Transcript Document

2nd Annual Cultural Competence Seminar
Paul F. Foster School of Medicine
Texas Tech University Health Sciences Center
April 12, 2013
Religious Diversity, Spirituality &
Implications for Clinical Practice
Chaplain John W. Ehman
University of Pennsylvania Medical Center – Penn Presbyterian
Philadelphia, PA
4/1/13
Plan for the Presentation:
1) Review the significance of spirituality/religion for clinical practice
in a diverse hospital setting
2) Provide a practical strategy for clinicians' support of diverse
patients who engage their religion or spirituality in relation to
their health and treatment
3) Suggest ways to manage potentially problematic aspects of
interaction around spirituality/religion across lines of diversity
The challenges of diverse religious patients:
A Catholic patient is distraught as she goes to surgery after her
request for the Eucharist has been denied by both her physician
and priest because she is NPO.
The challenges of diverse religious patients:
A Catholic patient is distraught as she goes to surgery after her
request for the Eucharist has been denied by both her physician
and priest because she is NPO.
A Muslim patient is found on the floor of his room, unable to get up.
He had gotten out of bed in order to kneel and pray.
The challenges of diverse religious patients:
A Catholic patient is distraught as she goes to surgery after her
request for the Eucharist has been denied by both her physician
and priest because she is NPO.
A Muslim patient is found on the floor of his room, unable to get up.
He had gotten out of bed in order to kneel and pray.
A Buddhist patient refuses pain medication, because he is worried
that it will cloud his mindful awareness.
The challenges of diverse religious patients:
A Catholic patient is distraught as she goes to surgery after her
request for the Eucharist has been denied by both her physician
and priest because she is NPO.
A Muslim patient is found on the floor of his room, unable to get up.
He had gotten out of bed in order to kneel and pray.
A Buddhist patient refuses pain medication, because he is worried
that it will cloud his mindful awareness.
A Jewish patient whose discharge paperwork was delayed until
after sunset on Friday now refuses to leave the hospital because
of religious restrictions on travel over the Sabbath.
The challenges of diverse religious patients:
A Catholic patient is distraught as she goes to surgery after her
request for the Eucharist has been denied by both her physician
and priest because she is NPO.
A Muslim patient is found on the floor of his room, unable to get up.
He had gotten out of bed in order to kneel and pray.
A Buddhist patient refuses pain medication, because he is worried
that it will cloud his mindful awareness.
A Jewish patient whose discharge paperwork was delayed until
after sunset on Friday now refuses to leave the hospital because
of religious restrictions on travel over the Sabbath.
A very spiritual patient with Cystic Fibrosis experiences a breathing
crisis. Her nurse knows that the patient usually prays to control her
anxiety and regulate her breathing, but the patient says, “I can’t
pray anymore to a God who is so uncaring.”
Number of Medline-Indexed English Articles by Year, with
Keywords: RELIGION and SPIRITUALITY
11
10
20
20
09
08
20
07
20
06
20
05
20
20
04
03
20
02
20
01
20
00
20
20
99
98
[ Includes the variations: religious, religiosity, religiousness, and spiritual ]
19
97
19
96
19
95
19
19
94
93
19
92
19
91
19
90
19
19
89
88
19
87
19
86
19
85
19
19
84
83
19
82
19
81
19
19
19
80
2200
2000
1800
1600
1400
1200
1000
800
600
400
200
0
John Ehman, 2012
Number of Medline-Indexed English Articles by Year, with
Keywords: RELIGION and SPIRITUALITY
11
10
20
20
09
08
20
07
20
06
20
05
20
20
04
03
20
02
20
01
20
00
20
20
99
98
[ Includes the variations: religious, religiosity, religiousness, and spiritual ]
19
97
19
96
19
95
19
19
94
93
19
92
19
91
19
90
19
19
89
88
19
87
19
86
19
85
19
19
84
83
19
82
19
81
19
19
19
80
2200
2000
1800
1600
1400
1200
1000
800
600
400
200
0
John Ehman, 2012
Number of Medline-Indexed English
Articles by Year, with Keywords
SPIRITUAL or SPIRITUALITY
800
700
600
500
400
300
200
100
20
06
20
04
20
02
20
00
19
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
80
0
John Ehman, 6/30/09
Number of Medline-Indexed English
Articles by Year, with Keywords
SPIRITUAL or SPIRITUALITY
800
700
600
500
400
300
200
100
20
06
20
04
20
02
20
00
19
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
80
0
John Ehman, 6/30/09
Among the factors in the mid-1990s affecting
the study of spirituality/religion & health:
• Greater attention paid to religious values, beliefs, and
practices as key aspects of patient diversity (e.g., new
emphasis by the Joint Commission)
• Growing sense among health care providers and researchers
of religion’s role in health-pertinent behaviors and health
care decision-making -- important for “knowing your patient”
• Research begins accumulating significant data that patients’
spirituality/religiosity may be important to medical outcomes
and thus to the process of “healing your patient”
Two things to keep in mind about the
modern field of Spirituality & Health:
1) It is still nascent in the current form
2) It has somewhat fluid terminology
In the health care literature, religion is associated
with institutional systems of beliefs and practices,
whereas spirituality is associated with personal
experiences and an individual quest for meaning.
