JAMA Study Shows Spirituality Plays an Important Role in Whole-Person Care

Stones in a Zen rock garden representing yin and yang

Addressing spirituality when caring for seriously ill patients may offer positive outcomes as part of a person-centered, value-sensitive program of care, according to a new study led by researchers at Harvard T.H. Chan School of Public Health (Harvard Chan School) and Brigham and Women’s Hospital, as well as the George Washington University Institute for Spirituality and Health (GWish). Researchers also suggests spirituality should be incorporated into care for both serious illness and overall health.

The study, “Spirituality in Serious Illness and Health,” was supported by the John Templeton Foundation and published in the Journal of the American Medical Association in July 2022.

“This study represents the most rigorous and comprehensive systematic analysis of the modern-day literature regarding health and spirituality to date,” said Tracy Balboni, lead author and senior physician at the Dana-Farber/Brigham and Women’s Cancer Center and professor of radiation oncology at Harvard Medical School, in a media release. “Our findings indicate that attention to spirituality in serious illness and in health should be a vital part of future whole person-centered care, and the results should stimulate more national discussion and progress on how spirituality can be incorporated into this type of value-sensitive care.”

The team conducted a systematic review of literature from 2000–20 that considered spirituality during serious medical illness or during end-of-life or palliative care, as well as associations of spirituality and health with health outcomes. Researchers also used the definition of spirituality, developed during a global consensus conference hosted by GWish, as the foundation. Using that data, they turned to a 27-member panel of experts in spirituality and health care, public health, and medicine. The panelists, representing diverse spiritual or religious views, evaluated the evidence and identified key arguments for incorporating spirituality in the care of patients with serious illness.

“We believe that attention to spiritual distress is a human right, as much as attention to other physical, emotional, and social concerns,” said Christina Puchalski, MD ’94, RESD ’97, founding director of GWish, who was among the co-authors of the study and provided expert consultation. “Spiritual health is critical across all ages and diagnoses, with particular importance for patients with serious or chronic illness.”

Based the strength of supporting data, the panel identified three implications for the role and inclusion of spirituality in health care.

First, routinely incorporating spiritual care into the medical care of patients with serious illness can support the beneficial associations of religious/spiritual community participation. This incorporation can ultimately improve medical care and population health.

Second, incorporating spiritual care education in the training of interdisciplinary health care teams dedicated to treating seriously ill patients can increase awareness of benefits of religious/spiritual community participation. According to the researchers, even the act of asking about a patient’s spirituality can influence key outcomes in illness, such as quality of life and medical care decisions, and should be part of patient-centered, value-sensitive care.

Finally, by including specialty practitioners of spiritual care, such as chaplains, health care teams can address spirituality as a social factor associated with health. These practitioners also serve as a liaison, as necessary, to patients’ spiritual communities.

“Overlooking spirituality leaves patients feeling disconnected from the health care system and the clinicians trying to care for them,” said Howard K. Koh, MD, the Harvey V. Fineberg Professor of the Practice of Public Health Leadership at Harvard Chan School, in a Press Releases. “Integrating spirituality into care can help each person have a better chance of reaching complete well-being and their highest attainable standard of health.”

GWish was established in 2001 to create widespread awareness about the importance of attending to the physical, emotional, social, and spiritual needs of patients. The institute collaborates with religious, spiritual, and health organizations to create more compassionate health care systems around the globe.

GWish recently received a $3 million grant from the John Templeton Foundation in support of a multi-year project to develop a model to address the spiritual needs of patients. The grant will fund the first phase of a broader 10-year initiative, Advancing Spiritual Care, designed to grow the field of spiritual care.

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