Is Evidence Able to Persuade Physicians to Discuss Spirituality with Patients?

Patients believe that spirituality informs health; frequently, they wish to share their beliefs with physicians. Although a large number of physicians believe it their responsibility to be aware of patient beliefs, many do not address spirituality because they do not believe it their role to do so. These physicians would perhaps feel differently if presented with evidence that associated spirituality with positive health outcomes. This national sample of family medicine residents were asked if, presented with evidence that spirituality was associated with improved outcomes, they would be more likely to initiate discussions of spirituality with patients. To varying degrees, most residents agreed that they would be more willing to initiate spirituality discussions if presented with good evidence. Geographic region of training, religious preference, and Spiritual Well-Being Scale quartile predicted both strength of agreement and whether a resident would be as responsive to spirituality oriented research as to investigations of traditional therapeutic modalities. Although residents indicated that they would be more responsive to publications on traditional medical therapies, familiarity with the spirituality literature as part of a residency educational curriculum may help break down barriers to addressing this issue with patients.     

Are Residents Willing to Discuss Spirituality with Patients?

Family medicine is redefining itself in the wake of the Future of Family Medicine Project, the move to the Patient-Centered Medical Home, and the 2010 Patient Protection and Affordable Care Act’s emphasis on primary care. This effort has included representing family doctors as physicians who “care for the whole person” and who “specialize in you.” Many patients believe that whole person care involves attention to spirituality and wish to share their beliefs in the medical encounter. This national survey investigated whether a random sample of family medicine residents were willing to address spirituality upon patient request. With varying degrees of willingness, most doctors said that they would discuss patient beliefs if asked. Denominational preference, residency training in addressing spirituality, and self-rated spirituality were all predictive of the strength of reported willingness. These results indicate that training in addressing spirituality may create residents more likely to discuss the topic in clinical practice.     

Should My Provider Pray with Me? Perspectives of Urban Adolescents with Asthma on Addressing Religious and Spiritual Issues in Hypothetical Clinical Settings

This qualitative study examined the preferences of urban adolescents with asthma for including religious/spiritual (R/S) inquiry in a variety of hypothetical clinical encounters. Twenty-one urban adolescents (M _age = 15.6 years, 52 % female, 81 % African American) with asthma participated in a semi-structured interview. Interviews were transcribed and underwent a thematic analysis. R/S preferences were contextual rather than personal, driven by: (1) acuity of the hypothetical clinical context; (2) nature of the patient–provider relationship; and (3) level of R/S intervention/inquiry. Most adolescents welcomed prayer if near death, but did not see the relevance of R/S in a routine office visit.     

How do Physicians Decide to Refer Their Patients for Psychiatric Genetic Counseling? A Qualitative Study of Physicians’ Practice

Psychiatric genetic counseling (PGC) is an emerging specialty discipline within the genetic counseling profession. A specialist PGC service was founded in 2012 in Vancouver, Canada, and though patient benefits have been demonstrated, many physicians do not regularly refer patients to the service despite awareness of its availability. We conducted a qualitative study involving semi-structured telephone interviews with Vancouver-based physicians who were aware of the PGC service to explore this phenomenon. Interviews were audio-recorded, transcribed verbatim, coded, and analysed for emergent themes. Consistent with a grounded theory approach, constant comparison was employed throughout data collection and analysis. Analyses of interviews conducted with 12 physicians revealed that referral practices were informed by perceptions about the purpose of PGC and interpretation of patient cues. Physicians perceived PGC as an information-focused intervention, and considered referral when patients explicitly expressed desire for information about recurrence risk or etiology that they felt unable to adequately address themselves. Even when physicians identified psychotherapeutic benefits of PGC, patient needs of this nature were not perceived as cues prompting referral to PGC. These data suggest that further work is necessary to position PGC in physicians’ minds as a service that could potentially benefit most individuals with psychiatric disorders and their families, and that it encompasses more than information provision. It is important to increase physicians’ awareness of the complementary role that genetic counselors can play to that of the physician in providing psychotherapeutically oriented counselling about illness etiology.     

Should We Respond to Evil with Indifference?

In a recent article, Adam Elga outlines a strategy for Defeating Dr Evil with Self-Locating Belief. The strategy relies on an indifference principle that is not up to the task. In general, there are two things to dislike about indifference principles: adopting one normally means confusing risk for uncertainty, and they tend to lead to incoherent views in some 'paradoxical' situations. I argue that both kinds of objection can be levelled against Elga's indifference principle. There are also some difficulties with the concept of evidence that Elga uses, and these create further difficulties for the principle.     

A Spiritual Revolution in Denmark?

ABSTRACT

Based on data from the Danish part of the European Values Study 1981–2008, this article explores the validity of the claim for a spiritual revolution as proposed by Paul Heelas and Linda Woodhead. The article suggests an operationalisation of spirituality. The results of the analyses are that religious values—Christian faith as well as spirituality—tend to be stable over an individual’s life course. This suggests that, if there is a spiritual revolution, it must be the product of cohort replacement. If a spiritual revolution is taking place, Christian faith would be expected to decline in younger cohorts while spirituality would increase, but an analysis of cohort support for Christian faith and spirituality from 1981 to 2008 shows that both were constant across cohorts. Thus Danish data contain no indication that a spiritual revolution is taking place or will take place. Finally, we show that, contrary to theoretical expectations, spirituality and Christian faith are strongly correlated. A closer analysis reveals an indirect and more complicated support for parts of the theory since the two variables are explained by different factors and it shows that Christian faith, but not spirituality, is correlated with morality.     

