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This activity is supported by funding from WebMD.

News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd

Complete author affiliations and disclosures, and other CME information, are available at the end of this activity.

Release Date: April 12, 2007; Valid for credit through April 12, 2008

Credits Available

Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians;
Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians

All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
Physicians should only claim credit commensurate with the extent of their participation in the activity.

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April 12, 2007 — Many clinicians believe religion and spirituality have a positive effect on patients' health, and clinicians' beliefs also influence their clinical observations, according to the results of a study reported in the April 9 issue of the Archives of Internal Medicine.

"In spite of a substantial body of empirical data, professional disagreement persists regarding whether and how religion and spirituality (R/S; treated as a single concept) influences health," write Farr A. Curlin, MD, from The University of Chicago in Illinois, and colleagues. "This study examines the association between physicians' religious characteristics and their observations and interpretations of the influence of R/S on health."

The investigators mailed a cross-sectional survey to a stratified, random sample of 2000 practicing US clinicians from all specialties. This survey asked clinicians to estimate how often patients mention R/S issues, how much R/S affects health, and in what ways this effect is evident.

The response rate to the survey was 63%. Although 56% of clinicians believed that R/S had much or very much influence on health, only 6% believed that R/S often changed "hard" medical outcomes. In contrast, most clinicians believed that R/S often helps patients to cope (76%), puts patients in a positive frame of mind (75%), and provides emotional and practical support via the religious community (55%).

Compared with clinicians reporting low religiosity, those reporting high religiosity are more likely to report that patients often mention R/S issues (36% vs 11%; P < .001), believe that R/S strongly affects health (82% vs 16%; P < .001), and interpret the effect of R/S in positive rather than in negative ways.

"Patients are likely to encounter quite different opinions about the relationship between their R/S and their health, depending on the religious characteristics of their physicians," the authors write.

Study limitations include possible response bias and difficulty in measuring clinician religiosity.

"Limitations notwithstanding, these findings challenge any aspirations to a consensus interpretation of the relationship between R/S and health," the authors conclude. "Indeed, consensus is probably an unrealistic aim if disagreements are rooted in differences that go as deep as religion. These findings might rather lend support to the Association of American Medical Colleges' recommendation that physicians 'recognize that their own spirituality... might affect the ways they relate to, and provide care to, patients.'"

The Greenwall Foundation, the Robert Wood Johnson Clinical Scholars Program, and the National Center for Complementary and Alternative Medicine of the National Institutes of Health supported this study. The authors have disclosed no relevant financial relationships.

Arch Intern Med. 2007;167:649-654.

Learning Objectives for This Educational Activity

Upon completion of this activity, participants will be able to:

• Describe what US clinicians believe about the role of R/S in healthcare.
• Describe the association between clinician religiosity and beliefs about the role of R/S on patients' health status.

Clinical Context

According to the authors of the current study, controversy about how religion and religiosity help or harm patients' health remains, and, to complicate matters, clinicians' own spiritual beliefs and practices also may influence the way clinicians interpret their clinical experiences. The authors also discuss a previous study in which they found that religious clinicians are more likely than their secular colleagues to inquire about and discuss R/S issues with their patients. The authors define religion and spirituality as a single concept: R/S.

This is a cross-sectional national survey conducted on a stratified random sample of US clinicians belonging to the American Medical Association database to examine if and how the varying R/S beliefs of clinicians influence their approach to patient health.

Study Highlights

• The mailed 12-page survey was conducted on a random sample of 2000 clinicians aged 65 years or younger who were practicing in the following US regions: Midwest, South, Northeast, and West.
• The survey was administered 3 times by mail.
• The terms "religion" and "spirituality" were not defined within the survey, and respondents were asked to apply their own working definitions.
• The clinicians' religious characteristics ("intrinsic religiosity") were defined by the extent to which they embraced their religion as the "master motive" guiding their life.
• This was measured by a response of "agree" or "disagree" to 2 statements: "I try hard to carry my religious beliefs over to all my other dealings in life" and "My whole approach to life is based on my religion."
• Intrinsic religiosity was defined as low if clinicians disagreed with both statements, moderate if they agreed with 1 and disagreed with the other, and high if they agreed with both.
• Clinicians' religious affiliations were categorized as "none" (includes atheist, agnostic, and none), "Protestant, Catholic, Jewish, and other" (includes Buddhist, Hindu, Mormon, Muslim, and other).
• Clinicians were asked for responses to survey questions addressing whether illness increased patient awareness of R/S, how much influence R/S had on health, and whether R/S helped to prevent "hard" medical outcomes, helped patients cope, or had potential negative influences on health.
• Responses were coded in 3 categories —"often/always," "sometimes," and "rarely/never" — or as yes/no binary responses.
• The response rate of eligible clinicians was 63% (n = 1144).
• Mean age was 49 years, 26% were women, 58% were from the Midwest and South, 78% were white, 12% were Asian, and 2% were black.
• The primary specialties were internal medicine (32%), family medicine (14%), pediatrics and subspecialties (13%), and surgical specialties (9%).
• Two thirds of clinicians believed that the experience of illness often or always increased patients' awareness of and focus on R/S issues.
• 56% believed that R/S very much influenced health, and 54% believed that sometimes the supernatural intervened.
• 85% believed that the influence of R/S was generally positive.
• Only 6% believed that R/S influenced "hard" medical outcomes.
• 76% believed that R/S often helps patients to cope, and 74% believed that it gave patients positive states of mind.
• 55% believed that R/S provided emotional and positive support via the religious community.
• 2% to 7% identified harmful effects of R/S including guilt, anxiety, and patients declining medical therapy.
• Clinicians with high intrinsic religiosity were much more likely to report that their patients brought up R/S issues, to believe that R/S strongly influenced health, and to interpret R/S influence in a positive way.
• Protestant clinicians were more likely to report that their patients believed that God intervened in health, that R/S helped patients to cope, and that R/S sometimes prevented adverse medical outcomes.
• Clinicians who practiced in the South and Midwest (where the authors reported a higher proportion of high intrinsic religiosity responses) were more likely than those practicing in the West and Northwest to believe that R/S influenced health in strong and positive ways.

Pearls for Practice

• Most US clinicians believe that R/S has a substantial and generally positive effect on patients' health.
• Clinicians with higher intrinsic religiosity are more likely to include R/S in their patient encounters and to interpret R/S influence on patients in a positive way.

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Target Audience

This article is intended for primary care clinicians and specialists interested in the association between spirituality and health.

Goal

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Accreditation Statements

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Authors and Disclosures

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News Author

Laurie Barclay, MD
is a freelance reviewer and writer for Medscape.

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Author

Désirée Lie, MD, MSEd
Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California

Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.

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