FICA Spiritual History Tool ©
The FICA Spiritual History Tool ©, created by Dr. Puchalski and colleagues in 1996, was first implemented in medical school curricula and later in clinical settings. To validate the effectiveness of the tool, a 2009 study was conducted by Dr. Betty Ferrell and her colleagues with City of Hope National Medical Center patients who had been diagnosed with solid tumors. The research showed that the FICA tool accurately assessed multiple components of spirituality when compared to data collected by the City of Hope-Quality of Life tool, most notably religion, spiritual activities, change in spirituality, positive life change, purpose, and hopefulness.
In the U.S and Canada, the FICA tool is widely used and integrated into many electronic health systems. GWish is currently developing resources to further implement the tool in clinical settings in the U.S. and other countries—the FICA tool has been translated into Spanish, Italian, and Portuguese. We also continue to conduct validation studies to verify accuracy and discover new ways to use the data to treat the whole patient—mind, body, and spirit.
GWish developed a small (2"x4") plastic pocket card for health care professionals to use when conducting spiritual assessments. The card lists the questions associated with each part of FICA, and is a handy tool to help implement the practice of conducting spiritual assessments. You can order these durable and convenient cards using the FICA card order form (PDF).
The FICA Spiritual History Tool ©™ was developed by Dr. Puchalski and a group of primary care physicians to help physicians and other health care 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.
We recommend the following for health care providers taking a patient's spiritual history:
Consider spirituality as a potentiality important component of every patient's physical well being and mental health.
Address spirituality at each complete physical examination and continue addressing it at follow-up visits if appropriate. In patient care, spirituality is an ongoing issue.
Respect a patient's privacy regarding spiritual beliefs; don't impose your beliefs on others.
Make referrals to chaplains, spiritual directors, or community resources as appropriate.
Be aware that your own spiritual beliefs will help you personally and will overflow in your encounters with those for whom you care to make the doctor-patient encounter a more humanistic one.
Simple yet powerful, the FICA Spiritual History Tool© offers a step-by-step guide to help you gather information about a patient’s spiritual history and preferences. Having a conversation about spirituality early in the relationship demonstrates to patients and their families that you are prepared to walk beside them on their health journey—particularly through acute illness, chronic illness, or end-of-life.
The FICA Spiritual History Tool© Acronym:
F - Faith and Belief
Determine whether or not the patient identifies with a particular belief system or spirituality at all.
I - Importance
Is this belief important to me? Does it influence how I think about my health and illness? Does it influence my health care decisions?
C - Community
Do I belong to a spiritual community (church, temple, mosque or other group)? Am I happy there? Do I need to do more with the community? Do I need to search for another community? If I don't have a community, would it help me if I found one?
A - Address in Care
What should be my action plan? What changes do I need to make? Are there spiritual practices I want to develop? Would it help for me to see a chaplain, spiritual director, or pastoral counselor?