Spirituality is generally seen as a broad concept,
going beyond the “limits” of religion.
The Two Most Common Views of the
Relationship of Spirituality to Religion
in the Current Health Care Literature
Spirituality
Spirituality
Religion
Religion
Terminology pairings in Medline articles, 1998-2011
220
200
180
160
140
120
100
80
60
40
20
Spiritual
Religious
Gr
ow
th
Re
so
ur
ce
s
th
St
ren
g
pin
g
Co
Pr
ob
lem
s
Cr
isi
Su
ffe
rin
g
St
ru
gg
le
str
es
s
Di
Pa
in
0
Existential
...And, how terms may be defined and used by
researchers or providers, in academic articles
or in clinical documentation systems, may not
be in sync with how the public or an individual
patient may relate to those terms.
Americans and Religious Affiliation
A 2012 Pew Research Center survey found that one-fifth of
the U.S. public – and a third of adults under 30 years old –
now describe themselves as “religiously unaffiliated.” This
is partly due to an increasing trend to drop all sense of
connection to a specific religious tradition when there is not
an active social involvement in a congregation.
Moreover, 18% of American adults describe themselves
now as “spiritual but not religious.”
Pew Research Center’s Forum on Religion & Public Life,
"'Nones' on the Rise…,” report issued October 9, 2012
I.
What is the significance of spirituality/religion and
of spiritual/religious diversity for clinical practice?
Polls re: Spirituality/Religion in the US
• 90-96% of adults in the US say they “believe in God”
• over 40% say they attend religious services regularly, usually
at least once a week
• 50-75% say religion is “very important” in their lives
• 90% say they pray, and most (54-75%) say they pray at least
once a day
• over 80% say that “God answers prayers”
• 79-84% say they believe in “miracles” and that “God answers
prayers for healing someone with an incurable illness”
--These percentages are summary characterizations of numerous
national surveys showing fairly consistent results across time
Recent health care literature largely
addresses spirituality/religion as…
… a ground for “religious” social support
… a value basis for personal meaning-making
(and therefore understanding illness and
coping with crises) and decision-making
… a context for behavior that can influence the
way the body works (e.g., meditation that
can affect physiological reactions to stress)
Research increasingly indicates that health-positive
effects of spirituality/religion far outweigh
concerns about health-negative effects.
For example:
• fewer dangerous behaviors (e.g., less substance abuse,
unsafe sex, or neglect of health screenings)
• less suicide and generally greater aversion to suicide
• less depression and faster recovery from depression
• greater sense of meaning/purpose in life, hopefulness
--See: Koenig, H.G, et al., Handbook of Religion and Health, 2001/2011;
and Koenig, H.G., Testimony to the US House of Representatives
Subcommittee on Research and Science Education, 9/18/08
• lower rates of coronary artery disease
• lower cardiovascular reactivity
• greater heart rate variability
• lower blood pressure and generally less hypertension
• tendency for better outcomes after cardiac surgery
• better endocrine function
• better immune function
• lower cancer rate and better outcomes
• lower mortality and longer survival generally
--ibid.
Theoretical Model of How Religion Affects Physical Health
--adapted from Koenig, et al., Handbook of Religion and Health, 2001
Stress
Hormones
R
E
L
I
G
I
O
N
Mental
Health
Social
Support
Health
Behaviors
Religion also affects Childhood Training,
Adult Decisions, and Values & Character;
which then in turn affect mental health,
social support, and health behaviors.
