The FICA Spiritual History Tool ©™ was developed by Dr. Puchalski and a group of primary care physicians to help physicians and other healthcare professionals address spiritual issues with patients. Spiritual histories are taken as part of the regular history during an annual exam or new patient visit, but can also be taken as part of follow-up visits, as appropriate. The FICA tool serves as a guide for conversations in the clinical setting.
The acronym FICA can help structure questions in taking a spiritual history by healthcare professionals.
F - Faith and Belief
"Do you consider yourself spiritual or religious?" or "Is spirituality something important to you” or “Do you have spiritual beliefs that help you cope with stress/ difficult times?" (Contextualize to reason for visit if it is not the routine history).
If the patient responds "No," the health care provider might ask, "What gives your life meaning?" Sometimes patients respond with answers such as family, career, or nature.
(The question of meaning should also be asked even if people answer yes to spirituality)
I - Importance
"What importance does your spirituality have in our life? Has your spirituality influenced how you take care of yourself, your health? Does your spirituality influence you in your healthcare decision making? (e.g. advance directives, treatment, etc.)
C - Community
"Are you part of a spiritual community? Communities such as churches, temples, and mosques, or a group of like-minded friends, family, or yoga can serve as strong support systems for some patients. Can explore further: Is this of support to you and how? Is there a group of people you really love or who are important to you?"
A - Address in Care
"How would you like me, your healthcare provider, to address these issues in your healthcare?" (With the newer models including diagnosis of spiritual distress A also refers to the "Assessment and Plan" of patient spiritual distress or issues within a treatment or care plan
© Copyright, Christina M. Puchalski, MD, 1996
Citation: Puchalski, C., & Romer, A. L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of palliative medicine, 3(1) 129-137.
As with any other part of the patient interview, the spiritual histories should be patient-centered. Thus, the tool is meant to create an environment of trust by indicating to the patient that the physician or other healthcare professional is open to listening to the patient about his or her spiritual issues, if the patient wants to talk about those issues. There are ethical guidelines to which the physician or healthcare provider should adhere when taking a spiritual history. Healthcare professionals are encouraged not to use the FICA tool as a checklist, but rather to rely on it as a guide to aid and open the discussion to spiritual issues. See this link for more recommendations for taking a spiritual history.
Order FICA Cards
GWish developed a small (2"x4") plastic pocket card for healthcare professionals to use when conducting spiritual assessments. The card lists the questions associated with each part of FICA and is a handy way to help implement the practice of conducting spiritual assessments. You can order plastic FICA cards using the this linked FICA card order form (pdf).
FICA for Self Assessment
The FICA tool can also be used for looking at your own spiritual history. Learn more about using FICA for self-assessment at this link.