1. Discussing Spiritual Health in Primary Care Ishbel Orla Whitehead Career Start GP and Post-CCT Academic Fellow
Introduction
Discussing spirituality and the taking of a spiritual history is viewed by the RCGP and the GMC as an essential part of holistic care.1 2 Models of spiritual health echo the ‘Five Ways to Wellbeing’ advocated by the government3, and signposting to religious/spiritual support could echo ‘social prescribing’ initiatives.
There are many barriers to GPs discussing spirituality with their patients.4-10 Some subscribe to the Cartesian model of medical training, others have concerns about proselytising, a lack of training, or causing offense. However, given the growing evidence that religiosity is associated with better health outcomes11, and conversely that spiritual distress can lead to slower recovery times and poorer health11 12, ignoring this aspect of holistic care could cause harm, and miss opportunity to do good.
Conclusion
Spiritual health is an oft neglected aspect of holistic care, and history taking tools will help address that. The planned study is to look at the acceptability of two tools with GPs in the north of England.
References
GMC. Good Medical Practice In: Council GM, ed. London, 2013.
2. RCGP. The RCGP Curriculum: Professional & Clinical Modules. In: Practitioners RCoG, ed. London, 2016.
3. Foresight. Five Ways to Wellbeing. In: Science GOf, ed., 2008.
4. Puchalski CM. The FICA Spiritual History Tool #274. Journal of Palliative Medicine;17(1):105-6.
5. Koenig HG. STUDENTJAMA. Taking a spiritual history. JAMA;291(23):2881.
6. Larimore WL. Providing basic spiritual care for patients: should it be the exclusive domain of pastoral professionals? American Family Physician;63(1):36,
7. Koenig HG. Spiritual assessment in medical practice. American Family Physician;63(1):30, 33.
8. Vermandere M, Choi Y-N, De Brabandere H, et al. GPs’ views concerning spirituality and the use of the FICA tool in palliative care in Flanders: a qualitative study. British Journal of General Practice 2012;62(603):e718
9. Harbinson MT, Bell D. How should teaching on whole person medicine, including spiritual issues, be delivered in the undergraduate medical curriculum in the United Kingdom? BMC medical education 2015; 15.
10. Vermandere M, De Lepeleire J, Smeets L, et al. Spirituality in general practice: a qualitative evidence synthesis. British Journal of General Practice 2011;61(592):e749.
11. Zimmer Z, Jagger C, Chiu C-T, et al. Spirituality, religiosity, aging and health in global perspective: A review. SSM - Population Health 2016;2:
12. Puchalski C. Spirituality in health: the role of spirituality in critical care. Critical Care Clinics;20(3): , x.
13. Anandarajah G, Hight E. Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. American Family Physician;63(1):81-9.
Methods
The planned study will look at the main tools offered in the literature to aid spiritual history taking in primary care, specifically the FICA4 and HOPE13 tools. A survey with vignettes will be used with a variety of GPs within the North East, to assess how palatable and useful these tools may be in opening the conversation between GPs and patients.
HOPE11
Hope
Organised religion
Personal spirituality and practices
Effects on medical care and end of life issues
FICA4
Faith
Importance and influence
Community
Address in care