Spirituality should be incorporated into care for both serious illness and overall health, according to a study led by researchers at Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital.
“This study represents the most rigorous and comprehensive systematic analysis of the modern day literature regarding health and spirituality to date,” said Tracy Balboni, lead author and senior physician at the Dana-Farber/Brigham and Women’s Cancer Center and professor of radiation oncology at Harvard Medical School. “Our findings indicate that attention to spirituality in serious illness and in health should be a vital part of future whole person-centered care, and the results should stimulate more national discussion and progress on how spirituality can be incorporated into this type of value-sensitive care.”
“Spirituality is important to many patients as they think about their health,” said Tyler VanderWeele, the John L. Loeb and Frances Lehman Loeb Professor of Epidemiology in the Departments of Epidemiology and Biostatistics at Harvard Chan School. “Focusing on spirituality in health care means caring for the whole person, not just their disease.”
The study, which was co-authored by Balboni, VanderWeele, and senior author Howard Koh, the Harvey V. Fineberg Professor of the Practice of Public Health Leadership at Harvard Chan School, will be published online in JAMA on July 12, 2022. Balboni, VanderWeele, and Koh are also co-chairs of the Interfaculty Initiative on Health, Spirituality, and Religion at Harvard University.
According to the International Consensus Conference on Spiritual Care in Health Care, spirituality is “the way individuals seek ultimate meaning, purpose, connection, value, or transcendence.” This could include organized religion but extends well beyond to include ways of finding ultimate meaning by connecting, for example, to family, community, or nature.
In the study, Balboni, VanderWeele, Koh, and colleagues systematically identified and analyzed the highest-quality evidence on spirituality in serious illness and health published between January 2000 and April 2022. Of the 8,946 articles concerned with serious illness, 371 articles met the study’s strict inclusion criteria, as did 215 of the 6,485 articles focused on health outcomes.
A structured, multidisciplinary group of experts, called a Delphi panel, then reviewed the strongest collective evidence and offered consensus implications for health and health care.
They noted that for healthy people, spiritual community participation–as exemplified by religious service attendance – is associated with healthier lives, including greater longevity, less depression and suicide, and less substance use. For many patients, spirituality is important and influences key outcomes in illness, such as quality of life and medical care decisions. Consensus implications included incorporating considerations of spirituality as part of patient-centered health care and increasing awareness among clinicians and health professionals about the protective benefits of spiritual community participation.
The 27-member panel was composed of experts in spirituality and health care, public health, or medicine, and represented a diversity of spiritual/religious views, including spiritual-not-religious, atheist, Muslim, Catholic, various Christian denominations, and Hindu.
According to the researchers, the simple act of asking about a patient’s spirituality can and should be part of patient-centered, value-sensitive care. The information gleaned from the conversation can guide further medical decision-making, including but not limited to notifying a spiritual care specialist. Spiritual care specialists, such as chaplains, are trained to provide clinical pastoral care to diverse patients–whether spiritual-not-religious or from various religious traditions. Chaplains themselves represent a variety of spiritual backgrounds, including secular and religious.
“Overlooking spirituality leaves patients feeling disconnected from the health care system and the clinicians trying to care for them,” said Koh. “Integrating spirituality into care can help each person have a better chance of reaching complete well-being and their highest attainable standard of health.”
Other Harvard Chan co-authors include Stephanie Doan-Soares and Katelyn Long.
This research was supported by the John Templeton Foundation.
“Spirituality in Serious Illness and Health,” Tracy Balboni, Tyler VanderWeele, Stephanie Doan-Soares, Katelyn Long, Betty Ferrell, George Fitchett, Harold Koenig, Paul Bain, Christina Puchalski, Karen Steinhauser, Daniel Sulmasy, and Howard K. Koh, JAMA, online July 12, 2022, doi: 10.1001/jama.2022.11086.
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