Understanding ICU Physician and Nurse Perspectives on Providing Spiritual Care
Philip Choi, MD, MA, Assistant Professor in Internal Medicine, University of Michigan; Rev. Christina L. Wright, PhD, Associate Director of Spiritual Care, Michigan Medicine; Kristin M. Collier, MD, FACP, Assistant Professor of Internal Medicine; and Christian K. Alch, MD, Intern, University of Michigan Hospital System Internal Medicine Residence Program
Admission to the ICU is a vulnerable time for patients and/or their surrogates. 1 in 5 deaths occurs in the ICU or shortly after being discharged, and most of these deaths come from withdrawing life support or from incurable illnesses (Angus, Barnato et al. 2004). During this vulnerable time, patients look not only for healing through conventional medical interventions, but also look for emotional and spiritual healing (Steinhauser, Christakis et al. 2000).
Religion and spirituality play an important role in the well-being of patients near the end of life. According to studies, up to 60% of Americans consider religion important to their everyday lives. This percentage seems to be higher in the face of terminal or critical illness (Balboni, Vanderwerker et al. 2007). Religion and spirituality are so important in end of life care that they have been included in national and international palliative care guidelines (Angus 2005, Sulmasy 2009). However, despite the recognized importance of addressing patients’ spiritual needs, spiritual needs are under addressed by patient care teams (Balboni, Vanderwerker et al. 2007).
Although religion and spirituality are important in the clinical encounter, physicians typically feel unprepared to elicit beliefs, include them in decision making, or meet families’ spiritual needs (Sloan, Bagiella et al. 1999, Ford, Downey et al. 2012). Physicians, when being self-assessed, often do not feel comfortable addressing religion and spirituality (Ford, Downey et al. 2012). When spiritual needs are not met, patients and families have rated care more poorly (Astrow, Wexler et al. 2007, Williams, Meltzer et al. 2011). Medical costs are also increased in this setting (Balboni, Balboni et al. 2011). While positive religious coping has been linked to more aggressive care and more ICU deaths (Phelps, Maciejewski et al. 2009), in a subset also receiving spiritual support from the medical team, there were less aggressive interventions and fewer ICU deaths (Balboni, Balboni et al. 2013). Therefore, meeting patients’ spiritual needs appears just as important as meeting their medical needs at the end of life.
Despite data suggesting physicians aren’t comforting addressing spirituality, recent research demonstrated that ICU clinicians see it as their role to address the religious and spiritual needs of their patients and report feeling comfortable doing so, but only a minority of these clinicians regularly address religious and spiritual needs in clinical practice (Choi et al 2018).
This proposed paper discusses a follow up study we are undertaking to understand why physicians and nurses do not regularly address religious and spiritual needs in clinical practice despite reporting that they feel it is their role to do so and they report being comfortable doing so. We utilize a qualitative approach to examine how physicians and nurses in the critical care medical unit (ICU) understand their role in caring for patients’ spiritual needs, including if they feel comfortable addressing these needs, if they regularly do address these needs, and what prevents those who do not address spiritual and religious needs from doing so.
Religion and spirituality play an important role in the well-being of patients near the end of life. According to studies, up to 60% of Americans consider religion important to their everyday lives. This percentage seems to be higher in the face of terminal or critical illness (Balboni, Vanderwerker et al. 2007). Religion and spirituality are so important in end of life care that they have been included in national and international palliative care guidelines (Angus 2005, Sulmasy 2009). However, despite the recognized importance of addressing patients’ spiritual needs, spiritual needs are under addressed by patient care teams (Balboni, Vanderwerker et al. 2007).
Although religion and spirituality are important in the clinical encounter, physicians typically feel unprepared to elicit beliefs, include them in decision making, or meet families’ spiritual needs (Sloan, Bagiella et al. 1999, Ford, Downey et al. 2012). Physicians, when being self-assessed, often do not feel comfortable addressing religion and spirituality (Ford, Downey et al. 2012). When spiritual needs are not met, patients and families have rated care more poorly (Astrow, Wexler et al. 2007, Williams, Meltzer et al. 2011). Medical costs are also increased in this setting (Balboni, Balboni et al. 2011). While positive religious coping has been linked to more aggressive care and more ICU deaths (Phelps, Maciejewski et al. 2009), in a subset also receiving spiritual support from the medical team, there were less aggressive interventions and fewer ICU deaths (Balboni, Balboni et al. 2013). Therefore, meeting patients’ spiritual needs appears just as important as meeting their medical needs at the end of life.
Despite data suggesting physicians aren’t comforting addressing spirituality, recent research demonstrated that ICU clinicians see it as their role to address the religious and spiritual needs of their patients and report feeling comfortable doing so, but only a minority of these clinicians regularly address religious and spiritual needs in clinical practice (Choi et al 2018).
This proposed paper discusses a follow up study we are undertaking to understand why physicians and nurses do not regularly address religious and spiritual needs in clinical practice despite reporting that they feel it is their role to do so and they report being comfortable doing so. We utilize a qualitative approach to examine how physicians and nurses in the critical care medical unit (ICU) understand their role in caring for patients’ spiritual needs, including if they feel comfortable addressing these needs, if they regularly do address these needs, and what prevents those who do not address spiritual and religious needs from doing so.