Part 2 of a Two-part Series
Patient Interviews and Surveys in the Medical SettingPart I (Mind and Body in Chronic Pain: The Role of Spirituality in Healing) can be accessed in the July-August Advocate Voice Newsletter at http://www.fmcpaware.org/the-role-of-spirituality-in-healing.html.
InterviewsMedical interview questions during an office visit should include: 1) clarifying a patient’s concerns; 2) making a connection; 3) identifying goals of care; and 4) mobilizing specific concerns. A 2002 JAMA article on spirituality gives several examples of how physicians can add these types of inquiries.1 Although specific to end-of-life issues, healthcare providers caring for patients with chronic pain conditions could benefit from suggested phrases to help them communicate better with patients to elicit their concerns and how to respond to theme.In a 2008 presentation by Dr. Harold G. Koenig (a physician who suffers with chronic pain), it was recommended that a brief (2-4 minute) spiritual history be presented to the patient as a routine part of the clinical visit.2 His presentation encourages the physician to determine:
- The patient’s religious or spiritual background
- Beliefs used to cope with illness or that are a source of distress
- Spiritual beliefs that might conflict with medical care or influence medical decisions
- Involvement in a spiritual community
- Spiritual needs that are presentPhysicians are encouraged to document the resulting history and recommendations or referrals and include them in the patient’s file for future reference.Following is a series of questions put together by a 1999 American College of Physicians Panel. They are adaptable to chronic pain and are an excellent reference for inexperienced or untrained doctors interested in taking a spiritual history. They include:
- Do you rely on your spiritual beliefs to help you cope with pain?
- How do your spiritual beliefs influence your medical treatment?
- Is faith (religion and spirituality) important to you in this illness (injury or disease)?
- Are there any religious or spiritual issues that need addressing?
- Would you like to explore religious matters with someone?FICA is the acronym for Faith or beliefs, the Importance of spirituality on the person’s life and health care decision making, the person’s spiritual Community, and interventions to Address the person’s needs. FICA is a Spiritual History Tool3-4 - that was developed by physicians as a guide for non-chaplain clinicians. It can be incorporated into a standard comprehensive history in the medical setting. Several studies suggest that this tool is feasible to use in the medical setting. Some sample questions include:
- Do you have spiritual beliefs that help you cope with stress?
- What role do your beliefs play in regaining your health?
- Are you a part of a spiritual or religious community? Is this of support to you? How?
- How would you like me, your healcare provider, to address these issues in your healthcare?FICA pocket cards and a demonstration on how to perform a spiritual history may be found at The George Washington Institute for Spirituality Health website www.gwish.org.Time restraints are voiced by most physicians about their inability to instigate a structured or unstructured spirituality interview. A patient self-report survey may help the physician to gain understanding and does not depend on whether the doctor “asks” about spirituality. For patients who have been disenchanted due to past experiences of rejection or non-response about spirituality issues, the survey tool itself is a prompt about the importance of spiritual practices and reveals the interest of the clinician in this topic.SurveysA screening tool used in the clinical setting needs to be easy for the patient to fill out and for the clinician to scan quickly. The physician should choose the survey that best conveys their comfort level with how the tool will be used. Suggestions include: basic assessment, providing positive feedback, referral, or to prompt discussion about non-pharmacologic approaches to pain management.Many self-report surveys will work as screening tools. In fact, 33 self-report surveys to assess spirituality are described on a website developed to create “a database of outcome measures of particular importance to complementary and Alternative Medicine (CAM) and Integrative Health Care (IHC) effectiveness and efficacy research.” The Coping Strategy Questionnaire (CSQ)5 is short, easy to administer, and was originally developed to identify how people cope with low back pain. It takes about 5 minutes to complete and is easy to score.In today’s world the Internet offers thousands of apps related to spirituality and religion. Numerous free Internet tools exist for researchers looking for help in gathering this type of information.So what treatment tips does spirituality offer?A physician who incorporates spirituality into his patient’s history has an extra tool in his arsenal to help a person with chronic pain who is not progressing with treatment or might be suffering in excess of the diagnosis. Today’s treating pain physician wants to incorporate alternative options to prescribing more medications.Non-pharmacological tips such as promotion of good sleep habits are often integrated into a chronic pain patient’s regimen. Spirituality tips such as meditation and mindfulness can also be added to a treatment protocol. Gratitude exercises and spiritual rituals are other spirituality processes that physician’s might integrate into their list of chronic pain treatment tips. A patient-friendly guide authored by Steven H. Richeimer, MD, covers these ideas as well as suffering. In the guide Dr. Richeimer identifies spiritual tools that a physician might consider using or that the patient could employ, including reframing spiritual thoughts, spiritual meditation, and motivation to help patients engage in life.In conclusion, chronic pain patients want their doctors to ask about spiritual issues. Surveys filled out by patients offer an efficient and easy first step. To learn more about spirituality and how to incorporate it into a patient’s treatment plan, physicians should make local connections with chaplains, psychologists and occupational therapists who prioritize spiritual issues.________________________________________
- 1. Lo B, Ruston, D, Kates LW. Discussing religious and spiritual issues at the end of life: A practical guide for physicians. JAMA. 2002;287(6):749-754.
2, Koenig HG, Religion, spirituality and health: Research and clinical applications. Publisher unknown. www.nacsw.org/Publications/Proceedings2008/KoenigHRelgion.pdf.Accessed July5,2014.
3. Puchalski C. Spiritual assessment in clinical practice. Psychiatric Ann 2007;36(3):150-155.
4. Puchalski C, Romer A. Taking a spiritual history allows clinicians to understand patients more fully. J Palliat
- 5. Rosenstiel AK,, Keefe FJ. The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain.1983:17(1):33-44.