Patient’s Perception of Physician’s Role in Spiritual Well-Being Andy Chen, D.O.

Introduction Spirituality is a complex human experience which involves cognitive and philosophical aspects to search for meaning, purpose, and truth in life. Medical literatures have suggested strong relationship between spirituality and health. (1) As physicians, we should consider patient’s physical, mental, and spiritual well-being.

Background Research A study called “Discussing Spirituality with Patients: A Rational and Ethical Approach” (2) Top five reasons of situations when most patients prefer their physicians to discuss about their spiritual beliefs: Very seriously ill with the possibility of dying (94%: 77%) Suffering from an ongoing, long-term, serious illness (91%: 74%) Just diagnosed with a serious illness (90%: 73%) Suffering from the loss of love ones (87%: 70%) Recovering from a serious illness (83%: 66%) * first number is the percent of the patients who wants to talk about spirituality, and second number is the percent of total

Background Research The top three reasons of what the responders wanted physician to do with the spiritual information: - So that the doctor can understand how your belief influence how you deal with being sick (87%: 68%) - So that the doctor can understand you better (85%: 65%) - So that the doctor would understand how you make decisions (83%: 64%)

Reason For the Study In Riverside County Regional Medical Center (RCRMC), although nurses address spirituality in the inpatient setting, there has been no formal process for physicians to address spirituality with patients during hospitalization or clinic visit.

Hypothesis This survey is intended to show that RCRMC patients report that their physicians do not routinely address patient’s spirituality when patients desire their physicians to do so.

Methods During April of 2007, 117 patients filled out a survey titled “Physician’s Role in Patient’s Spiritual Well-being” at RCRMC. The surveys were distributed randomly to all patients upon registration to the clinic visit. Patients who were willing to participate were given either the English or Spanish version according to their language of preference.

Survey Sex: Male Female Age: 21-30 31-40 41-50 51-60 61 or older Riverside County Regional Medical Center 26520 Cactus Ave, Moreno Valley, CA 92555 Physician’s Role in Patient’s Spiritual Well-Being The completion of this form is strictly voluntary. Whether you choose to complete this form or not, it will make no difference in the care that you will receive from RCRMC. After you have completed the form, please drop it off at the front desk of Family Care Clinic. Sex: Male Female Age: 21-30 31-40 41-50 51-60 61 or older Ethnicity: Caucasian Hispanic African American Asian Other: Marital Status: Single Married Divorced/Separated Widow Other: Language: English Spanish Both Other: Education: Less than elementary Elementary Junior High High School College More than College Other: Religion: None Christian Catholic Morman Buddhism Islam Hinduism Judaism Other:

Survey 1. How important of a role does spirituality play in your life? Very important Important Somewhat important Not important 2. Do you believe that spirituality can affect your health? Yes No I don’t know 3. Do you want your doctor to speak with you regarding your spiritual well-being? Yes No I don’t know 4. Did your doctor speak with you regarding your spiritual well-being?

Survey 5. Under what settings do you want your doctor to speak with you regarding your spiritual well-being? (Please circle all that apply) A. Routine office visits B. Urgent visits C. During hospitalization 6. Under what circumstances do you want your doctor to speak with you regarding your spiritual well-being? (Please circle all that apply) A. Very ill with the possibility of dying B. Serious chronic medical illness C. Addiction to smoking, alcohol, or drug use D. Acute medical problems 7. Why do you want your doctor to know about your spiritual well-being? (Please circle all the apply) A. To understand you better B. To help you with your current medical condition C. To refer you to a spiritual advisor D. To pray with you

Result – Demographics (N=117) Sex: Male Female Unknown 34% (40) 55% (64) 11% (13) Age: 21-30 31-40 41-50 51-60 61 or Older 12% (14) 16% (19) 30% (35) 26% (31) 14% (16) 2% (2) Ethnicity: Caucasian Hispanic African American Asian Other 31% (36) 41% (48) 25% (29) 1% (1) 5% (7) 0%

