Transcript No Slide Title

The Faith Factor: Getting to the Soul
of the Matter
Mark C. Pettus M.D. FACP
Clinical Associate Professor of Medicine
University of Massachusetts Medical School
Points To Be Made
• Diverse forms of faith, spiritual, and religious practice
are central in the lives of most people we treat.
• Often when confronting illness, spiritual and religious
concerns are awakened or intensified.
• A greater awareness and understanding of these
issues, in some circumstances, strengthens our
therapeutic potential as clinicians.
• There appears to be a clear relationship between
individual spirituality and individual health.
Influence of faith perspectives on the
experience of illness
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Meaning in the context of illness
Coping strategies and self-care
Medical decision making
Care management
Avenues for healing not routinely addressed
in a biomedical model of care
Religion vs. Spirituality
• Religion: an organized belief system that
fosters a closeness to God
• Spirituality: quest for understanding,
meaning, and purpose that nurtures a deeper
connection to held values that may (or may
not) lead to development of religious rituals
and community
“Nothing in life is more wonderful
than faith….mysterious,
indefinable, known only by its
effects”
William Osler
“God heals, and the doctor
takes the fees”
Benjamin Franklin
How Might Spiritual Practices Heal?
• Social support, community, a key to health and longevity
• Our wellness is clearly influenced by our physical,
mental, emotional, and spiritual health.
• Spiritual practices can sometimes assist people to better
handle illness, suffering, and loss.
• Relaxation response with resultant reduction in stress,
lowering of BP, with decreases in metabolic, heart and
respiratory rate, as can be seen with prayer or
meditation.
• Placebo Effect-A biologic manifestation of faith?
Where Might Spirituality and
Coping Intersect?
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Nighttime fear
Psychiatric problems
Suffering e.g., from domestic abuse
Hospitalization
Disability
Substance abuse
Terminal Illness
How does a spiritual wound appear?
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Lack of meaning and purpose
Hopelessness
Despair
Not being remembered
Guilt or shame
Abandonment
Grief
Loss
Anger
“Religion without science is blind.
Science without religion is lame.”
Albert Einstein
“The spiritual dimension cannot
be ignored, for it is what makes us
human”
Victor E. Frankl
Religious and Spiritual Perspectives and Practice
Religious Beliefs of Americans
Gallup Poll
• 92% believe in God
• 83% view the Bible as the actual or inspired word
of God.
• 65% pray at least once daily
• 50% say religion is “very important” in their life
• 35% have attended worship services within the
last week
Faith and Healing
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Time/CNN Poll (n=1004)
82% believe in the healing power of prayer
77% believe God may cure serious illness
73% say praying for others can help cure
illness
• 64% say MDs should pray with patients if
requested
Use of religion and spirituality for health
reasons in African-American Women
2004
• Whitney Dessio et al.
• 43% had used religion/spirituality for health
reasons in the past year
• Most often used these practices for serious
conditions such as cancer, heart disease, and
depression
Most frequently chosen behaviors to
improve mood
Time Magazine2004 (1000 Americans)
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Talking to family and friends
Listening to music
Prayer
Helping others in need
JCACHO 2003
• 1,720,000 individuals providing information
regarding preferences for medical care
• Meeting spiritual and emotional needs was
the most common priority noted by patients
and families.
National Center for Health Statistics and
NCCAM
31,000 adults - May 2004
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45% had used prayer for health reasons
43% prayed for their own health
25% had others pray for them
10% participated in a prayer group for their
health
A Sampling of the Data
Linking Spiritual Practice with Positive Health
Outcomes
Improving Immune Function
• 1,700 older adults from N.C.
• Those who attended church at least once/week
were half as likely as non-attendees to have
elevated IL-6 levels and CRP
• Lower levels of alpha-2 globulin and fibrin ddimers
• Koenig et al. Int.J. Psych Med 1997;27(3)
Religious Beliefs and Advanced Cancer
• In many studies published in the palliative care
literature, support of spiritual and religious
faith perspectives were positively correlated
with life satisfaction, happiness and improved
symptom management, but not survival.
