For some patients, faith plays an important part in how they cope with treatment and recovery, but whether it extends to the exam room depends on many factors.
About six months before her diagnosis, 22-year-old Reagan Barnett realized there was a possibility she might have cancer. While her symptoms had been troublesome, Barnett’s age made it difficult for doctors to consider cancer as her diagnosis. But she began preparing herself emotionally and spiritually, which made the diagnosis of stage 2 colon cancer easier to receive.
“I feel like my faith prepared me for cancer,” Barnett says, which is why she wanted her medical team to understand the role spirituality would play in her recovery.
It was difficult for her to find appropriate support services at her initial hospital. So when it came to time to decide where to have surgery, Barnett made it a priority to look for a surgeon with a background in religion.
Although Barnett’s doctor prayed with her family before her total colectomy, she found it was easier, as the patient, to discuss her religious beliefs with an outside friend who was a pastor.
For many patients, faith plays an important part in how they cope with treatment and recovery, but whether it extends to the exam room depends on many factors.
Anees Chagpar, director of the Breast Center at Smilow Cancer Hospital at Yale-New Haven in New Haven, Conn., says discussing spirituality starts with the patient and physician relationship.
“When a patient says, 'I want you to pray with me,' then I think as physicians, we’re able to do that regardless of our personal religious beliefs…We support our patients, being empathetic human beings,” Chagpar says.
In a recent study published in CA: A Cancer Journal for Clinicians, researchers found a majority of patients facing the end of life considered attention to spiritual concerns by doctors and nurses to be “an important part of cancer care.” However, all patients, regardless of the severity of their illness, should feel safe discussing their faith with their medical team.
"Spirituality” can be defined as an aspect of humanity, not just organized religion.
“They should be aware that their spirituality is a part of who they are, and be comfortable enough to address that on the table so that complete holistic care is given,” says Deacon Thomas J. Devaney, director of Mission and Pastoral Care at MedStar Georgetown University Hospital in Washington, D.C.
Christina Puchalski, director of the George Washington Institute for Spirituality and Health in Washington, D.C, says “spirituality” can be defined as an aspect of humanity, not just organized religion. It can include the way individuals seek meaning or purpose, and the way they experience their connection to self, to others and to nature, and to those significant or sacred.
Patients should let the medical team know if they are struggling with spiritual or emotional distress. Those types of discussions can directly affect quality of life. It can also open up channels of communications between the patient and medical team to address those quality of life issues, including a referral to a hospital chaplain or other support services.
Puchalski says spiritual care is about providing compassionate care for patients. Patients want clinicians to “listen to their whole story including that which is significant or sacred to the patient.”
She recalls a patient struggling with a personal tragedy, where she identified spiritual distress. Puchalski deliberated over how best to help her patient, and eventually referred her to a chaplain who was able to address the patient’s spiritual distress and respond to the questions of faith that had been troubling the patient.
To open a dialogue between patients and physicians, Puchalski created a spirituality history tool that helps doctors identify the spiritual needs or resources of strength of their patients, which includes questions such as:
• Do you consider yourself spiritual or religious?
• What gives your life meaning?
• What importance does your faith or belief have in your life? How does it influence your healthcare decision?
• Are you a part of a spiritual or religious community? Is this of support to you and how?
• How would you like me, your healthcare provider, to address these issues in your health care?
There are, however, certain boundaries that exist when physicians and patients discuss spirituality, including respect of beliefs on both sides. Puchalski says physicians should respect the patient’s spirituality and values, and not impose their own beliefs or dismiss the patient’s views because they differ from their own.
For Karen Green of Los Angeles, a diagnosis of acute lymphoblastic leukemia (ALL) made her search for faith to face the challenges ahead. While she questioned her spirituality before her diagnosis, with cancer, the questions multiplied, including what would happen to her and her family.
Eventually Green was able to find answers in a way that both inspired and encouraged her to remain upbeat throughout chemotherapy and beyond.
She credits the hospital chaplain for teaching her deep breathing and meditation, and believes she helped her recognize her inner spirituality. The next chaplain who visited Green focused less on meditation and more on her religious faith. “I grew in my faith as a result of his services,” she says.
Not all patients share the same experiences when dealing with the ups and downs of cancer. According to Chagpar, patients find themselves thinking and talking about spirituality differently throughout their cancer trajectory.
“Some people talk about it right away, as a means to find inner strength to face what, for many, is a harrowing experience,” Chagpar says. “For others, at initial diagnosis it’s much more of a pragmatic approach, but they will kind of turn more to [spirituality] at later stages.”
When seeking spiritual support, patients are often directed to a hospital chaplain or social worker. However, if spirituality is important to a patient, he or she should let their healthcare team know. They may be open to integrating spiritual care more directly into their medical care.