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God in the Exam Room

Praise the LORD, O my soul; all my inmost being, praise his holy name. Praise the LORD, O my soul, and forget not all his benetswho forgives all your sins and heals all your diseases, who redeems your life from the pit and crowns you with love and compassion, who satises your desires with good things so that your youth is renewed like the eagle's. (Ps 103:1-4)

Rev Sue Carr & Dr. David Chan CMDS National Conference April 30, 2010, Alliston, Ontario

"When you enter a town and are welcomed, eat what is set before you. Heal the sick who are there and tell them, 'The kingdom of God is near you. (Luke 10:8-9)

Case 1
C.S., a 35 year old single mom with diabetes and chronic back pain on disability comes to see you and tells you that she no longer needs the opiate treatment because she is now managing the pain with the help of prayers and support from church friends. How do you react to that?

Case 2
Mrs X was told by the Oncologist today that the latest test results showed that she has ovarian cancer. Mrs X is a devout Christian. She was disappointed that the doctor, who is also a known Christian, did not even ask how her faith may play a role in facing such a difficult diagnosis and choice of treatment. Should we expect the oncologist to initiate the faith topic?

Workshop Outline
Introduction: the Spiritual Gap
What does research show

The HOPE assessment


Why use it How to use it

Practice session
Practice in pairs Debrief

How to incorporate into your practice Praying for each other

The Spiritual Gap


95% of Americans believe in God versus 64% of physicians believe in God 77% believe physicians should consider their spiritual needs, but only 10-20% report that their physician discusses religion or spirituality with them 96% of physicians believe spiritual well-being is important in health but only 11% frequently inquire about spiritual issues

Mr. Delgado responds that he is unwilling to take medications because he feels healthy and that he believes that reducing his weight is not a realistic goal, given his familys cultural values and use of food as an integral part of all social activities. He is proud that his wife and children actively participate in all family events and attend church with him weekly. He has read that being religious and attending church regularly prolongs life and reduces the risk for dying of heart disease. He is willing to increase his church attendance to improve his health. How should his physician respond?

Research shows that spiritual belief is associated with


Positive effects in terms of reduced coronary heart disease, high blood pressure, stroke, most cancers, and several health status indicators. Reduced all-cause morbidity and mortality. No matter how religion was defined or measured (i.e., as beliefs, experiences, behavior, or attitudes). Findings have been generally positive across all cultures

Research shows that spiritual belief is associated with Higher rates of overall well being and life satisfaction Lower rates of depressive symptoms and suicide Lower rates of divorce and higher rates of marital satisfaction Lower rates of alcohol and abuse and other drug abuse, including cigarette smoking and recreational drug use

The HOPE Assessment


H: Sources of Hope, meaning, comfort, strength, peace, love and connection

Example Questions - H
We have been discussing your support systems. I was wondering, what is there in your life that gives you internal support? What do you hold on to during difficult times? What sustains you and keeps you going? For some people, their religious or spiritual beliefs act as a source of comfort and strength in dealing with lifes ups and downs; is this true for you?

The HOPE Assessment


H: Sources of Hope, meaning, comfort, strength, peace, love and connection O: Organized religion

Example Questions - O
Do you consider yourself part of an organized religion? How important is this to you? What aspects of your religions are helpful and not so helpful to you? Are you part of a religious or spiritual community? Does it help you? How?

The HOPE Assessment


H: Sources of Hope, meaning, comfort, strength, peace, love and connection O: Organized religion P: Personal spirituality and Practices

Example Questions - P
Do you have personal spiritual beliefs that are independent of organized religion? What are they? Do you believe in God? What kind of relationship do you have with God? What aspects of your spirituality or spiritual practices do you find most helpful to you personally? (e.g., prayer, meditation, reading scripture, attending religious services, listening to music, hiking, communing with nature)

The HOPE Assessment


H: Sources of Hope, meaning, comfort, strength, peace, love and connection O: Organized religion P: Personal spirituality and Practices E: Effects on medical care and end-oflife issues

Example Questions - E
Has being sick (or your current situation) affected your ability to do the things that usually help you spiritually? (Or affected your relationship with God?) Are you worried about any conflicts between your beliefs and your medical situation/care/decisions? Are there any specific practices or restrictions I should know about in providing your medical care? (e.g., dietary restrictions, use of blood products)

How to incorporate into your practice


Discerning instances for overt spiritual assessment Displaying a genuine and caring attitude Encouraging the use of existing spiritual practices Documenting spiritual care for continuity of care Managing perceived barriers to spiritual care

References
Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment. (Am Fam Physician 2001;63:81-8,89) Physicians Role in Addressing Spiritual Needs. (Southern Medical Journal 2007;vol 100 No 9:932-933) Spirituality, Religion, and Health. An emerging research field. (American Psychologist 2003;vol 58 No 1:24-35) How Family Practitioners, Nurse Practitioners, and Physician Assistants incorporate Spiritual Care in Practice. J Am Acad Nurse Pract. 2009 Dec;21(12): 690-7

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