1. Spirituality/Religion & Health Research: A Few Introductory Points Chaplain John W. Ehman Penn Presbyterian Medical Center Philadelphia, PA 6/3/14

2. Number of Medline-Indexed English Articles by Year, with Keywords: RELIGION and SPIRITUALITY [ Includes the variations: religious, religiosity, religiousness, and spiritual ] John Ehman, 2012

3. Number of Medline-Indexed English Articles by Year, with Keywords: RELIGION and SPIRITUALITY [ Includes the variations: religious, religiosity, religiousness, and spiritual ] John Ehman, 2012

4. Number of Medline-Indexed English Articles by Year, with Keywords SPIRITUAL or SPIRITUALITY John Ehman, 6/30/09

5. Number of Medline-Indexed English Articles by Year, with Keywords SPIRITUAL or SPIRITUALITY John Ehman, 6/30/09

6. Among the factors in the mid-1990s affecting the study of spirituality/religion & health: Greater attention paid to religious values, beliefs, and practices as key aspects of patient diversity (e.g., new emphasis by the Joint Commission) Growing sense among health care providers and researchers of religion’s role in health-pertinent behaviors and health care decision-making -- important for “knowing your patient” Research begins accumulating significant data that patients’ spirituality/religiosity may be important to medical outcomes and thus to the process of “healing your patient”

7. Two things to keep in mind about the modern field of Spirituality & Health: 1) It is still nascent in the current form 1) It is still nascent in the current form 2) It has somewhat fluid terminology

8. In the health care literature, religion is associated with institutional systems of beliefs and practices, whereas spirituality is associated with personal experiences and an individual quest for meaning. Spirituality is generally seen as a broad concept, going beyond the “limits” of religion.

9. The Two Most Common Views of the Relationship of Spirituality to Religion in the Current Health Care Literature Spirituality Religion Spirituality Religion

10. ‘‘Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.’’ A New and Important Definition of Spirituality: — p. 646 of Puchalski, C. M., et al., "Improving the Spiritual Dimension of Whole Person Care: Reaching National and International Consensus," Whole Person Care: Reaching National and International Consensus," Journal of Palliative Medicine 17, no. 6 (June 2014): 642-656 Journal of Palliative Medicine 17, no. 6 (June 2014): 642-656

11. While the broad concept of spirituality holds strong appeal in the practice of health care and is prominent in the literature, religion tends to be favored as the focus of research because the concept highlights factors that can be more easily specified, observed, and quantified.

12. However, a growing problem with religion- focused research is that Americans are increasingly less likely to see themselves and fit themselves in traditional categories of religion.

13. Americans and Religious Affiliation A 2012 Pew Research Center survey found that one-fifth of the U.S. public – and a third of adults under 30 years old – now describe themselves as “religiously unaffiliated.” This is partly due to an increasing trend to drop all sense of connection to a specific religious tradition when there is not an active social involvement in a congregation. Moreover, 18% of American adults describe themselves now as “spiritual but not religious.” Pew Research Center’s Forum on Religion & Public Life, "'Nones' on the Rise…,” report issued October 9, 2012

14. Polls re: Religion/Spirituality in the US 90-96% of adults in the US say they “believe in God” over 40% say they attend religious services regularly, usually at least once a week 50-75% say religion is “very important” in their lives 90% say they pray, and most (54-75%) say they pray at least once a day over 80% say that “God answers prayers” 79-84% say they believe in “miracles” and that “God answers prayers for healing someone with an incurable illness” --These percentages are summary characterizations of numerous national surveys showing fairly consistent results across time

15. Religion-focused research remains the driving force in the overall field of “Spirituality & Health” because it is conducive to drawing practical connections with health issues. For example: fewer dangerous behaviors (e.g., less substance abuse, unsafe sex, or neglect of health screenings) less suicide and generally greater aversion to suicide less depression and faster recovery from depression greater sense of meaning/purpose in life, hopefulness --See: Koenig, H.G, et al., Handbook of Religion and Health, 2001/2011; and Koenig, H.G., Testimony to the US House of Representatives Subcommittee on Research and Science Education, 9/18/08

16. lower rates of coronary artery disease lower cardiovascular reactivity greater heart rate variability lower blood pressure and generally less hypertension tendency for better outcomes after cardiac surgery better endocrine function better immune function lower cancer rate and better outcomes lower mortality and longer survival generally --ibid.

17. Theoretical Model of How Religion Affects Physical Health --adapted from Koenig, et al., Hand- book of Religion and Health, 2001 Religion also affects Childhood Training, Adult Decisions, and Values & Character; which then in turn affect mental health, social support, and health behaviors. Infection Cancer Heart Disease Hyper- tension Stroke Stomach & Bowel Liver & Lung Accidents & STDs Stress Hormones Immune System Autonomic Nervous System Disease Detection and Treatment Compliance High Risk Behaviors (smoking, drugs) Mental Health Social Support Health Behaviors RELIGIONRELIGION

18. Recent health care literature largely addresses religion/spirituality as… … a ground for “religious” social support … a value basis for personal meaning-making (and therefore understanding illness and coping with crises) and decision-making … a context for behavior that can influence the way the body works (e.g., meditation that can affect physiological reactions to stress)