Recovery from Depression
• 87 depressed hospitalized patients.
• Duke University- Outcome in terms of
depressive symptoms was strongly
predicted by the extent to which a patient’s
religious faith was a central motivating
force in their lives.
• George et al. Am J Psych
Religious-spiritual expression and relationship
to psychiatric and substance use disorders
Kendler KS et al. Am J Psych 2003
• Gratitude, forgiveness, God as personal
support/judge and social religiosity were
associated with reduced risk for depression,
anxiety disorders, bulimia, antisocial
behavior, nicotine, alcohol and drug abuse
or dependence.
Religion and Health in American
Youth
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5000 high school seniors
Religiosity linked to better decision making
Lower rates of drinking, smoking, drug use
Lower teen pregnancy rates
Higher life-satisfaction, academic and social
competence
• Lower suicidal ideation
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Jessor,R. et al. J Pers Soc Psychol. 1998
Wallace et al. Health Educ Behave. 1998
DuRant, RH et al. Pediatrics. 1996
Donelson, E. et al. J Adolescence. 1999
Cornelius, MD et al. Pediatrics. 1995
Scheidlinger s, et al. Psychoanal Rev. 1997
Adjustment, spirituality, and health in
women on hemodialysis
Tanyi RA et al. Clin Nurs Res 2003
• 65 women aged 24-82 receiving
hemodialysis at 5 outpatient centers in
Minnesota
• Psychosocial adjustment and self-perceived
health correlated highly with religious and
spiritual well-being
Lower Mortality in Religious Kibbutzim
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3,900 Israelis followed for 15 years
8% death rate in secular kibbutzim
4% death rate in religious kibbutzim
AM J Pub Health 1996
Mortality
• 1931 older residents from Marin County, Ca.
• Regular church attendance reduced mortality over a
five year period.
• Physical functioning and social support.
• Other factors need to be examined.
• Oxman AmJPubHealth 1998 88;(10)
Active Religious Involvement Increases the
Chances of Living Longer by 29%.
• Metaanalysis of 42 studies
• 126,000 people
• Attendance at religious services, personal importance of
one’s religious faith, comfort with one’s relationship with
God
• Stronger link with participation in religious organizations
• Controlled for other factors
• McCullough, Larson et al. Health Psychology 2000;19(3)
Post CABG
• Dr. Thomas Oxman
• The factor that best predicted survival of
coronary bypass surgery and a smooth
post-op course was the degree of religious
strength and spiritual meaning people
found in their lives
Recovery from Elective Cardiac
Surgery
• Six Month Mortality Rates (n=232)
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Group
Rate
• Overall
9%
• Churchgoers
5%
• Non-churchgoers
12%
• Deeply Religious
0%
• Oxman, Psychosom Med 1995;57:5-15
The Cochrane Database of Systematic
Reviews
• Current data on the health effects of
intercessory prayer are inconclusive.
• The evidence that exists, however is
interesting enough to justify further
study.
• Any effects may be beyond present
scientific understanding.
Reducing Length of Hospital Stays
• 542 patients age 60 or older
• Those attending religious services weekly
or more, reduced LOS by more than half
and were 43% less likely to have been
admitted in the previous year
• Koenig et al. South Med J 1998;91(10)
Mind-Body Neuroscience
The Faith Factor
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Bonding-attachment, social connectivity
Reward-”meaning-maker”
Belief and expectation
Prayer as a form of meditation
Reduction of allostatic load
Health-promoting virtues
Resilience
Are there Negative Impacts of Religion?
Reliance on Faith Healing
• 172 children who died after their parents
relied on faith healing instead of standard
medicine.
• 140 children (81%) had treatable problems
allowing excellent prognosis eg.