Result - Demographics Single Married Widow Other 31% (36) 37% (43) 26% Marital Status Single Married Divorced/ Separated Widow Other 31% (36) 37% (43) 26% (30) 3% (4) Language English Spanish Both 66% (77) 16% (19) 15% (17)

Result - Demographics Education: Less than elementary 2% (2) 6% (7) Junior High High School 46% (54) College 30% (35) More than 10% (12) Other 0%

Result - Demographics Religion None 9% (11) Christian 56% (65) Catholic 24% (28) Morman 3% (3) Buddhism 2% (2) Islam 1% (1) Hinduism 0% Judaism Other 6% (7)

Result 1. How important of a role does spirituality play in your life? 63%(74) 25%(29) 7%(8) 4%(5)

Result 2. Do you believe that spirituality can affect your health? 11%(13) 68%(79) 21%(25)

Result 3. Do you want your doctor to speak with you regarding your spiritual well-being? 37%(44) 44%(52) 18%(21)

Result 4. Did your doctor speak with you regarding your spiritual well-being? 6%(7) 79%(92) 15%(18)

Result 5. Under what setting do you want your doctor to speak with you regarding your spiritual well-being? 50%(58) 27%(32) 50%(58)

Result 6.Under what circumstances do you want your doctor to speak with you regarding your spiritual well-being? 43%(50) 43%(50) 15%(18) 34%(40)

Result 7. Why do you want your doctor to know about your spiritual well-being? 38%(44) 37%(43) 15%(18) 24%(28)

Result (Additional Analysis) Among patients who stated No or I don’t know to question 3 (do you want your doctor to speak to you regarding your spiritual well-being?), 74% of them wanted doctor to speak to them under special setting or circumstance. Therefore, 84% of the total patients would like their doctor to speak with them regarding their spiritual well-being under special settings or circumstances.

Result (Additional Analysis). 3 Result (Additional Analysis) *3. Do you want your doctor to speak with you regarding your spiritual well-being? (Adjusted) Yes, including “No” and “I don’t know” to initial question 3 No to all questions 0%(0) 84%(98) 16%(19)

Result (Relationship Analysis 1) For patients who stated that spirituality is very important/important to them, do they think spirituality can affect health? [questions 1->2] (total:104) 72%(75) 15%(16) 12%(12)

Result (Relationship Analysis 1) For patients who stated that spirituality is somewhat or not important, do they think spirituality will affect their health? [questions 1->2] (total:13) 15%(2) 62%(8) 23%(3)

Result (Relationship Analysis 1) Is there a relationship between the role of spirituality in patient’s life and the believe that spirituality can affect patient’s health? [question 1->2] Using Chi square test to compute the data of question 1 and 2 Chi square = 18.7 P value <0.001 Therefore, there is a statistical significance in the relationship between the role of spirituality in patient’s life and the believe that spirituality can affect patient’s health.

Result (Relationship Analysis 2) For patients who believe that spirituality can affect their health, do they want doctor to speak with them regarding spiritual well-being? [question 2->3] (total:79) 41%(32) 39%(31) 20%(16)

Result (Relationship Analysis 2) Result (Relationship Analysis 2) *For patients who believe that spirituality can affect their health, do they want doctor to speak with them regarding spiritual well-being? [question 2->3*] (total:79) *Adjusted Value 90%(71) 10%(8) 0%(0)

Result (Additional Analysis 2) For patients who stated “no” or “I don’t know” regarding whether spirituality can affect their health, do they want their doctor to speak with them regarding their spiritual well-being? [question 2->3] (total: 39) 28%(11) 62%(11) 10%(4)

Result (Relationship Analysis 2) Result (Relationship Analysis 2) *For patients who stated “no” or “I don’t know” regarding whether spirituality can affect their health, do they want their doctor to speak with them regarding their spiritual well-being? [question 2->3*] (Total:39) *Adjusted Value 62%(24) 30%(12) 8%(3)

Result (Relationship Analysis 2) Is there a relationship between whether patients think spirituality can affect their health and whether patients wants doctors to speak to them regarding spirituality? Chi square= 5.41 P value <0.1 Not clinically significant However, if compute the data after adjustment for under special settings or circumstances: *Chi square=13.3 *P value <0.001 Clinically significant Therefore, patients who think spirituality can affect their health want their doctors to speak to them under special settings/circumstances.

