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The Faith Factor: Getting to the Soul of the Matter

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Title: The Faith Factor: Getting to the Soul of the Matter


1
The Faith Factor Getting to the Soul of the
Matter
Mark C. Pettus M.D. FACP Clinical Associate
Professor of Medicine University of Massachusetts
Medical School
2

3
Points To Be Made
  • Diverse forms of faith, spiritual, and religious
    practice are central in the lives of most people
    we treat.
  • Often when confronting illness, spiritual and
    religious concerns are awakened or intensified.
  • A greater awareness and understanding of these
    issues, in some circumstances, strengthens our
    therapeutic potential as clinicians.
  • There appears to be a clear relationship between
    individual spirituality and individual health.

4
Influence of faith perspectives on the experience
of illness
  • Meaning in the context of illness
  • Coping strategies and self-care
  • Medical decision making
  • Care management
  • Avenues for healing not routinely addressed in a
    biomedical model of care

5
Religion vs. Spirituality
  • Religion an organized belief system that
    fosters a closeness to God
  • Spirituality quest for understanding, meaning,
    and purpose that nurtures a deeper connection to
    held values that may (or may not) lead to
    development of religious rituals and community

6
Nothing in life is more wonderful than
faith.mysterious, indefinable, known only by its
effects
  • William Osler

7
God heals, and the doctor takes the fees
  • Benjamin Franklin

8
How Might Spiritual Practices Heal?
  • Social support, community, a key to health and
    longevity
  • Our wellness is clearly influenced by our
    physical, mental, emotional, and spiritual
    health.
  • Spiritual practices can sometimes assist people
    to better handle illness, suffering, and loss.
  • Relaxation response with resultant reduction in
    stress, lowering of BP, with decreases in
    metabolic, heart and respiratory rate, as can be
    seen with prayer or meditation.
  • Placebo Effect-A biologic manifestation of faith?

9
Where Might Spirituality and Coping Intersect?
  • Nighttime fear
  • Psychiatric problems
  • Suffering e.g., from domestic abuse
  • Hospitalization
  • Disability
  • Substance abuse
  • Terminal Illness

10
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11
How does a spiritual wound appear?
  • Lack of meaning and purpose
  • Hopelessness
  • Despair
  • Not being remembered
  • Guilt or shame
  • Abandonment
  • Grief
  • Loss
  • Anger

12
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13
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14
Religion without science is blind. Science
without religion is lame.
  • Albert Einstein

15
The spiritual dimension cannot be ignored, for
it is what makes us human
Victor E. Frankl
16
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17
Religious and Spiritual Perspectives and Practice
18
Religious Beliefs of Americans Gallup Poll
  • 92 believe in God
  • 83 view the Bible as the actual or inspired word
    of God.
  • 65 pray at least once daily
  • 50 say religion is very important in their
    life
  • 35 have attended worship services within the
    last week

19
Faith and Healing
  • Time/CNN Poll (n1004)
  • 82 believe in the healing power of prayer
  • 77 believe God may cure serious illness
  • 73 say praying for others can help cure illness
  • 64 say MDs should pray with patients if requested

20
Use of religion and spirituality for health
reasons in African-American Women 2004
  • Whitney Dessio et al.
  • 43 had used religion/spirituality for health
    reasons in the past year
  • Most often used these practices for serious
    conditions such as cancer, heart disease, and
    depression

21
Most frequently chosen behaviors to improve
mood Time Magazine2004 (1000 Americans)
  • Talking to family and friends
  • Listening to music
  • Prayer
  • Helping others in need

22
JCACHO 2003
  • 1,720,000 individuals providing information
    regarding preferences for medical care
  • Meeting spiritual and emotional needs was the
    most common priority noted by patients and
    families.

