Among inpatients at a large urban medical center, 41% desired a discussion of R/S concerns while hospitalized, and only half of those (and 32% of inpatients overall) reported having such a discussion. Importantly, those who discussed their spiritual concerns were more likely to have very positive assessments of their inpatient stay.
Our finding that only 41% of patients wanted to discuss religious or spiritual concerns with someone while in the hospital is comparable to a prior study of family medicine inpatients in which 37% said they wanted to discuss their R/S beliefs with physicians more frequently.27
We expected the percentage to be somewhat higher given that our patient population included a large percentage of patients who were women and Black/African-American,3,27–29
both of which are associated with higher levels of R/S belief. The relatively low percentage may reflect other factors particular to the patients found in this one medical institution.
Of those patients who indicated that they did have a R/S discussion with someone during the hospitalization, the discussion usually occurred with a hospital chaplain. Only 8% reported having discussed R/S concerns with a physician. This is comparable to a previous study of family medicine inpatients where 12% reported that physicians had discussed their religious beliefs with them.27
The generally low prevalence of physicians discussing R/S with patients stands in contrast to surveys indicating that physicians believe they should be aware of patients’ spirituality (84.5% of physicians at teaching hospitals in Monroe’s study).30
While physicians can become aware of these R/S needs by reading a chaplain’s chart note, or talking with the patient’s friends and family, this may not adequately replace face to face conversations about R/S matters. Our study indicates that, according to patients, there is ample room for physicians and other health care professionals to engage them in conversations about R/S concerns. Moreover, with only a third of patients reporting a discussion of their R/S concerns, it would seem that the Joint Commission’s goal that all patients receive a spiritual assessment is far from being attained and that there is room for further training of clinicians.4,8
While it is intuitive that religious and spiritual patients would be more likely to desire and to engage in conversations about R/S concerns, it is perhaps not as obvious why patients in severe pain would be more likely to desire and to have conversations about R/S. Perhaps these patients have more advanced disease, and as a result are thinking more about life and death questions that religion and spirituality often address. Alternatively, patients may cope with uncontrolled pain by drawing on religious and spiritual resources.31
Patient race, age, and gender were all associated with having discussed R/S issues with someone while hospitalized. Blacks/African-Americans were slightly less likely to report having had discussion of spiritual concerns, indicating that racial and ethnic disparities in health care may include disparities in spiritual care. Women and older patients were more likely to discuss R/S concerns, a finding consistent with Johnson’s report that women and older people have stronger spiritual beliefs.28
Although these associations are intriguing, they do not seem large enough to warrant singling out any of these categories from broader efforts to address patient’s R/S concerns.
Patients who had religious and spiritual discussions during their hospitalization were more likely to give a positive assessment of their care. This was true even for patients who did not initially desire a discussion of their religious or spiritual issues. These findings are consistent with but also augment the findings of Clark et al., whose analysis of the 2001 Press Ganey National Inpatient data (n
1,732,562) demonstrated that there is a high association between the “degree to which staff addressed emotional/spiritual needs” and “overall patient satisfaction.”13
(Clark also reported that emotional and spiritual needs ranked second on the National Inpatient Priority Index from 1998–2001.13
) Clark combined emotional and spiritual needs, noting, “those needs directly involved a range of emotions experienced during hospitalization, including search for meaning, transcendence, desire to maintain formal religious practices, alleviating fear and loneliness, and the presence of God.”13
In contrast, our measure focused specifically on talking to patients about religious and spiritual issues, suggesting that for many patients it may not be enough to address emotional concerns without specifically asking about R/S issues.
Another possible explanation for these patients’ high ratings of satisfaction is that reporting having had R/S discussions is a proxy for greater overall coordination of care or for more comprehensive, multidisciplinary care. It may also reflect better communication among all members of the health care team.
This study has limitations. The study population was large, but necessarily excluded numerous patients who declined to participate or did not complete all aspects of the study. Discussions of R/S issues are known only by patient self-report. Chart reviews or direct observations would help provide a fuller account of what sorts of discussions actually took place. Social desirability bias can affect survey responses, especially with survey items addressing satisfaction ratings. We are not able to assess causality, and can only infer associations. Drawing patients from a single medical center limits our ability to generalize the findings to other patient populations.