Infection
Cancer
Immune
System
Autonomic
Nervous
System
Disease Detection
and Treatment
Compliance
High Risk
Behaviors
(smoking, drugs)
Heart
Disease
Hypertension
Stroke
Stomach
& Bowel
Liver
& Lung
Accidents
& STDs
A Caution about Expectations of “Dramatic” Effects
of Spirituality/Religion on Medical Outcomes
We should be prepared to appreciate how empirical
findings may indicate significant -- but not “dramatic”
or “sensational” -- effects of spirituality/religion on
medical outcomes.
Spirituality, the Brain, and Cell Life
Studies using MRI indicate not only that certain kinds of
religious/spiritual meditative practices can influence blood
flow and activity in the brain but can even have a lasting
effect on brain function and perhaps structure.
--Newberg, A. B., et al., "Cerebral blood flow differences between long-term meditators
and non-meditators,“ Consciousness & Cognition 19, no. 4 (Dec 2010): 899-905.
Some forms of mindfulness meditation, practiced over time,
appear to control cognitive stress reactions like threat
appraisal and rumination to such a degree as to protect
against the cellular process of the deterioration of telomeres,
affecting cell life.
--See: Epel, E., et al., "Can meditation slow rate of cellular aging? Cognitive stress,
mindfulness, and telomeres," Annals of the New York Academy of Sciences 1172
(Aug 2009): 34-53.
Frontal Lobe Activity of Buddhists Meditating
--see Newberg, et al., "The measurement of regional cerebral blood flow…,”
Psychiatry Research: Neuroimaging 106, no, 2 (April 10, 2001): 113-122.
Parietal Lobe Activity of Buddhists Meditating
--see Newberg, et al., "The measurement of regional cerebral blood flow…,”
Psychiatry Research: Neuroimaging 106, no, 2 (April 10, 2001): 113-122.
Non-Meditators and Long-Term Meditators
--Newberg, A. B., et al., "Cerebral blood flow differences between long-term meditators
and non-meditators,“ Consciousness & Cognition 19, no. 4 (Dec 2010): 899-905.
Patients’ Spiritual Beliefs, Health Care
Decision-Making, and Physician Inquiry
• A University of Pennsylvania study (n=177) indicated that
nearly half of patients may have spiritual/religious beliefs
that would influence their health care decision-making if
they became gravely ill.
• Two-thirds of patients would welcome a carefully worded
exploratory question about spiritual or religious beliefs.
(E.g., “Do you have spiritual or religious beliefs that may
affect your medical decisions?”)
• Two-thirds of patients think that such an inquiry by a
physician would make them trust the physician more.
-- Ehman, J.W., et al., “Do patients want physicians to inquire…,”
Archives of Internal Medicine 159, no. 15 (1999): 1803-1806
Spiritual/Religious Support & Medical Costs
• A multisite study by a Harvard group found that medical
costs for cancer patients in the last week of life (n=339)
were higher for those who reported not receiving sufficient
spiritual/religious support from the care team as a whole.
• On average, care cost $2441 more than for those who
received spiritual/religious support from the team, but
$4060 for “high religious coping” patients and $4206
among racial/ethnic minorities
• Costs centered around ICU care and hospice care in the
last week of life.
-- Balboni, T., et al., “Support of cancer patients’ spiritual needs
and associations with medical care costs at the end of life,”
Cancer 117, no. 23 (Dec 1, 2011): 5383-5391
The picture emerging from spirituality/religion & health
research is promising, but application to the
clinical setting remains complex.
Causal relationships/mechanisms are not well understood.
The nascency of the field means that few findings
have been tested across diverse populations.
Application of the findings relates not only to questions of
health but to patients’ rights regarding spirituality/religion.
The role or function of spirituality/religion in the
life of any patient is notoriously hard to predict.