23
National Center for Health Statistics and
NCCAM 31,000 adults - May 2004
  • 45 had used prayer for health reasons
  • 43 prayed for their own health
  • 25 had others pray for them
  • 10 participated in a prayer group for their
    health

24
A Sampling of the Data Linking Spiritual Practice
with Positive Health Outcomes
25
Improving Immune Function
  • 1,700 older adults from N.C.
  • Those who attended church at least once/week were
    half as likely as non-attendees to have elevated
    IL-6 levels and CRP
  • Lower levels of alpha-2 globulin and fibrin
    d-dimers
  • Koenig et al. Int.J. Psych Med 199727(3)

26
Religious Beliefs and Advanced Cancer
  • In many studies published in the palliative care
    literature, support of spiritual and religious
    faith perspectives were positively correlated
    with life satisfaction, happiness and improved
    symptom management, but not survival.

27
Recovery from Depression
  • 87 depressed hospitalized patients.
  • Duke University- Outcome in terms of depressive
    symptoms was strongly predicted by the extent to
    which a patients religious faith was a central
    motivating force in their lives.
  • George et al. Am J Psych

28
Religious-spiritual expression and relationship
to psychiatric and substance use
disorders Kendler KS et al. Am J Psych 2003
  • Gratitude, forgiveness, God as personal
    support/judge and social religiosity were
    associated with reduced risk for depression,
    anxiety disorders, bulimia, antisocial behavior,
    nicotine, alcohol and drug abuse or dependence.

29
Religion and Health in American Youth
  • 5000 high school seniors
  • Religiosity linked to better decision making
  • Lower rates of drinking, smoking, drug use
  • Lower teen pregnancy rates
  • Higher life-satisfaction, academic and social
    competence
  • Lower suicidal ideation

30
  • Jessor,R. et al. J Pers Soc Psychol. 1998
  • Wallace et al. Health Educ Behave. 1998
  • DuRant, RH et al. Pediatrics. 1996
  • Donelson, E. et al. J Adolescence. 1999
  • Cornelius, MD et al. Pediatrics. 1995
  • Scheidlinger s, et al. Psychoanal Rev. 1997

31
Adjustment, spirituality, and health in women on
hemodialysis Tanyi RA et al. Clin Nurs Res 2003
  • 65 women aged 24-82 receiving hemodialysis at 5
    outpatient centers in Minnesota
  • Psychosocial adjustment and self-perceived health
    correlated highly with religious and spiritual
    well-being

32
Lower Mortality in Religious Kibbutzim
  • 3,900 Israelis followed for 15 years
  • 8 death rate in secular kibbutzim
  • 4 death rate in religious kibbutzim
  • AM J Pub Health 1996

33
Mortality
  • 1931 older residents from Marin County, Ca.
  • Regular church attendance reduced mortality over
    a five year period.
  • Physical functioning and social support.
  • Other factors need to be examined.
  • Oxman AmJPubHealth 1998 88(10)

34
Active Religious Involvement Increases the
Chances of Living Longer by 29.
  • Metaanalysis of 42 studies
  • 126,000 people
  • Attendance at religious services, personal
    importance of ones religious faith, comfort with
    ones relationship with God
  • Stronger link with participation in religious
    organizations
  • Controlled for other factors
  • McCullough, Larson et al. Health Psychology
    200019(3)

35
Post CABG
  • Dr. Thomas Oxman
  • The factor that best predicted survival of
    coronary bypass surgery and a smooth post-op
    course was the degree of religious strength and
    spiritual meaning people found in their lives

36
Recovery from Elective Cardiac Surgery
  • Six Month Mortality Rates (n232)
  • Group Rate
  • Overall 9
  • Churchgoers 5
  • Non-churchgoers 12
  • Deeply Religious 0
  • Oxman, Psychosom Med 1995575-15

37
The Cochrane Database of Systematic Reviews
  • Current data on the health effects of
    intercessory prayer are inconclusive.
  • The evidence that exists, however is interesting
    enough to justify further study.
  • Any effects may be beyond present scientific
    understanding.

