Patient desire for spiritual assessment is unmet in urban and rural primary care settings

Abstract

Background Incorporation of patient religious and spiritual beliefs in medical care has been shown to improve the efficacy of medical interventions and health outcomes. While previous study has highlighted differences in patient desire for spiritual assessment based on patient religiosity, little is known about patient desire for spiritual assessment based on community type, particularly in urban compared to rural communities. We hypothesized that, given demographic trends which show a higher degree of religiosity in rural areas, patients in rural communities will be more likely to desire spiritual assessment. Methods In this cross-sectional study of 141 adult primary care patients in rural and urban Colorado at non-religiously affiliated clinics, we surveyed patient demographic information, measures of religiosity, patient desire for spiritual assessment, and frequency of spiritual assessment in practice. Univariate logistic regression analyses were used to compare the two populations. Results In both Denver County (urban) and Lincoln County (rural) over 90% of patients identified as religious, spiritual, or a combination of the two. Thirty eight percent (38.3%) of patients in Denver County and 49.1% of patients in Lincoln desired spiritual assessment. Over 97% of patients in both areas reported rarely or never being asked about their R/S within the past year. For patients who have had five or more clinic visits in the past year, more than 91% in both areas stated they have never or rarely been asked about their beliefs. Conclusions While the majority of patients in this study identify as religious or spiritual and many patients desire spiritual assessment, the majority of patients have never or rarely been asked about their spirituality within the past year. This demonstrates a significant gap between patient preference and provider practice of spiritual assessment in the primary care setting, which was similar in both rural and urban settings. This highlights the need for interdisciplinary focus on spiritual assessment and incorporation of patient R/S beliefs in medical care to provide holistic patient care and improve health outcomes.

Barriers and facilitators to resilience for rural cancer survivors during COVID‐19

“…Previous studies suggest cancer patients’ QoL and health outcomes (e.g., mortality) improve when clinicians incorporate faith‐based or spiritual care (Kamijo & Miyamura, 2020; Koenig, 2012). Furthermore, rural patients have reported wanting spirituality and faith to be incorporated into their healthcare (Fuchs et al., 2021), as did our participants. However, nurses report challenges to incorporating spiritual/faith‐inclusive care, such as lack of training in faith interventions (Zumstein‐Shaha et al., 2020), and perhaps, like our participants stated, because they fear their practice will be viewed as unscientific.…”

Making Time and Being Present

“…The literature suggests that spiritual needs of patients are largely unmet. In a study comparing urban and rural patients, researchers found a significant gap between patients and healthcare providers on the importance of spiritual assessments in the primary care setting (Fuchs et al, 2021). Approximately 40% of patients desired spiritual assessment, yet 97% did not recall being asked about religiosity or spirituality in the previous year.…”

Training General Practitioners and Medical Assistants Within the Framework of HoPES3, a Holistic Care Program for Elderly Patients to Integrate Spiritual Needs, Social Activity, and Self-Care into Disease Management in Primary Care

“…27,28 However, as Frick et al and Puchalski and Romer stated, it is precisely the interventional effect of proactively asking the patient about his or her spirituality that may open the door for new and unexpected coping resources. 19,21,31 Taking a spiritual history gives the patient " … permission to talk about those kinds of [spiritual] issues". 19 From current literature, we know that training in spiritual assessment reduces the barriers that exist for GPs to proactively address spiritual needs among their patients.…”