Spirituality  Grave Illness & Treatment
● Congregational connections may bring social support and practical
assistance
● Patients’ own clergy may bring “authoritative” support and guidance
for coping
● Scriptures may help patients find focus and direction amid crisis
● Religious rituals may bring a sense of assurance and “deepening”
● Prayer/meditation may bring peace and encouragement
Spirituality  Grave Illness & Treatment
● Congregational connections may bring social support and practical
assistance (or constrict the patient by the imposition of the group’s
norms)
● Patients’ own clergy may bring “authoritative” support and guidance
for coping (or may give “simple” answers, poor guidance, or even
shaming chastisement)
● Scriptures may help patients find focus and direction amid crisis (or,
as complex documents, scriptures may be confusing or disturbing)
● Religious rituals may bring a sense of assurance and “deepening”
(but are often disrupted by illness and treatment, causing stress)
● Prayer/meditation may bring peace and encouragement (but some
patients find prayer/meditation practice difficult during illness)
Grave Illness & Treatment  Spirituality
● Patients may experience “stress-related growth” that is spiritual
in nature or is spiritually enriching
● Questions of “what really matters” can open some gravely ill
patients to affirm who they are “at the core,” spiritually
● Patients may find in their self-experience of resilience an
affirmation of their spirituality
● The experience of loss of control can shift a patient’s sense of
locus of control from himself/herself to a “higher power”
Grave Illness & Treatment  Spirituality
● Patients may experience “stress-related growth” that is spiritual
in nature or is spiritually enriching (or they may feel diminished,
cut off, and beaten by illness/treatment and spiritually withered)
● Questions of “what really matters” can open some gravely ill
patients to affirm who they are “at the core,” spiritually (or can
lead them to question long-held spiritual/religious beliefs)
● Patients may find in their self-experience of resilience an
affirmation of their spirituality (or may see in their self-perceived
weaknesses, such as feelings of fearfulness, a spiritual “failure”)
● The experience of loss of control can shift a patient’s sense of
locus of control from himself/herself to a “higher power” (or can
create a sense of sheer vulnerability and “abandonment by God”)
II.
What are practical strategies to recognize the
potential importance of spirituality/religion in the
clinical setting while working with diverse patients?
-- John Ehman
Need for a strategy for health care
providers to support patients spiritually...
…that can work across lines of religious diversity
…that takes very little time in the clinical encounter,
while potentially bringing clinically significant benefits
…that does not necessitate a large knowledge base
regarding spiritual/religious traditions and issues
…that does not blur professional roles/boundaries,
and especially does not ask health care providers
to act as spiritual counselors
A Pastoral Care Approach …with Implications
Chaplains often work across lines of religious diversity by
focusing on the experiential and emotional issues or
dynamics that affect the patient’s sense of meaning, quest,
and relationship. Chaplains try to follow the lead of the
patient, to help him/her feel heard, connected, and safe to
venture wherever he/she feels distress or otherwise has
need. The chaplain expresses an openness to spiritual
concerns and keeps in mind that identified needs which are
not explicitly religious/spiritual may still be spiritually relevant
for the patient. Also, non-religious or non-theistic patients
may have “spiritual” needs.
This approach may have implications for the general spiritual
support of patients by physicians, nurses, and others.
Health care providers can support
diverse patients spiritually by:
● acknowledging patients’ statements of meaning,
quest, and relationship
● affirming the emotional nature of our humanity
● looking/listening for indications of possible
spiritual distress
● expressing interest in the patient’s spirituality
per se: particular spiritual resources & issues
pertinent to the provider-patient relationship
MEDS
Supporting Patients Spiritually with MEDS
M
= acknowledge statements of meaning/quest/relationship
E
= affirm the emotional nature of our humanity
D
= look/listen for indications of possible spiritual distress
S
= express an interest in the patient’s spirituality per se:
particular resources and issues pertinent to the
provider-patient relationship; and consider options
for explicit inquiry
MEDS
M
= acknowledge statements of meaning/quest/relationship
E = affirm the emotional nature of our humanity
D = look/listen for indications of possible spiritual distress
S = express an interest in the patient’s spirituality per se:
particular resources and issues pertinent to the
provider-patient relationship; and consider options
for explicit inquiry
Acknowledging Patients’ Statements of
Meaning, Quest, and Relationship
Patients may make overtly religious/spiritual statements of
meaning, quest, and relationship, but often the expression is
more subtle and indirect. E.g.: “God has a plan,” “I know God’s
with me,” or “God didn’t bring me this far to let me down now”;
but also, “I'm sure learning a lot,” “Something like this changes
your priorities,” or “I'm so thankful for my family.”
Acknowledgement can be made as simply as reflecting or
paraphrasing the patient's statement or by saying, for instance:
“I appreciate your perspective,” “You're finding your way ahead
through this,” “You're in touch with what's important,” or “This is
a journey.”
--Such statements generally open up communication
Responding to a patient is these ways might seem a matter
of general courtesy and sensitivity, but at the right moment
can be experienced very much as a spiritual support.
MEDS
M = acknowledge statements of meaning/quest/relationship
E
= affirm the emotional nature of our humanity
D = look/listen for indications of possible spiritual distress
S = express an interest in the patient’s spirituality per se:
particular resources and issues pertinent to the
provider-patient relationship; and consider options
for explicit inquiry
Emotion and Spirituality
Emotion may be said to be the “heart” of spirituality, and an
affirmation of emotion can help patients express spiritual need.
