Wellness Check: Spirituality

2 Minute Medicine is pleased to announce that we are launching Wellness Check, a new series dedicated to exploring new research evidence focused on wellness. Each week, we will report on articles examining different aspects of wellness, including (but not limited to) nutrition, sleep, reproductive health, substance use and mental health. This week, we explore the latest evidence-based updates in spirituality. 

The spiritual history may improve the quality of the doctor-patient relationship

1. According to this study, majority of patients found a spiritual history (SH) to be helpful.

2. Many patients who had a longer conversation about spirituality with their general practitioner reported a better relationship with their provider.

Evidence Rating Level: 3 (Average)

Spirituality is considered to be a dimension of being human and as such, healthcare providers should explore patient’s spirituality to better provide support in this area, especially in older adults. As a first contact for health issues, general practitioners (GPs) are well suited to integrate this aspect of humanity into the healthcare of patients. Consequently, the objective of the present mixed-methods study was to investigate the patient’s views concerning the value of eliciting a patient’s spiritual history as well as its effects.

The present study was part of the Holistic Care Program for Elderly Patients to Integrate Spiritual Needs,Social Activity and Self-Care into Disease Management in Primary Care (HoPE53) trial which has been previously published. 133 patients were invited to participate in a semi-structured telephone interview from February-June 2020 and a written survey 2 weeks after the social history. In total, 29 qualitative interviews were conducted. Patients were included if they were ≥70 years old and had at least 3 chronic diseases. The data analysis was performed with Reflexive Thematic Analysis.

The results demonstrated that most patients found the spiritual history to be helpful. Furthermore, many patients who had a longer conversation about spirituality with their general practitioner reported having a better relationship with them. The present study was limited by the heterogeneity in interviews due to the COVID-19 pandemic, where participants could originally choose between a face-to-face interview and a phone interview. Nonetheless, this study was significant in highlighting the importance of eliciting a spiritual history in elderly patients.

The religious and spiritual beliefs of cancer patients may influence decision making

1. Overall, the influence of religion and spirituality on treatment decision making was both active and passive.

2. Though there were differences relative to rate and ethnicity, the impact of religion and spirituality was more pronounced among black patients.

Evidence Rating Level: 2 (Good)

Religious and Spirituality (R&S) forms a component of the World Health Organization’s definition of health. Unfortunately, the R&S needs of many patients go unmet, especially in patients with cancer. There is a current gap in how R&S influence cancer treatment decision making. As a result, the objective of the present systematic review was to evaluate the influence of R&S on treatment decision making among patients and providers in cancer care.

From 311 screened studies, 32 were included from 1997-2020. Articles were included if they explicitly discussed the relationship between R&S and treatment decision making. Articles were excluded if they focused on meditative practices and interventions such as mindfulness and yoga. Study outcomes focused on study demographics, R&S influence on providers and patients, and decision-making context.

Results showed that overall, the influence of religion and spirituality on treatment decision making was both active and passive, where some patients wanted more direct integration of their R&S beliefs. In contrast, patients with passive beliefs may want providers to be aware of their R&S preferences yet not want to discuss these topics explicitly. Furthermore, though there were differences relative to rate and ethnicity, the impact of religion and spirituality was more pronounced amongst black patients. The present study was limited by the greater representation on patient R&S topics rather than provider R&S relative to treatment decision making. However, these results suggest the need for providers to be aware of the impact of R&S on treatment decision making.

The relationship between mental health and religiosity may not be bi-directional

1. In this study, religious attendance was not associated with later or concurrent mental health.

2. Higher levels of depression and anxiety were associated with a later increase in religious attendance.

Evidence Rating Level: 2 (Good)

Currently, the literature suggests that religiosity has been associated with better mental health outcomes. However, there are no investigations of the potential bi-directional relationship between religious involvement and mental health. As a result, the objective of the present cohort study was to investigate the bi-directional associations between religious attendance and mental health.

The present retrospective cohort included 2125 participants (51% male) from the Medical Research Council National Survey of Health and Development (1946 British birth cohort study). These participants took part in the most recent data collection at age 68-69. Symptoms of anxiety and depression were measured at different time points using the General Health Questionnaire (GHQ-28). Similarly, frequency of religious attendance was assessed at different time points using a postal questionnaire. An auto-regressive cross-lagged model was used to assess longitudinal associations between mental health and religious attendance over time using three-repeated measures for each of these variables.

Results demonstrated that religious attendance was not associated with later or concurrent mental health. Furthermore, higher levels of depression and anxiety were associated with a later increase in religious attendance. An important limitation of the study was that religious attendance and mental health were not always collected at the same time which may have influenced the cross-lagged model’s assumption of synchronicity. Nonetheless, this study was significant as it was the first to describe a lack of bi-directionality between religiosity and mental health in the United Kingdom.

Image: PD

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