Spirituality in Serious Illness and Health

Background: Spirituality is important in medical decision-making and despite the evidence, spirituality in serious illness and health has not been systemically assessed. The objective of the study was to review evidence concerning spirituality and health and to identify implications for patient care and health outcomes.

Design and Participants: Searches of PubMed, PsycINFO, and Web of Science identified articles with evidence addressing spirituality in serious illness or health, published January 2000 to April 2022.Independent reviewers screened, summarized, and graded articles that met eligibility criteria. Eligible serious illness studies included 100 or more participants; were prospective cohort studies, cross-sectional descriptive studies, meta-analyses, or randomized clinical trials; and included validated spirituality measures.

Eligible health outcome studies prospectively examined associations with spirituality as cohort studies, case-control studies, or meta-analyses with samples of at least 1000 or were randomized trials with samples of at least 100 and used validated spirituality measures. Applying Cochrane criteria, studies were graded as having low, moderate, serious, or critical risk of bias, and studies with serious and critical risk of bias were excluded. Multidisciplinary Delphi panels qualitatively synthesized and assessed the evidence and offered implications for health care. Evidence-synthesis statements and implications were derived from panelists’ qualitative input: panelists rated the former on a 9-point scale (from “inconclusive” to “strongest evidence”) and ranked the latter by order of priority.

Results: Of 8946 articles identified, 371 articles met inclusion criteria for serious illness; of these, 76.9% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for serious illness:

(1) incorporate spiritual care into care for patients with serious illness

(2) incorporate spiritual care education into training of interdisciplinary teams caring for persons with serious illness

(3) include specialty practitioners of spiritual care in care of patients with serious illness.

Of 6485 health outcomes articles, 215 met inclusion criteria; of these, 66.0% had low to moderate risk of bias.

The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for health outcomes:

(1) incorporate patient-centered and evidence-based approaches regarding associations of

spiritual community with improved patient and population health outcomes

(2) increase awareness among health professionals of evidence for protective health associations of spiritual community

(3) recognize spirituality as a social factor associated with health in research, community assessments, and program implementation.

Commentary: Based on this evidence, the Delphi panel’s top-ranked suggested implication for health outcomes was that health care professionals recognize and consider the benefits of spiritual community as a part of efforts to improve well-being. Further research should explore the dimensions of and mechanisms by which spirituality may influence health and well-being. Moreover, standardized measures are needed to move the field toward more consistent, multidimensional assessment of spirituality, a shift that requires multidisciplinary insights. Additionally, research must inform best practices, as well as potential harms, to ensure optimal person- and community-centered attention to spiritual health.

Bottom Line: This review suggests that addressing spirituality in serious illness has implications in health outcomes as part of person-centered, value-sensitive care.

Source:

Balboni, T. A., VanderWeele, T. J., Doan-Soares, S. D., Long, K. N., Ferrell, B. R., Fitchett, G., ... & Koh, H. K. (2022). Spirituality in serious illness and health. JAMA, 328(2), 184-197.