Result (Relationship Analysis 3) Is there a relationship between how important of a role does spirituality play in a patient’s life and whether they want their doctor to speak with their spiritual well-being? [question 1->3] Chi square=8.8 P value < 0.01 Clinically significant After adjusted with special settings or circumstances: *Chi square=9.6 *P value < 0.01 Therefore, patients who believe spiritually plays an important part of their life want their doctors to speak with their spiritual well-being.

Result (Relationship Analysis 4) Is there a relationship between patient’s age and whether they want their doctor to speak about spirituality? Patient data was separated between age 21-40 and age greater than 41. Chi square = 5.69 P value <0.025 Clinically significant. However, after adjusted by special settings or circumstances: *Chi square = 0.36 *P value <1 Not Clinically significant.

Result (Relationship Analysis 5) For patients that stated they want their doctor to speak to them regarding spiritual well-being, did their doctors actually speak with them? [question 3->4] (total: 44) 11%(5) 70%(31) 18%(8)

Conclusion This study showed that at RCRMC, 84% of patients would like their doctor to speak with them regarding their spiritual well-being under special settings or circumstances. However, only 11% of those patients (6% of total) patients reported ever having their doctor discussed about their spiritual well-being.

Conclusion Majority of patients (68%) believes that spirituality can affect their health. Among patients who stated “No” or “I don’t know” to whether they want their doctor to speak to them regarding spiritual well-being, 74% of them wanted doctor to speak to them under special settings or circumstances.

Conclusion Patients welcome spiritual discussion under special settings or circumstances regardless of their age. Patients are equally open to discuss about their spiritual well-being in routine office visits (50%) or during hospitalizations (50%).

Conclusion Patients most likely want their physicians to address their spiritual well-being when they have serious chronic medical illness (43%) or when they are very ill with the possibility of dying (43%).

Conclusion Patients’ main reason for wanting the physicians to know about their spiritual well-being is because they believe that physicians can understand better (38%) and can better help them with their medical condition (37%).

Limitations 1. Study Size 2. Multiple unfilled data 3. Lack of Spanish speaking participants 4. Subjects who participated in the study had higher educational levels than our average patient population

Recommendations Physicians should look to address patient’s spiritual need in both inpatient or outpatient setting. Physicians should be more aware of patient’s spiritual needs when patients are diagnosed with serious medical problems or when patients are very ill with the possibility of dying. Patient might be more likely to comply with the treatment plan if physicians address their spiritual needs.

Implication If patients’ believe that spirituality can affect their health and wants physician’s involvement of their spiritual well-being, why are the physicians ignoring the patients’ need?

Implication As family physicians, we should treat the patient as a whole person. Therefore, we should care about the patient’s physical, mental, and spiritual health.

Implication The only way to find out your patient’s spiritual well-being is by asking.

References 1. Koenig H, McCullough M, Larson D. Handbook of Religion and Health. Oxford, 2001 2. McCord G, Gilchrist VJ, Groossman SD, et al. Discussing spirituality with patients: a rational and ethical approach. Annals of Family Practice. 2004;2:356-361 2. Chi Square Tutorial and Calculator. http://www.georgetown.edu/faculty/ballc/webtools/web_chi_tut.html

Special Thanks Special thanks to Dr.Jafri for encouraging me to pursue this project. Special thanks to Dr.Lee for helping me make this project possible. Special thanks to Dr.Carmichael for suggestions on improving my project. Special thanks to the FCC front desk crew for passing out the surveys. Special thanks to God for letting me realize the importance of patient’s spiritual health.