Some of my most satisfying moments with patients have been our conversations about religion and spirituality, often beginning with questions like- How important would you say religion is in your life- very important, fairly important or not very important?
This question was part of a 2012 Gallup poll which showed approximately 70% of Americans consider themselves moderately or very religious. An increasing number also describe themselves as believers unaffiliated with a particular denomination or religion (often described as “spiritual but not religious”).
The religious and spiritual beliefs of doctors and patients can affect medical care and healthcare decision-making. Spiritual sensitivity is an important component of cultural sensitivity, which is an increasingly appreciated attribute of compassionate patient-centered care. Doctors are advised to include spiritual assessments in their history-taking and patient management. But when doctors and patients differ widely on religion and spirituality there can be undesirable consequences. Recent research shows that, compared to doctors who consider themselves deeply religious, atheist or agnostic doctors are almost twice as willing to make decisions they believe will hasten the end of a very sick patient’s life. Women seeking certain birth control or abortion options may find their views at odds with the religious beliefs of their physicians.
Some studies show that religiosity and spirituality (R/S) have no impact on health, while others even show a negative impact. Yet the vast majority of research on R/S shows a beneficial impact on health. This inconsistency has been the source of considerable debate. Over time, the quality of research has improved and the importance of the topic has been widely acknowledged by patients, their physicians, the broader healthcare system and health professional education.
Harold Koenig MD directs the Center for Spirituality, Theology and Health at Duke University Medical Center. The Center is devoted to a rigorous examination of religion and spirituality as factors in health. Koenig and the Center reviewed the published literature on R/S through 2010. Their findings provide an important and impartial assessment of the state of the science on a subject that is both vital to the lives of many patients and doctors and fraught with conflicting personal views and beliefs.
The majority of studies on the “positive” aspects of mental health showed a benefit for those who considered themselves at least moderately R/S. Hope, optimism, sense of well-being, meaning, purpose, self-esteem and sense of personal control all tended to be greater in those who self-described as moderately or highly R/S. The majority of studies on the ‘negative’ aspects of mental health found moderate or high levels of R/S were related to lower levels of depression, attempted or completed suicide and less alcohol and drug use or abuse.
The majority of the research on social health found that greater R/S predicted less anti-social behavior, crime, delinquency, divorce, marital separation and spousal abuse. They also showed greater R/S was associated with more altruism (volunteering, donating to the needy), gratefulness, marital satisfaction, commitment, relationship cohesion, sexual fidelity, couples’ problem solving, forgiveness, community involvement, trust, membership in civic, political and social justice groups and school performance (GPA, graduation rates).
Research on physical health tended to show that moderate to high levels of R/S were associated with healthier diet and exercise patterns, less smoking and coronary heart disease, lower blood pressure, less risky sexual behavior and lower levels of stress hormones such as cortisol, epinephrine and norepinephrine. Nevertheless, some studies showed higher blood pressure, including clinical hypertension. Some studies showed healthier weights and some showed unhealthier weights. There were conflicting results from a small number of studies regarding the impact of R/S on strokes, carotid artery disease, dementia and cognitive impairment.
Cancer and overall longevity are two topics of increasing concern to our aging population. Moderate to high R/S tends to be associated with greater longevity and a reduced incidence of cancer, its progression over time and long-term cancer survival. However, some studies show reduced longevity and a higher rate of cancer in the moderately to highly R/S.
One of the most interesting areas of research involves the use of spirituality interventions (such as prayer, meditation, yoga and mindfulness) as non-drug complements to conventional treatment. There is some evidence that such interventions can lead to better cardiac surgery outcomes, better blood pressure control, healthier cardiovascular stress-related reactivity, better immune function and lower levels of stress hormones. There is also evidence that regular practice of techniques that evoke empathy and compassion can actually increase the size of brain areas involved in these activities.
The Duke Center and Koenig’s review of several thousand studies performed through 2010 shows a definite tendency for a positive association between religion, spirituality and health. Some of the best of these studies have followed patients for up to 50 years. Hundreds of studies have studied large numbers of people from different population groups, giving these findings more scientific legitimacy. Studies including people from many religious backgrounds from most of the world’s countries have shown mostly positive associations. Critics of these studies point to poor study design, many studies with small numbers of patients and claims often made by researchers that are not supported by the data.
It seems clear that religion and spirituality will receive increasing attention as we seek to create a health care system that is more humane and compassionate for patients, their families and health care providers.
Let your doctor know if religion and spirituality are important to you or your family. It might make a tremendous difference in your relationship with your physician and in your experience of health and illness.
Resources-
Center for Spirituality, Theology and Health http://www.spiritualityandhealth.duke.edu
Harold Koenig
Spirituality and Health Research- Methods, Measurements, Statistics and Resources
