Whatever your religious beliefs, they’re unlikely to get addressed in the intensive care unit, a new study finds.
Religion or spirituality is important to many people nearing the end of life, but intensive care clinicians rarely talk to patients or their families about those beliefs, the study authors said.
“We found that religious or spiritual considerations were discussed in only 16 percent of family meetings in ICUs and when such concerns arose,” said study author Dr. Douglas White, an associate professor of critical care medicine at the University of Pittsburgh Medical Center. “Health care professionals only rarely asked questions to better understand the patient or family’s religious or spiritual ideas.”
That omission leaves a need unfulfilled, experts said.
“The findings regarding the silence surrounding religion and/or spirituality in ICU conversations are loud and clear,” Dr. Tracy Balboni, associate professor at Harvard Medical School, and her co-authors wrote in an editorial accompanying the study. “The question remains whether we who care for dying persons and their families will learn how to be present and listen.”
The study and editorial were published Aug. 31 in JAMA Internal Medicine.
The study authors found that almost 78 percent of people acting on behalf of patients in intensive care said that religion or spirituality was fairly or very important to them.
Yet their beliefs came up in only 40 out of nearly 250 family conferences with medical professionals. In 26 of those 40 cases, the patient’s family member brought up the subject first.
White’s team established their findings by recording these meetings, with permission from everyone involved, and analyzing the conversations.
The study authors found that medical staff tended to respond to expressions of spiritual need in one of four ways. Most often, the response focused on a medical care plan or treatment goal, as in the case of one family member who said she was praying that the patient wouldn’t have to have a tube inserted to breathe.
The physician’s response was highly clinical and did not address the prayer reference: “The long-term question is how to prevent the pancreatitis from happening again. It’s not a question, but it’s gonna be a question pretty soon, I think.”
In 13 of those 40 meetings where spirituality came up, the clinician responded with empathy. One doctor said, “Hang in there. I know it’s hard. I know,” to a loved one who observed “prayer’s not gonna work.”
But in one-quarter of meetings where beliefs were mentioned, the doctor simply responded with a curt “OK” or “Mhmm.”
A handful of physicians, in four of 40 meetings, still didn’t respond directly to the religious need but promised high-quality health care. For instance, one doctor replied, “We’ll do the best with what we’ve got” to the patient surrogate who said, “I know my God’s a big God. And I know He can even guide your guys’ hands to do the right thing.”
White said clinicians might avoid directly addressing these belief expressions for different reasons.
“It may be that clinicians, on average, are less religious than their patients,” he said. “It may be that clinicians do not know how to navigate these conversations or that they were taught to avoid discussion of such topics in favor of prioritizing discussion of medical facts.”
Patients and their family members can take these matters into their own hands, as many did in the study, by bringing up beliefs that are important to them.
“If religious or spiritual considerations are important to patients or their families, it may be important for families to inform clinicians of this and to request the involvement of spiritual care providers,” White said.
And when patients and their loved ones bring up belief needs, the clinicians should pay attention, said White.
“Physicians should take an interest in respectfully understanding more about the patients’ beliefs, such as by asking questions and listening carefully,” he said.
“For example,” White added, “a physician might say, ‘You mentioned you are trusting God. Tell me more about that.’ Then stop and listen.”
The U.S. National Cancer Institute talks about other end-of-life concerns.
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