E.g.: patients who are ashamed of their anxiousness or tears
may be blocked from expressing or exploring spiritual issues, or
emotional lability may be experienced as a spiritual problem.
Affirmation of emotion can occur through acknowledgement and
normalization. For instance:
● “Your tears show how deeply you feel, how important things
are to you.”
● “There's so much about what’s happening that’s scary.”
● “Illness and treatment can be such an emotional rollercoaster.”
● “Your spirit feels heavy. I want to affirm how well you are
managing in all of this.”
--Listen for spiritual content in patients’ responses.
MEDS
M = acknowledge statements of meaning/quest/relationship
E = affirm the emotional nature of our humanity
D
= look/listen for indications of possible spiritual distress
S = express an interest in the patient’s spirituality per se:
particular resources and issues pertinent to the
provider-patient relationship; and consider options
for explicit inquiry
Spiritual Distress
Any sign of physical or psychological distress may
have connections to a patient's spirituality, including
unexplained or unmanaged pain, trouble sleeping,
anxiety or agitation.
Spiritual distress can have mundane indicators.
Conversational Hints of Possible Spiritual Distress
1) Interruption of religious practices / rituals of every kind (e.g.,
congregational or social religious activities, prayer)
2) Issues of meaning amid change (e.g., questions/statements
about the meaning or purpose of his/her pain or illness or of life
in general, expressions about a sense of injustice, overwhelming
salience of loss, hopelessness, abandonment/withdrawal from
relationships or groups)
3) Religiously associated expressions (e.g., mentions illness as
“deserved” and/or “punishment,” talks of “evil” or “the enemy,”
describes self as “bad” or “sinful,” uses colloquial expressions
with religious overtones like “this is hell,” repetition of
“forgiveness” language, refers to death as “judgment day,” or
wonders about “God's plan”)
One effective way to be alert to spiritual distress
is to think of how a patient’s physical challenges
may be problematic to spiritual activities:
● Barriers to attending congregational activities (including
treatments or check-ups over religious holidays)
● Inability to kneel [--also a falling hazard]
● Difficulty using hands (e.g., to make religious gestures or
to hold religious objects or scriptures)
● Trouble seeing (e.g., to read religious material)
● Trouble hearing (e.g., to listen to music or religious
broadcasts or speak on the phone with friends/clergy)
● Pain and medication issues (e.g., affecting meditation/prayer)
● Body image issues affecting a sense of “cleanliness”
(including difficulty washing)
MEDS
M = acknowledge statements of meaning/quest/relationship
E = affirm the emotional nature of our humanity
D = look/listen for indications of possible spiritual distress
S
= express an interest in the patient’s spirituality per se:
particular resources and issues pertinent to the
provider-patient relationship; and consider options
for explicit inquiry
An Inquiry about Spiritual/Religious Beliefs
● Provider initiative may be necessitated by patients'
reluctance to introduce the topic --because of fears of
provider reaction (and power dynamics), lack of salience
about the subject during often highly directed clinical
interactions, or uncertainty about how to talk about
beliefs outside of a familiar religious context.
● Inquiry can bring to light important information affecting
how providers and patients work together, including
how patients may make health care decisions.
● A carefully worded inquiry about spiritual/religious beliefs
may be experienced as a significant support, and that
could have larger implications for provider-patient
communication and relationship.
Health care provider inquiries
about spirituality should…
…implicitly or explicitly indicate that the purpose
is to provide health care that honors patients’
beliefs and values (and that the question is not
a judgment about the patient’s values)
…give patients an “easy way out” if they don’t want
to talk about their spirituality
Note the construction of a question like:
“Do you have religious or spiritual concerns
that may affect your medical care?”
Taking a Spiritual History
The FICA tool was created by Christina Puchalski to help
physicians engage patients about spiritual/religious factors that
may be pertinent for care. It is a guide for conversation in the
clinical setting, covering four basic areas.
F
I
C
A
–
–
–
–
Faith or Beliefs
Importance or Influence
Community
Address in Care
For more, see: www.GWISH.org
George Washington Institute for Spirituality & Health
Overall Primary Strategy for Clinicians:
Find ways of inviting patients to interpret to you
how their spiritual/religious values, beliefs, and
practices may affect their health and care.
