The State of the Science in Spirituality and Palliative Care was convened to address the current landscape of research at the intersection of spirituality and palliative care and to identify critical ...next steps to advance this field of inquiry. Part I of the SOS-SPC two-part series focuses on questions of 1) What is spirituality? 2) What methodological and measurement issues are most salient for research in palliative care? And 3) What is the evidence relating spirituality and health outcomes? After describing current evidence we make recommendations for future research in each of the three areas of focus. Results show wide variance in the ways spirituality is operationalized and the need for definition and conceptual clarity in research in spirituality. Furthermore, the field would benefit from hypothesis-driven outcomes research based on a priori specification of the spiritual dimensions under investigation and their longitudinal relationship with key palliative outcomes, the use of validated measures of predictors and outcomes, and rigorous assessment of potential confounding variables. Finally, results highlight the need for research in more diverse populations.
ABSTRACTThis study examined the prevalence and predictors of moral injury (MI) symptoms in 181 health care professionals (HPs; 71% physicians) recruited from Duke University Health Systems in Durham, ...NC. Participants completed an online questionnaire between November 13, 2019, and March 12, 2020. Sociodemographic, clinical, religious, depression/anxiety, and clinician burnout were examined as predictors of MI symptoms, assessed by the Moral Injury Symptoms Scale–Health Professional, in bivariate and stepwise multivariate analyses. The prevalence of MI symptoms causing at least moderate functional impairment was 23.9%. Younger age, shorter time in practice, committing medical errors, greater depressive or anxiety symptoms, greater clinician burnout, no religious affiliation, and lower religiosity correlated with MI symptoms in bivariate analyses. Independent predictors in multivariate analyses were the commission of medical errors in the past month, lower religiosity, and, especially, severity of clinician burnout. Functionally limiting MI symptoms are present in a significant proportion of HPs and are associated with medical errors and clinician burnout.
In this rejoinder, I comment on Irmak’s 2014 article titled “Schizophrenia or Possession?” published in the
Journal of Religion and Health
(Irmak, 2014; JORH 53(3):773–777.
...https://doi.org/10.1007/s10943-012-9673-y
). After providing a brief overview of the article and two commentaries on it, I examine the role that demonic possession may or may not play in the development and course of schizophrenia. While keeping an open mind to the possibility of evil influences on the course of illness in those with or without psychosis, I emphasize that schizophrenia is a neurobiological illness that requires compassionate care and expert psychobiological treatment.
Although medicine is practised in a secular setting, religious and spiritual issues have an impact on patient perspectives regarding their health and the management of any disorders that may afflict ...them. This is especially true in psychiatry, as feelings of spirituality and religiousness are very prevalent among the mentally ill. Clinicians are rarely aware of the importance of religion and understand little of its value as a mediating force for coping with mental illness. This book addresses various issues concerning mental illness in psychiatry: the relation of religious issues to mental health; the tension between a theoretical approach to problems and psychiatric approaches; the importance of addressing these varying approaches in patient care and how to do so; and differing ways to approach Christian, Muslim and Buddhist patients.
This article summarizes research prior to 2010 and more recent research on religion, spirituality, and health, including some of the latest work being done by research teams at Columbia University, ...Harvard University, Duke University, and other academic medical centers. First, terms such as religion, humanism, and spirituality are defined. Second, based on his research team's previous systematic review of quantitative studies published in the peer-reviewed literature prior to 2010, the author discusses the findings from that research on the effects of religion and spirituality (R/S) on (1) mental health-well-being, purpose in life, hope, optimism, self-esteem, depression, anxiety, suicide, and substance abuse; (2) health behaviors-exercise, diet, cigarette smoking, and risky sexual activity; and (3) physical health-coronary artery disease, cancer, and all-cause mortality. Third, the author examines the latest research on the prevalence of spiritual needs among individuals with serious or terminal medical illnesses, the consequences of ignoring those needs, and the results of clinical trials that have examined the effects of spiritual assessments by physicians. Finally, the author reviews the research currently being conducted at Duke University on the efficacy of religious cognitive-behavioral therapies and on the effects of religious involvement on telomere length in stressed caregivers. Resources are provided that will assist seasoned researchers and clinicians who might be interested in doing research in this novel and expanding area of whole-person medicine.
Moral injury (MI), originally discussed in relationship to transgressing moral beliefs and values during wartime among military personnel, has expanded beyond this context to include similar emotions ...experienced by healthcare professionals, first responders, and others experiencing moral emotions resulting from actions taken or observations made during traumatic events or circumstances. In this article, we review the history, definition, measurement, prevalence, distinctiveness, psychological consequences, manifestations (in and outside of military settings), and correlates of MI in different settings. We also review secular psychological treatments, spiritually integrated therapies, and pastoral care approaches (specific for clergy and chaplains) used to treat MI and the evidence documenting their efficacy. Finally, we examine directions for future research needed to fill the many gaps in our knowledge about MI, how it develops, and how to help those suffering from it.
Despite empirical evidence of a relationship between religiosity/spirituality (R/S) and mental health and recommendations by professional associations that these research findings be integrated into ...clinical practice, application of this knowledge in the clinic remains a challenge. This paper reviews the current state of the evidence and provides evidence-based guidelines for spiritual assessment and for integration of R/S into mental health treatment.
PubMed searches of relevant terms yielded 1,109 papers. We selected empirical studies and reviews that addressed assessment of R/S in clinical practice.
The most widely acknowledged and agreed-upon application of R/S to clinical practice is the need to take a spiritual history (SH), which may improve patient compliance, satisfaction with care, and health outcomes. We found 25 instruments for SH collection, several of which were validated and of good clinical utility.
This paper provides practical guidelines for spiritual assessment and integration thereof into mental health treatment, as well as suggestions for future research on the topic.
Recent events have led to concerns about whether U.S. service members are “ready” to engage in combat operations. With most discussions now focused on military readiness, attention paid to warfighter ...readiness may have fallen behind. Service members typically receive extensive training in the tactical, physical, mental, social, and behavioral aspects of readiness, while the spiritual aspects are often ignored. This review examines (1) recent concerns over warfighter readiness, (2) mental health problems that are common among members of the U.S. military, (3) definitions and determinants of “spiritual readiness” (SR), (4) the impact of SR on human flourishing (HF) and warfighter readiness, (5) research on the effects of religious/spiritual involvement on HF, and (6) those responsible for building and sustaining SR in the military. An extensive body of research over the past 30 years has documented the impact of religious/spiritual (R/S) involvement on many aspects of human flourishing, thereby affecting the warfighter’s readiness to perform duties at the highest level. Military chaplains, mental health professionals, and medical providers all play important roles in building and sustaining the spiritual readiness of those in the U.S. military, thereby ensuring that these individuals perform in a way that maximizes their success during combat operations.
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