38
Reducing Length of Hospital Stays
  • 542 patients age 60 or older
  • Those attending religious services weekly or
    more, reduced LOS by more than half and were
    43 less likely to have been admitted in the
    previous year
  • Koenig et al. South Med J 199891(10)

39
Mind-Body Neuroscience The Faith Factor
  • Bonding-attachment, social connectivity
  • Reward-meaning-maker
  • Belief and expectation
  • Prayer as a form of meditation
  • Reduction of allostatic load
  • Health-promoting virtues
  • Resilience

40
Are there Negative Impacts of Religion?
41
Reliance on Faith Healing
  • 172 children who died after their parents relied
    on faith healing instead of standard medicine.
  • 140 children (81) had treatable problems
    allowing excellent prognosis eg. Dehydration,
    diabetes, pneumonia, appendicitis, epilepsy
  • Asser et al, Pediatrics 1998 101(4)

42
Options for Spiritual Intervention
  • Ignore spiritual issues/content
  • Acknowledge role of religion/spirituality in
    patients care
  • Inquire about beliefs and practices
  • Refer to clergy
  • Provide spiritual counseling
  • Pray for/with patients

43
Taking a Spiritual History Developed by Christina
Puchalski MD, GWISH
  • Faith e.g. Does faith play an important role
    in your life? What gives you meaning?
  • Influence e.g. Does your faith influence the way
    you care for yourself?
  • Community e.g. Are you a member of any
    congregation or spiritual community?
  • Address e.g. How would you like me as your
    doctor to address these issues in your care?

44
What I am not saying
  • Physicians should supplant clergy
  • Prayer should supplant Prozac
  • Outcomes of studies are proof/disproof of divine
    intervention
  • Saints are healthier than sinners
  • Prayer is a magic bullet or panacea
  • Religious or spiritual issues should be addressed
    in every clinical situation

45
What I am saying
  • Physicians help patients (and themselves) by
    acknowledging and respecting individual
    experiences, beliefs, practices and autonomy in
    matters pertaining to spirituality and religion.
  • Spiritual beliefs and practices may be
    beneficial for health and are very cost
    effective.
  • The medical effect of faith depends more on the
    individual intensity of ones spiritual
    commitment than on the particularity of ones
    faith tradition.

46
  • Physicians and other health care providers are in
    unique positions to explore and optimize the the
    benefits of faith in those they treat, when
    appropriate

47
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48
Patterns in Physicians Referral to Hospital-Based
Chaplaincy Services and Views on Spiritual
Care. Rodrigues, Phillips, and Kliewer OHSU 2002
Role of Spirituality in Physicians Life
BMC n20 Study n1590
Very Significant
Significant
Some Significance
Very Little
None
49
Participation in a Community of Faith
50
Participation in Personal Spiritual Practices
Worship in a Faith Community
Prayer
Meditation
Fasting
Study of Religious Writings
51
Physician Inquires About Patients Faith Practice
Never
Rarely
Sometimes
Often
Always
52
Physician Waits for Patient to Bring Up the Topic
of Spirituality First
Rarely
Often
53
Physician Considers the Patients Spiritual Needs
in Care of Patient
Rarely
Often
54
What do you see as the obstacles to narrowing the
gap between the importance that spirituality
plays in our patients lives and the infrequency
with which these issues are addressed in the
clinical setting?
  • More appropriate for attending to discuss.
  • Educational deemphasis
  • Lack of motivation
  • Often awkward with fleeting patient relationships
  • Time constraints
  • Personal awareness and comfort
  • Lack of acceptance by medical community
  • Inattentiveness

55
CDC -Carter Centers Interfaith Health Programs
  • Witness Project A community-based breast and
    cervical cancer education program.
  • Project Vision Preventing and controlling risk
    factors associated with cardiovascular disease.
  • Heart Body and Soul 230 churches in East
    Baltimore conducting education and training in
    health screening and smoking cessation.

56
A Survey of Our Senior Residents
(n20) Spirituality plays an important role in
the lives of people I treat.
  • Not important 0
  • Somewhat Important 30
  • Important 45
  • Very Important 25

57
Patients views regarding spirituality can
influence the way they view their
illness/wellness.
  • Not important 0
  • Somewhat important 10
  • Important 40
  • Very Important 50

58
Spirituality Plays an Important Role in My Life.
  • Not Important 10
  • Somewhat Important 15
  • Important 20
  • Very Important 55

59
I feel comfortable addressing spirituality with
my patients.
  • Not at all
    5
  • Somewhat 20
  • Depends on the circumstances 50
  • Always, if the circumstances are
    appropriate
    25
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