Should Doctors Suggest Euthanasia to Their Patients? Reflections on Dutch Perspectives

During the summer of 1999 and in April 2002 Iwent to the Netherlands in order to meet someof the leading authorities on the euthanasiapolicy. They were asked multiple questions.This study reports the main findings to thequestion: should doctors suggest euthanasia totheir patients? Some interviewees did notobserve any significant ethical concernsinvolved in suggesting euthanasia. For variousreasons they thought physicians should offereuthanasia as an option. Two intervieweesasserted that doctors don't propose euthanasiato their patients. Five interviewees objectedto physician's initiative.

     

Inner Spiritual Voices or Auditory Hallucinations?

The author suggests that the phrase, auditory hallucinations needs to be replaced since it has negative connotations. Inner voices is the preferred phrase since it can be used to describe the full range of internally perceived voices. Inner voices may be associated with the different layers that comprise consciousness or spirituality. Within an individual these layers appear to form an upward spiral that are centered in the chakras. The DSM-IV's definition of auditory hallucinations also needs to be revised to incorporate a multilayered model of consciousness and to be congruent with people's experiences.     

A Spiritual Dimension to Sex Education?

This article engages in a preliminary exploration from a broadly philosophical perspective of the notion of a 'spiritual dimension' to sex education. An inescapable 'value' dimension to sex education is recognized, and the possibility that this might include a 'spiritual' dimension is pursued in the light of a consideration of the nature of the spiritual domain. A distinction is drawn between 'religiously tethered' and 'religiously untethered' conceptions of spirituality and four strands characteristic of the spiritual domain are outlined. Possibilities relating to a 'spiritual' dimension in sex education are identified in relation to each of the strands and their value and justification are discussed in relation to common school and separate religious schools, respectively.     

Should Analytic Patients Be “Created”? Reflections on Arnold Rothstein's Psychoanalytic Technique and the Creation of Analytic Patients

Abstract

The five points of Arnold Rothstein's interesting monograph are each discussed and critiqued in this article. In particular, Rothstein is commended for his commitment to expanding the availability of an intensive, psychoanalytic treatment for a broad spectrum of patients who may often be very difficult to engage. Rothstein also accounts for difficulties in engaging analytic patients from obstacles in the attitudes of analysts such as a latent lack of conviction about the efficacy of psychoanalysis and from overly restricted stereotypes about the spectrum of appropriate patients. He recommends a flexibility of technique and accommodation to the needs of patients with which this author agrees.

Others of Rothstein's observations and recommendations seem more problematic. Specifically, issue is taken with his suggestion that analysts attempt to provide a trial of psychoanalysis for all nonpsychotic patients and to begin on a less intensive basis only within the frame or interpreting prospective patients' objections as a resistance. This author also disagrees with Rothstein's interpretation that patients resist the offer of a psychoanalysis out of a self-defeating masochistic enactment that needs interpretation. Case examples are provided that belie this overly generalized interpretation. Additionally, this author critiques the metapsychological assumptions underlying this particular mode of interpreting a reluctance to begin psychoanalysis.

While commending Rothstein's therapeutic goals and recommended flexibility of technique, this author would also stress a fundamental concern about the patient's conscious and unconscious experience of the analyst's agenda. In other words, rather than working toward the analyst's goal of establishing a psychoanalytic situation, emphasis is placed instead on the basic right of patients to proceed in a manner that respects their sovereignty over how intensively they may choose to work. Therefore, in contradistinction to Rothstein's suggestions, it is recommended that the analyst's primary focus should be to provide an availability to work on the patient's conflicts and developmental needs with a respect for the timing of their emergence and expression within a treatment frame that invites but does not prematurely elicit and confront. By proceeding in this way a patient's salient dynamics will be allowed to emerge “organically” instead of being hastened prematurely in reaction to the analyst's insistence on the Tightness of a particular schedule or manner of proceeding. This author believes that with this approach more, rather than fewer, patients will be able to accept the recommendation of an intensive psychoanalytic treatment.     

What is Spiritual Development? Primary Headteachers' Views

Recent legislation has made it a legal requirement for schools' contribution to their pupils' spiritual development to be inspected as part of the school inspection process. However, some confusion exists about the meaning of the term ‘spiritual development’. The first part of this article reviews some of the meanings ascribed to the term by educationalists and theologians while the second part examines headteachers' perceptions of the meaning of the term within the context of primary schools.     

Is Evidence Based Spiritual Care an Oxymoron?

Evidence based spiritual care utilizes empirical evidence on spirituality in addressing the spiritual needs of patients. Objections to evidence based spiritual care include issues of methodology and ethics. Reasons favoring evidence based spiritual care stem from a view that it is not an oxymoron but a paradox. An example of evidence based spiritual care is described using cardiac patients in a CCU unit. Concluding remarks note that we are at the beginning and need a new scientific/theological paradigm that integrates not separates science and theology.     

Widows' Spiritual Journeys: Do They Quest?

SUMMARY

Two studies examined the spiritual experiences of older women shortly after their husbands' deaths. The central question was, in the process of becoming and being a widow, do the older women begin a reflective dialogue with existential questions and initiate spiritual journeys as recent widows? One study is based on the widows within a random sample of older adults. The second study involved in-depth interviews with 15 recent widows. Both studies included Batson's measures of means, ends, and quest religious orientations. There was more evidence of an “ends” (intrinsic) orientation among the widows than “means” (extrinsic) for religious involvement; there was also no change over time in these orientations. Their quest orientation, however, became significantly less prevalent in the follow-up. It seems that women indeed quested, and by follow-up engaged their faith for religious consolation. Data from Study 2 revealed two themes: religious involvement provided a sense of continuity and direction, and through faith and prayer the women were able to (re)find meaning and purpose to life.