am J Epidemiol. 2022;191(1):31-35. doi:
31.
Puchalski CM. The FICA Spiritual History Tool #274. J Palliat Med. 2014;17(1):105-106. doi:
32.
Puchalski C, Jafari N, Buller H, Haythorn T, Jacobs C, Ferrell B. Interprofessional spiritual care education curriculum: a milestone toward the provision of spiritual care. J Palliat Med. 2020;23(6):777-784. doi:
33.
Sulmasy DP. Spiritual issues in the care of dying patients: “…it’s okay between me and God”. Ѵ. 2006;296(11):1385-1392. doi:
34.
Koenig HG, Hooten EG, Lindsay-Calkins E, Meador KG. Spirituality in medical school curricula: findings from a national survey. Int J Psychiatry Med. 2010;40(4):391-398. doi:
35.
Koenig HG, Perno K, Erkanli A, Hamilton T. Effects of a 12-month educational intervention on clinicians’ attitudes/practices regarding the screening spiritual history. South Med J. 2017;110(6):412-418. doi:
36.
VanderWeele TJ. Religion and health: a synthesis. In: Balboni MJ, Peteet JR, eds. Spirituality and Religion Within the Culture of Medicine: From Evidence to Practice. Oxford University Press; 2017:357-401.
37.
Koenig H, Koenig HG, King D, Carson VB. Handbook of Religion and Health. Oxford University Press; 2012.
38.
Oman D, ed. Why Religion and Spirituality Matter for Public Health: Evidence, Implications, and Resources. Springer; 2018. doi:
39.
Idler EL, ed. Religion as a Social Determinant of Public Health. Oxford University Press; 2014. doi:
40.
Haneuse S, VanderWeele TJ, Arterburn D. Using the E-value to assess the potential effect of unmeasured confounding in observational studies. Ѵ. 2019;321(6):602-603. doi:
41.
United Health Foundation. Health Disparities Report 2021. Published 2021. Accessed June 16, 2022.
Views 18,296
Special Communication
ܱ12, 2022

Spirituality in Serious Illness and Health

Author Affiliations
  • 1Departments of Radiation Oncology and Psychosocial Oncology and Palliative Care, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
  • 2Harvard Medical School, Boston, Massachusetts
  • 3Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 4Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts
  • 5Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 6Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, California
  • 7Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois
  • 8Departments of Psychiatry and Behavioral Sciences and Medicine, Duke University Medical Center, Duke University, Durham, North Carolina
  • 9Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
  • 10The George Washington Institute for Spirituality and Health, Departments of Medicine and Health Care Sciences, George Washington University, Washington, DC
  • 11Division of Palliative Medicine, Department of Medicine, Duke University Medical Center, Duke University, Durham, North Carolina
  • 12Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
  • 13Kennedy Institute of Ethics, Departments of Medicine and Philosophy and the Pellegrino Center for Clinical Bioethics, Georgetown University, Washington, DC
  • 14John F. Kennedy School of Government, Harvard University, Boston, Massachusetts
JAMA. 2022;328(2):184-197. doi:10.1001/jama.2022.11086
Key Points

Question How can considerations of spirituality guide health care and health outcomes?

Findings A systematic review and a multidisciplinary Delphi panel assessed the evidence regarding spirituality and health, developed 16 evidence statements, and offered 6 implications regarding incorporation of spirituality in the care of patients with serious illness and in health outcomes.

Meaning This systematic review and process, based on the highest-quality evidence available and expert review, led to consensus-suggested implications for how to address spirituality in serious illness and health outcomes.

Abstract

Importance Despite growing evidence, the role of spirituality in serious illness and health has not been systematically assessed.

Objective To review evidence concerning spirituality in serious illness and health and to identify implications for patient care and health outcomes.

Evidence Review Searches of PubMed, PsycINFO, and Web of Science identified articles with evidence addressing spirituality in serious illness or health, published January 2000 to April 2022. Independent reviewers screened, summarized, and graded articles that met eligibility criteria. Eligible serious illness studies included 100 or more participants; were prospective cohort studies, cross-sectional descriptive studies, meta-analyses, or randomized clinical trials; and included validated spirituality measures. Eligible health outcome studies prospectively examined associations with spirituality as cohort studies, case-control studies, or meta-analyses with samples of at least 1000 or were randomized trials with samples of at least 100 and used validated spirituality measures. Applying Cochrane criteria, studies were graded as having low, moderate, serious, or critical risk of bias, and studies with serious and critical risk of bias were excluded. Multidisciplinary Delphi panels consisting of clinicians, public health personnel, researchers, health systems leaders, and medical ethicists qualitatively synthesized and assessed the evidence and offered implications for health care. Evidence-synthesis statements and implications were derived from panelists’ qualitative input; panelists rated the former on a 9-point scale (from “inconclusive” to “strongest evidence”) and ranked the latter by order of priority.

Findings Of 8946 articles identified, 371 articles met inclusion criteria for serious illness; of these, 76.9% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for serious illness: (1) incorporate spiritual care into care for patients with serious illness; (2) incorporate spiritual care education into training of interdisciplinary teams caring for persons with serious illness; and (3) include specialty practitioners of spiritual care in care of patients with serious illness. Of 6485 health outcomes articles, 215 met inclusion criteria; of these, 66.0% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for health outcomes: (1) incorporate patient-centered and evidence-based approaches regarding associations of spiritual community with improved patient and population health outcomes; (2) increase awareness among health professionals of evidence for protective health associations of spiritual community; and (3) recognize spirituality as a social factor associated with health in research, community assessments, and program implementation.

Conclusions and Relevance This systematic review, analysis, and process, based on highest-quality evidence available and expert consensus, provided suggested implications for addressing spirituality in serious illness and health outcomes as part of person-centered, value-sensitive care.

×