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Creating a safe space: A qualitative inquiry into the way doctors discuss spirituality

Published online by Cambridge University Press:  03 November 2015

Megan Best Open the ORCID record for Megan Best [Opens in a new window] ,
Phyllis Butow  and
Ian Olver
Megan Best*
Affiliation:
Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, New South Wales, Australia
Phyllis Butow
Affiliation:
Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, New South Wales, Australia
Ian Olver
Affiliation:
Cancer Council Australia, Sydney, New South Wales, Australia
*
Address correspondence and reprint requests to: Megan Best PoCoG, Level 6 North, Lifehouse C39Z, University of Sydney, New South Wales 2006, Australia. E-mail: megan.best@sydney.edu.au
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Abstract

Objective:

Spiritual history taking by physicians is recommended as part of palliative care. Nevertheless, very few studies have explored the way that experienced physicians undertake this task.

Method:

Using grounded theory, semistructured interviews were conducted with 23 physicians who had experience in caring for advanced cancer patients. They were asked to describe the way they discuss spirituality with their patients.

Results:

We have described a delicate, skilled, tailored process whereby physicians create a space in which patients feel safe enough to discuss intimate topics. Six themes were identified: (1) developing the self: physicians describe the need to understand and be secure in one's own spirituality and be comfortable with one's own mortality before being able to discuss spirituality; (2) developing one's attitude: awareness of the importance of spirituality in the life of a patient, and the need to respect each patient's beliefs is a prerequisite; (3) experienced physicians wait for the patient to give them an indication that they are ready to discuss spiritual issues and follow their lead; (4) what makes it easier: spiritual discussion is easier when doctor and patient share spiritual and cultural backgrounds, and the patient needs to be physically comfortable and willing to talk; (5) what makes it harder: experienced physicians know that they will find it difficult to discuss spirituality when they are rushed and when they identify too closely with a patient's struggles; and (6) an important and effective intervention: exploration of patient spirituality improves care and enhances coping.

Significance of results:

A delicate, skilled, tailored process has been described whereby doctors endeavor to create a space in which patients feel sufficiently safe to discuss intimate topics.

Keywords

SpiritualityNeoplasmsPhysician–patient communicationQualitativeEnd of life
Type
Original Articles
Information
Palliative & Supportive Care , Volume 14 , Issue 5 , October 2016 , pp. 519 - 531
Copyright
Copyright © Cambridge University Press 2015 

