Fast Fact and Concept #019; Taking a Spiritual History

2nd Edition

Author(s): Bruce Ambuel, PhD

Illness raises fundamental questions -- For what may I hope? Why do I suffer? Does my suffering have meaning?What happens after I die? When a physician stands with a patient as they face death, the physician inevitably plays a role in supporting the patient’s inquiry into these spiritual questions. In addition some patients have specific preferences or needs regarding medical care, death and dying that are based upon their religious beliefs. The physician often plays an important role in supporting a patient’s exploration of these issues. Taking a spiritual history is one way to support the patient in this exploration. Maugans (1997) presents a framework for taking a spiritual history; the interview below comes primarily from Maugans’ article with some modification based upon the other sources cited.

Taking a Spiritual History

S—spiritual belief system

• Do you have a formal religious affiliation? Can you describe this?
• Do you have a spiritual life that is important to you?
• What is your clearest sense of the meaning of your life at this time?

P—personal spirituality

• Describe the beliefs and practices of your religion that you personally accept.
• Describe those beliefs and practices that you do not accept or follow.
• In what ways is your spirituality/religion meaningful for you?
• How is your spirituality/religion important to you in daily life?

I—integration with a spiritual community

• Do you belong to any religious or spiritual groups or communities?
• How do you participate in this group/community? What is your role?
• What importance does this group have for you?
• In what ways is this group a source of support for you?
• What types of support and help does or could this group provide for you in dealing with health issues?

R—ritualized practices and restrictions

• What specific practices do you carry out as part of your religious and spiritual life (e.g. prayer, meditation, service, etc.)
• What lifestyle activities or practices does your religion encourage, discourage or forbid?
• What meaning do these practices and restrictions have for you? To what extent have you followed these guidelines?

I—implications for medical care

• Are there specific elements of medical care that your religion discourages or forbids? To what extent have you followed these guidelines?
• What aspects of your religion/spirituality would you like to keep in mind as I care for you?
• What knowledge or understanding would strengthen our relationship as physician and patient?
• Are there barriers to our relationship based upon religious or spiritual issues?
• Would you like to discuss religious or spiritual implications of health care?

T—terminal events planning

• Are there particular aspects of medical care that you wish to forgo or have withheld because of your religion/spirituality?
• Are there religious or spiritual practices or rituals that you would like to have available in the hospital or at home?
• Are there religious or spiritual practices that you wish to plan for at the time of death, or following death?
• From what sources do you draw strength in order to cope with this illness?
• For what in your life do you still feel gratitude even though ill?
• When you are afraid or in pain, how do you find comfort?
• As we plan for your medical care near the end of life, in what ways will your religion and spirituality influence your decisions?

References:

1. Maugans TA. The SPIRITual History. Arch Fam Med. 5:11-16, 1997.
2. Ambuel, B & DE Weissman. Discussing spiritual issues and maintaining hope. In DE Weissman & B Ambuel, Improving End-of-Life Care: A Resource Guide for Physician Education, 2nd Edition. Medical College of Wisconsin, Milwaukee, 1999.
3. Griffith, JL & ME Griffith. Hope in suffering/pain in health: Talking with patients about spiritual issues. Presented at The Eighteenth Forum for the Behavioral Sciences in Family Medicine, Chicago, Illinois, October, 1997.

Fast Facts were edited by David Weissman MD, Palliative Care Center, Medical College of Wisconsin until January 2007.  For comments/questions write to the current editor, Drew Rosielle MD: drosiell@mcw.edu. The complete set of Fast Facts is available at EPERC: www.eperc.mcw.edu

Copyright/Referencing Information : Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing. Fast Facts and Concepts #19 Ambuel B. Taking a spiritual history. August 2005. 2nd Edition. End-of-Life Palliative Education Resource Center www.eperc.mcw.edu.

Disclaimer : Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Creation Date: 7/2000; August 2005. 2nd Edition

Purpose: Instructional Aid, Teaching

Audience(s)

ACGME Competencies: Interpersonal and Communication Skills

Keyword(s): communication, psychosocial and spiritual experience