1. Principles of Family Medicine “Spirituality and Clinical Care” Victor Sierpina, M.D. Michael M. Olson, Ph.D.

2. Overview of Seminar  Introduction  Controversies and Consensus  Clinical Cases  Interns small group session/discussion  Break (10 minutes)  Evidence-base for impact of spirituality/religion on health care outcomes  Spiritual History Models  Practice

3. Religion – Spirituality Defined

4. Controversy and Consensus

5. Consensus  Intertwined  Prescribing/Proselytizing  Pt. Initiated prayer  Taking spiritual hx./talking about issues is delicate, not indicated in all visits.  Collaboration needed  Decisions made by pt./fam./dct.  Ethics, power, boundaries, all challenges

6. Clinical Experience/Vignettes* *Olson, M. M., Dollahite, D. C., & White, M. B. (2002). Involved fathering of children with special needs: Relationships and religion as resources. Journal of Religion, Health, and Disabilities 6 (1), 47-73.

7. Research

8. U.S. Beliefs: Faith, Prayer, & Health 79%Believe spiritual faith can help one recover from illness, injury, or disease 56%Believe their faith helped them recover from illness, injury, or disease 63%Believe doctors should talk to patients about their spiritual faith Only 10% of doctors have done so USA Weekend, April 5-7, 1996.

9. More Statistics  9 out of 10 adult Americans pray.  96% of Americans currently believe in a God or a universal Spirit, and the majority of Americans feel that religion is an important component in their lives (Kudlac, 1991; McAllister, 1998; Thoresen, 1998)

10. Physicians’ view of top 5 barriers to addressing patient spiritual concerns: Lack of time71% Lack of training 59% Uncertainty identifying spiritual needs 56% Concern projecting own beliefs 53% Uncertainty managing pts. spiritual issues 49% Ellis MR, et al. Addressing spiritual concerns of patients’ family physicians’ attitudes and practices. Journal of Fam Pract 1999;48(2):105-9.

11. Family Physician’s View of Spirituality National survey of family physicians Felt somewhat close to God 77% Attend religious services monthly 74% Pray, spend time in spiritual practice daily 35% Did not believe in God, higher power, force 5% Daaleman TP, Frey B. Spiritual and religious beliefs and practices of family physicians: a national survey. J Fam Pract 1999; 48(2):98-104.

12. Evidence-based Practice  Koenig, H. G., McCullough, M. E., & Larson, M.D. (2001). Handbook of Religion and Health. Oxford Press.  Mayo Clinic Proceedings. 2001; 76: 1225-1235. – Critical review of the research literature (published studies, meta-analyses, systematic reviews, and subject reviews)

13. Religious Involvement, Spirituality, and Health  Decreased mortality  Decreased cardiovascular disease  Decreased hypertension  Health promoting behaviors  Terminally ill patients

14. Religious Involvement, Spirituality, and Health  Depression  Anxiety  Substance Abuse

15. Negative Influences of Religion/Spirituality on Health  ( - ) correlation in appx. 5% of studies:  RX  Timely medical care  Blood  Immunizations  Refusing pre-natal care  Replacing MHC w/ Religion

16. Effect on Attitudes, Cognitive Thought Processes, Behavior  Can promote rigid thinking, over- dependence on laws and rules, and disregard for personal individuality and autonomy.  Excessive reliance on religious rituals or counsel may delay seeking necessary treatment for health problems

17. Spiritual History Models

18.  Practice:  1. Pair up with person next to you and choose one of the spiritual history models you prefer to use. Practice assessment.  2. Responder: Either use your own life/experience or that of someone you know well enough that you could respond with sufficient information to be meaningful.  After you’ve finished switch roles and practice again.