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References

REFERENCES

Al-Yousefi, N.A. (2012). Observations of Muslim physicians regarding the influence of religion on health and their clinical approach. Journal of Religion and Health, 51(2), 269–280.Google Scholar
Anandarajah, G. & Hight, E. (2001). Spirituality and medical practice: Using the HOPE questions as a practical tool for spiritual assessment. American Family Physician, 63(1), 81–88.Google Scholar
Arman, M., Rehnsfeldt, A., Lindholm, L., et al. (2002). The face of suffering among women with breast cancer: Being in a field of forces. Cancer Nursing, 25, 96–103.Google Scholar
Asai, M., Morita, T., Akechi, T., et al. (2007). Burnout and psychiatric morbidity among physicians engaged in end-of-life care for cancer patients: A cross-sectional nationwide survey in Japan. Psycho-Oncology, 16(5), 421–428.Google Scholar
Astrow, A.B., Wexler, A., Texeira, K., et al. (2007). Is failure to meet spiritual needs associated with cancer patients' perceptions of quality of care and their satisfaction with care? Journal of Clinical Oncology, 25(36), 5753–5757.Google Scholar
Balboni, M.J., Puchalski, C.M. & Peteet, J.R. (2014 a). The relationship between medicine, spirituality and religion: Three models for integration. Journal of Religion and Health, 53(5), 1586–1598.Google Scholar
Balboni, M.J., Sullivan, A., Enzinger, A.C., et al. (2014 b). Nurse and physician barriers to spiritual care provision at the end of life. Journal of Pain and Symptom Management, 48(3), 400–410.Google Scholar
Balboni, T.A., Vanderwerker, L.C., Block, S.D., et al. (2007). Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. Journal of Clinical Oncology, 25(5), 555–560.CrossRefGoogle ScholarPubMed
Best, M., Butow, P. & Olver, I. (2014). Spiritual support of cancer patients and the role of the doctor. Supportive Care in Cancer, 22(5), 1333–1339.CrossRefGoogle ScholarPubMed
Best, M., Aldridge, L., Butow, P., et al. (2015 a). Treatment of holistic suffering in cancer: A systematic literature review. Palliative Medicine. Epub ahead of print April 20. pii: 0269216315581538.Google Scholar
Best, M., Aldridge, L., Butow, P., et al. (2015 b). Conceptual analysis of suffering in cancer: A systematic review. Psycho-Oncology, 24, 977–986.CrossRefGoogle ScholarPubMed
Best, M., Butow, P. & Olver, I. (2015 c). Doctors discussing religion and spirituality: A systematic literature review. Palliative Medicine. Epub ahead of print August 12. pii: 0269216315600912.Google Scholar
Boston, P., Bruce, A. & Schreiber, R. (2011). Existential suffering in the palliative care setting: An integrated literature review. Journal of Pain and Symptom Management, 41(3), 604–618.CrossRefGoogle ScholarPubMed
Brady, M.J., Peterman, A.H., Fitchett, G., et al. (1999). A case for including spirituality in quality of life measurement in oncology. Psycho-Oncology, 8(5), 417–428.Google Scholar
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London, Sage Publications Limited.Google Scholar
Chibnall, J.T. & Brooks, C.A. (2001). Religion in the clinic: The role of physician beliefs. Southern Medical Journal, 94(4), 374–379.CrossRefGoogle ScholarPubMed
Cobb, M., Puchalski, C.M. & Rumbold, B. (eds.) (2012). Oxford textbook of spirituality in healthcare. Oxford, Oxford University Press.CrossRefGoogle Scholar
Curlin, F.A., Chin, M.H., Sellergren, S.A., et al. (2006). The association of physicians' religious characteristics with their attitudes and self-reported behaviors regarding religion and spirituality in the clinical encounter. Medical Care, 44(5), 446–453.CrossRefGoogle ScholarPubMed
Delgado-Guay, M., de la Cruz, M. & Epner, D. (2013). “I don't want to burden my family”: Handling communication challenges in geriatric oncology. Annals of Oncology, 24(Suppl. 7), vii30–vii35.Google Scholar
Eakin, E.G. & Strycker, L.A. (2001). Awareness and barriers to use of cancer support and information resources by HMO patients with breast, prostate, or colon cancer: Patient and provider perspectives. Psycho-Oncology, 10(2), 103–113.CrossRefGoogle ScholarPubMed
Edwards, A., Pang, N., Shiu, V., et al. (2010). Review: The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: A meta-study of qualitative research. Palliative Medicine, 24(8), 753–770.CrossRefGoogle ScholarPubMed
Ellis, M., Thomlinson, P., Gemmill, C., et al. (2013). The spiritual needs and resources of hospitalized primary care patients. Journal of Religion and Health, 52(4), 1306–1318.CrossRefGoogle ScholarPubMed
Ellis, M.R. & Campbell, J.D. (2005). Concordant spiritual orientations as a factor in physician–patient spiritual discussions: A qualitative study. Journal of Religion and Health, 44(1), 39–53.Google Scholar
Ford, D., Downey, L., Engelberg, R., et al. (2012). Discussing religion and spirituality is an advanced communication skill: An exploratory structural equation model of physician trainee self-ratings. Journal of Palliative Medicine, 15(1), 63–70.CrossRefGoogle ScholarPubMed
Fredriksson, L. & Eriksson, K. (2001). The patient's narrative of suffering: A path to health? Scandinavian Journal of Caring Sciences, 15(1), 3–11.Google Scholar
Frick, E., Riedner, C., Fegg, M., et al. (2006). A clinical interview assessing cancer patients' spiritual needs and preferences. European Journal of Cancer Care, 15(3), 238–243.Google Scholar
Girgis, A., Hansen, V. & Goldstein, D. (2009). Are Australian oncology health professionals burning out? A view from the trenches. European Journal of Cancer, 45(3), 393–399.Google Scholar