Note that this strategy tends to go against the medical culture
of clinical deduction and challenges some assumptions about
the practice of assessment.
The Conundrum of Spiritual “Assessment”
(or Why We Currently Focus Mostly on Information-Gathering)
● no consensus at this point, esp. re: diversity dynamics
● gap between research measures and clinically useful tools
● logistics of implementation
● patient experience of the process
● pressure in modern health care to assess spirituality in
ways beyond what can be supported sufficiently by the
relatively new field of spirituality/religion & health
III.
How can we in the clinical setting manage
potentially problematic aspects of interaction
around spirituality/religion, across lines of
diversity?
One of the biggest barriers to working
across lines of religious diversity is
fear of awkward missteps that can
create embarrassment and conflict.
Fact of life: working with religious
diversity is complex and messy
and often leads to faux pas.
What spirituality/religion adds to the
dynamics of cultural diversity:
● moral dimension
● complexity of dogma and ritual
● increased “hard-to-relate” factor
● authoritative claims regarding an absolute reality
● particular historical sensibility/sensitivity
● increased potential for visceral feelings/reactions
What spirituality/religion adds to the
dynamics of cultural diversity:
● moral dimension
● complexity of dogma and ritual
● increased “hard-to-relate” factor
● authoritative claims regarding an absolute reality
● particular historical sensibility/sensitivity
● increased potential for visceral feelings/reactions
These prospects can make us especially
apprehensive about faux pas.
Modeling Behavior:
Modeling a non-anxious response to faux pas can
be helpful to patients, since crossing lines of
religious/cultural diversity can be as intimidating a
task for patients as it can be for care providers.
Affirming the Patient-Provider Relationship:
It is often the case that a “break” in one’s sense of
safety with another person can lead to a deeper
sense of trust when that “break” is sensitively
redressed. The experience can lead to an explicit
affirmation of care and concern.
Responding to Faux Pas re: Religion
● Check your natural response to protect yourself
(e.g., flee, deny, dismiss, blame, etc.)
● Keep in mind that anything related to religion
touches us at a deep level.
● Observe that a misstep has occurred, and express
concern about how this feels to the patient.
● Show that you’re interested in listening to the patient
and working together toward the goal of healing.
● Be personal. Use “I” statements.
● Avoid getting drawn into a religious debate.
Example of Avoiding Religious Debate:
Patient: “What do you believe about ____________?”
Physician: “That’s an interesting question, but I
think I should stay focused on medicine.
Is something troubling you, though?”
Patient: “I was just wondering _______________.”
Physician: “It sounds important that you have an
opportunity to discuss this. Would you
like to talk to a hospital chaplain?”
Respond positively and show an interest in engagement,
while setting a boundary to discussion that
recognizes your professional role.
Responding to Patient Invitations of Prayer:
If a patient asks for prayer, providers may choose to
decline but should still respond appreciatively/positively.
For instance:
●
“I'd prefer if you’d pray, and I could be with you quietly.”
●
“Thank you for offering to have me join you in prayer,
but it's not my practice to pray with my patients.”
●
“I'm not sure about praying together, but I am sure that
we can work together, and I do honor your spiritual life.”
However, what if you do want to participate
in corporate prayer with a patient:
● Keep it simple
● Act to "mark off" or distinguish the prayer time
(e.g., a few seconds of silence; take a breath)
● Avoid putting doctrinal statements into the patient’s
mouth (esp. in light of patient-provider power inequity)
● Be alert to how any formal “traditional” prayer is
laden with a specific theological history
● Focus on the immediate situation (as has been
indicated by the patient)
● Consider making personal well-wishing statements
Example: "I pray for Bob, who is in the midst of so much and
who is today feeling anxious about the tests that are planned.
I pray that he feel an affirmation and a peace in all that he is
doing. I pray for blessings upon him. Amen."
--Note that such a personal and spontaneous
prayer may not be aligned with the religious
practice of patients from traditions that tend to
use formal, set prayers. This fact bespeaks the
inherent complexity of interfaith corporate prayer.
● Shared prayer can be a helpful support to patients, under the
right circumstances, but it must be done very carefully.
● Caution is necessary to protect against the imposition of the
provider's values or a blurring of the provider's role.
● Consulting a chaplain about a particular case may be helpful.
An encouraging thought:
Never underestimate the drive of many patients to
connect with you across lines of cultural diversity,
including religious diversity
…and…
how much patients often appreciate your efforts to
connect personally with them in a time of health crisis.
[email protected]