Does It Pay to Be Spiritual (But Not Necessarily Religious)?While onsite at the American Psychiatric Association's 168th Annual Meeting in Toronto, Ontario, Canada, Medscape spoke with Anthony Cannon, MD, a psychiatrist resident at Northwestern University in Chicago, about his new study exploring the effects of spiritually and religiosity on quality of life (QOL) in cancer survivors.[1]
Medscape: What were the objectives of your study?
Dr Cannon: We conducted a prospective cohort study of cancer patients after treatment to determine the relationship of spirituality and religiosity with patient QOL at 1 year. The National Cancer Institute defines spirituality as an individual's sense of peace or purpose and feelings about the meaning of life in general. Religiosity can be a conduit for spirituality in the context of specific beliefs and practices, usually in conjunction with other people who hold the same beliefs. On the basis of that construct, an individual can be spiritual, religious, both, or none. A total of 551 patients completed an initial questionnaire (baseline), with the same questionnaire administered at 6- and 12-month follow-up. The patients in our study underwent treatment for various cancers at an academic medical center between 2006 and 2008. We measured QOL with the Short Form-12 (SF-12), a validated scale which asks patients to rate various aspects of their physical and mental QOL. Medscape: What did your findings reveal about the relationship between spirituality, religiosity, and QOL? Dr Cannon: In terms of physical QOL, we found that religious patients had better QOL if they were highly spiritual. For mental QOL, we found a significant difference between the extreme groups (low spirituality/low religiosity and high spirituality/high religiosity), but our findings for mental QOL had another level of subtlety which raises a question as to what the role of religiosity is in mental QOL. For example, among patients who have low levels of religiosity, patients who are highly spiritual have better mental QOL. Similarly, among patients who are highly religious, those who were highly spiritual had better QOL. However, among patients who were highly spiritual, we failed to detect a significant difference in mental QOL when comparing patients with high and low levels of religiosity. Medscape: To a degree, your findings suggest that spirituality is more important than religiosity in terms of QOL, at least in this patient population.Dr Cannon: For mental health, our findings say precisely that. Spirituality also confers benefits among patients who are highly religious, helping with physical QOL as well. Medscape: Can you elaborate on why spirituality vs religiosity might have contributed to improved QOL in these patients? Dr Cannon: There are a number of hypotheses as to why spirituality and not religiosity has a more significant impact on mental QOL. One hypothesis could certainly be that some religious beliefs may view cancer as a punishment from God. Another may be that religion tends to be more external, and while a religious community may augment psychosocial support, the religious beliefs themselves may not translate into a broader understanding of the meaning of their cancer, or the meaning of their life in general. Conversely, spirituality tends to be more intrinsic: Peace, purpose, the meaning of life, and connectedness to others are concepts that must be considered and understood by each individual. Therefore, we postulate that the aspects which constitute heightened spiritual awareness are the ones that preserve mental QOL because they help individuals cope with and understand hardship—in this case, a diagnosis of cancer. Medscape: How might your findings be incorporated into patient care? Dr Cannon: There's an abundance of emerging evidence that patients desire spirituality and religiosity to be addressed and incorporated alongside the medical treatments for their cancer. Addressing spirituality and religiosity may not change the way we treat illnesses, but it fundamentally changes the way we engage patients. We're not proposing the imposition of a specific spiritual paradigm or intervention, but rather a genuine exploration with patients about how they understand their illness and their lives, and about how that understanding can be enhanced so as to help each patient live a richer and more fulfilling life despite a difficult diagnosis and circumstance. The impact of this study is high because we're adding to the evidence that addressing spiritual/religious concerns of patients can measurably improve QOL and is therefore time well spent. In spite of being able to understand the benefits of spirituality on QOL, we need to better understand the process of inquiry in ascertaining the role of spirituality and religion for each patient. For example, mindfulness meditation has promising data about improving QOL in medically ill patients, but it may not be a great fit for all patients. As providers, we need to resist the urge to say, "You should engage in this specific practice." Because each patient is different, we must resist the one-size-fits-all approach in addressing concepts that are so intrinsic, innate, and personal. Our data suggest that our role as providers should be to explore with patients and help them implement interventions that are most likely to be meaningful to them, rather than prescribing one approach. Religious/spiritual beliefs can be intensely held and deeply personal, which is one of the reasons why clinicians are often reticent to address this with patients; it's a very intimidating, taboo topic. We're often taught not to talk about religion and politics. However, genuine curiosity, expressed in a caring, nonjudgmental, and open-ended fashion, is neither abrasive nor offensive. Medscape: But maybe in some cases, especially given your findings, it's appropriate. Dr Cannon: Yes, I think it's inherently individual. That's why it should be framed as part of a process of inquiry and understanding with patients. There are a lot of emerging data to suggest that patients want these spiritual or religious concerns addressed concurrently with their medical care. Eighty-four percent of Americans report a religious affiliation; three quarters of Americans report a sense of spiritual awareness. And that proportion grows to 85%-90% among patients who have cancer.[2] Patients want to discuss spirituality and religiosity. We're realizing that these conversations can lead to interventions that profoundly enhance the humanity of our patients, if framed in the right way and with the right patients. References
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