Graham, J., Ramirez, A., Cull, A., et al. (1996). Job stress and satisfaction among palliative physicians. Palliative Medicine, 10(3), 185–194.Google Scholar
Grant, E., Murray, S.A., Kendall, M., et al. (2004). Spiritual issues and needs: Perspectives from patients with advanced cancer and nonmalignant disease. A qualitative study. Palliative & Supportive Care, 2(04), 371–378.Google Scholar
Jones, A. (1999). “Listen, listen. Trust your own strange voice”: Psychoanalytically informed conversations with a woman suffering serious illness. Journal of Advanced Nursing, 29, 826–831.Google Scholar
Kendall, M., Carduff, E., Lloyd, A., et al. (2015). Dancing to a different tune: Living and dying with cancer, organ failure and physical frailty. BMJ Supportive & Palliative Care, 5(1), 101–102.CrossRefGoogle Scholar
Kristeller, J., Rhodes, M., Cripe, L., et al. (2005). Oncologist-Assisted Spiritual Intervention Study (OASIS): Patient acceptability and initial evidence of effects. International Journal of Psychiatry in Medicine, 35(4), 329–347.Google Scholar
Kübler-Ross, E. & Kessler, D. (2014). On grief and grieving: Finding the meaning of grief through the five stages of loss. New York: Simon & Schuster.Google Scholar
Langegard, U. & Ahlberg, K. (2009). Consolation in conjunction with incurable cancer. Oncology Nursing Forum, 36, E99–E106.Google Scholar
Matthews, D.A., McCullough, M.E., Larson, D.B., et al. (1998). Religious commitment and health status: A review of the research and implications for family medicine. Archives of Family Medicine, 7(2), 118–124.Google Scholar
Maugans, T.A. (1996). The SPIRITual history. Archives of Family Medicine, 5(1), 11–16.Google Scholar
McCord, G., Gilchrist, V.J., Grossman, S.D., et al. (2004). Discussing spirituality with patients: A rational and ethical approach. Annals of Family Medicine, 2(4), 356–361.Google Scholar
Meldrum, H. (2011). Spirituality in medical practice: How humanitarian physicians draw their boundaries with patients. Integrative Medicine: A Clinician's Journal, 10(3), 26–30.Google Scholar
Ohlen, J., Bengtsson, J., Skott, C., et al. (2002). Being in a lived retreat: Embodied meaning of alleviated suffering. Cancer Nursing, 25, 318–325.Google Scholar
Pathy, R., Mills, K., Gazeley, S., et al. (2011). Health is a spiritual thing: Perspectives of health care professionals and female Somali and Bangladeshi women on the health impacts of fasting during Ramadan. Ethnicity & Health, 16(1), 43–56.Google Scholar
Penderell, A. & Brazil, K. (2010). The spirit of palliative practice: A qualitative inquiry into the spiritual journey of palliative care physicians. Palliative & Supportive Care, 8(4), 415–420.Google Scholar
Phelps, A.C., Maciejewski, P.K., Nilsson, M., et al. (2009). Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer. The Journal of the American Medical Association, 301(11), 1140–1147.Google Scholar
Phelps, A.C., Lauderdale, K.E., Alcorn, S., et al. (2012). Addressing spirituality within the care of patients at the end of life: Perspectives of patients with advanced cancer, oncologists, and oncology nurses. Journal of Clinical Oncology, 30(20), 2538–2544.CrossRefGoogle ScholarPubMed
Puchalski, C. (2006). Spiritual assessment in clinical practice. Psychiatric Annals, 36(3), 150–155.Google Scholar
Puchalski, C., Ferrell, B., Virani, R., et al. (2009). Improving the quality of spiritual care as a dimension of palliative care: The report of the Consensus Conference. Journal of Palliative Medicine, 12(10), 885–904.Google Scholar
Ramondetta, L.M., Sun, C., Surbone, A., et al. (2013). Surprising results regarding MASCC members' beliefs about spiritual care. Supportive Care in Cancer, 21, 2991–2998.Google Scholar
Rehnsfeldt, A. & Eriksson, K. (2004). The progression of suffering implies alleviated suffering. Scandinavian Journal of Caring Sciences, 18, 264–272.Google Scholar
Saunders, C. (1988). Spiritual pain. Journal of Palliative Care, 4(3), 29–32.CrossRefGoogle ScholarPubMed
Sepúlveda, C., Marlin, A., Yoshida, T., et al. (2002). Palliative care: The World Health Organization's global perspective. Journal of Pain and Symptom Management, 24(2), 91–96.Google Scholar
Steinhauser, K., Voils, C., Clipp, E., et al. (2006). “Are you at peace?”: One item to probe spiritual concerns at the end of life. Archives of Internal Medicine, 166(1), 101–105.Google Scholar
Surbone, A. & Baider, L. (2010). The spiritual dimension of cancer care. Critical Reviews in Oncology/Hematology, 73(3), 228–235.Google Scholar
Tong, A., Sainsbury, P. & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ), a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357.Google Scholar
Vermandere, M., Choi, Y.N., de Brabandere, H., et al. (2012). GPs' views concerning spirituality and the use of the FICA tool in palliative care in Flanders: A qualitative study. The British Journal of General Practice, 62(603), e718–e725.Google Scholar
Virdun, C., Luckett, T., Davidson, P.M., et al. (2015). Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important. Palliative Medicine, 29(9), 774–796.CrossRefGoogle ScholarPubMed
Williams, A.-L. (2006). Perspectives on spirituality at the end of life: A meta-summary. Palliative & Supportive Care, 4, 407–417.CrossRefGoogle ScholarPubMed
Williams, J.A., Meltzer, D., Arora, V., et al. (2011). Attention to inpatients' religious and spiritual concerns: Predictors and association with patient satisfaction. Journal of General Internal Medicine, 26(11), 1265–1271.Google Scholar