Primary care physician preferences regarding spiritual behavior in medical practice.

BACKGROUND: Knowledge of physician attitudes and preferences regarding religion and spirituality in the medical encounter is limited by the nonspecific questions asked in previous studies and by the omission of specialties other than family practice. This study was designed to determine the willingness of internists and family physicians to be involved with varying degrees of spiritual behaviors in varied clinical settings. METHODS: The study was a multicenter, cross-sectional, nonrandomized design recruiting physicians from 6 teaching hospitals with sites in North Carolina, Vermont, and Florida. A self-administered survey was used to explore physicians' willingness to address religion and spirituality in the medical encounter. Data were gathered on the physicians' religiosity and spirituality and sociodemographic characteristics. RESULTS: Four hundred seventy-six physicians responded, for a response rate of 62.0%. While 84.5% of physicians thought they should be aware of patients' spirituality, most would not ask about spiritual issues unless a patient were dying. Fewer than one third of physicians would pray with patients even if they were dying. This number increased to 77.1% if a patient requested physician prayer. Family practitioners were more likely to take a spiritual history than general internists. CONCLUSIONS: Most primary care physicians surveyed would not initiate any involvement with patients' spirituality in the medical encounter except for the clinical setting of dying. If a patient requests involvement, however, most physicians express a willingness to comply, even if the request involves prayer.

Patient preference for physician discussion and practice of spirituality.

OBJECTIVE: To determine patient preferences for addressing religion and spirituality in the medical encounter. DESIGN: Multicenter survey verbally administered by trained research assistants. Survey items included questions on demographics, health status, health care utilization, functional status, spiritual well-being, and patient preference for religious/spiritual involvement in their own medical encounters and in hypothetical medical situations. SETTING: Primary care clinics of 6 academic medical centers in 3 states (NC, Fla, Vt). PATIENTS/PARTICIPANTS: Patients 18 years of age and older who were systematically selected from the waiting rooms of their primary care physicians. MEASUREMENTS AND MAIN RESULTS: Four hundred fifty-six patients participated in the study. One third of patients wanted to be asked about their religious beliefs during a routine office visit. Two thirds felt that physicians should be aware of their religious or spiritual beliefs. Patient agreement with physician spiritual interaction increased strongly with the severity of the illness setting, with 19% patient agreement with physician prayer in a routine office visit, 29% agreement in a hospitalized setting, and 50% agreement in a near-death scenario (P <.001). Patient interest in religious or spiritual interaction decreased when the intensity of the interaction moved from a simple discussion of spiritual issues (33% agree) to physician silent prayer (28% agree) to physician prayer with a patient (19% agree; P <.001). Ten percent of patients were willing to give up time spent on medical issues in an office visit setting to discuss religious/spiritual issues with their physician. After controlling for age, gender, marital status, education, spirituality score, and health care utilization, African-American subjects were more likely to accept this time trade-off (odds ratio, 4.9; confidence interval, 2.1 to 11.7). CONCLUSION: Physicians should be aware that a substantial minority of patients desire spiritual interaction in routine office visits. When asked about specific prayer behaviors across a range of clinical scenarios, patient desire for spiritual interaction increased with increasing severity of illness setting and decreased when referring to more-intense spiritual interactions. For most patients, the routine office visit may not be the optimal setting for a physician-patient spiritual dialog.