Dehydration, diabetes, pneumonia,
appendicitis, epilepsy
• Asser et al, Pediatrics 1998; 101(4)
Options for Spiritual Intervention
• Ignore spiritual issues/content
• Acknowledge role of religion/spirituality in
patient’s care
• Inquire about beliefs and practices
• Refer to clergy
• Provide spiritual counseling
• Pray for/with patients
Taking a Spiritual History
Developed by Christina Puchalski MD, GWISH
• Faith e.g. Does faith play an important role in your
life? What gives you meaning?
• Influence e.g. Does your faith influence the way you
care for yourself?
• Community e.g. Are you a member of any
congregation or spiritual community?
• Address e.g. How would you like me as your doctor to
address these issues in your care?
What I am not saying
• Physicians should supplant clergy
• Prayer should supplant Prozac
• Outcomes of studies are proof/disproof of divine
intervention
• Saints are healthier than sinners
• Prayer is a magic bullet or panacea
• Religious or spiritual issues should be addressed
in every clinical situation
What I am saying
• Physicians help patients (and themselves) by
acknowledging and respecting individual
experiences, beliefs, practices and autonomy in
matters pertaining to spirituality and religion.
• Spiritual beliefs and practices may be beneficial
for health and are very cost effective.
• The medical effect of faith depends more on the
individual intensity of one’s spiritual commitment
than on the particularity of one’s faith tradition.
• Physicians and other health care providers
are in unique positions to explore and
optimize the the benefits of faith in those
they treat, when appropriate
Patterns in Physicians Referral to Hospital-Based
Chaplaincy Services and Views on Spiritual Care.
Rodrigues, Phillips, and Kliewer OHSU 2002
Role of Spirituality in Physician’s Life
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BMC n=20
40
Study n=1590
35
30
25
BM C
Study
20
15
10
5
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Very
Significant
Significant
Some
Significance
Very
Little
None
Participation in a Community of Faith
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80
70
60
50
BM C
Study
40
30
20
10
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Yes
No
Participation in Personal Spiritual
Practices
80
70
60
50
BM C
Study
40
30
20
10
0
Prayer
Meditation
Worship in a
Faith
Community
Fasting
Study of
Religious
Writings
Physician Inquires About Patient’s
Faith Practice
35
30
25
20
BM C
Study
15
10
5
0
Never
Rarely
Sometimes
Often
Always
Physician Waits for Patient to Bring Up the
Topic of Spirituality First
45
40
35
30
25
BM C
Study
20
15
10
5
0
Never
Rarely
Sometimes
Often
Always
Physician Considers the Patient’s Spiritual
Needs in Care of Patient
60
50
40
BM C
Study
30
20
10
0
Never
Rarely
Sometimes
Often
Always
What do you see as the obstacles to narrowing the gap
between the importance that spirituality plays in our patients
lives and the infrequency with which these issues are
addressed in the clinical setting?
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More appropriate for attending to discuss.
Educational deemphasis
Lack of motivation
Often awkward with fleeting patient relationships
Time constraints
Personal awareness and comfort
Lack of acceptance by medical community
Inattentiveness
CDC -Carter Center’s Interfaith Health
Programs
• Witness Project: A community-based breast
and cervical cancer education program.
• Project Vision: Preventing and controlling risk
factors associated with cardiovascular disease.
• Heart Body and Soul: 230 churches in East
Baltimore conducting education and training in
health screening and smoking cessation.
A Survey of Our Senior Residents (n=20)
Spirituality plays an important role in the lives of people I treat.
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Not important:
Somewhat Important:
Important:
Very Important:
0%
30%
45%
25%
Patient’s views regarding spirituality can
influence the way they view their illness/wellness.
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Not important:
Somewhat important
Important
Very Important
0%
10%
40%
50%
Spirituality Plays an Important Role
in My Life.
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Not Important:
Somewhat Important:
Important:
Very Important:
10%
15%
20%
55%
I feel comfortable addressing spirituality
with my patients.
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Not at all:
5%
Somewhat:
20%
Depends on the circumstances: 50%
Always, if the circumstances are
appropriate:
25%