A patient in the hospital receives a long line of visitors, from physicians to nurses to medical students to other staff members. The conversations with most of these personnel tends to be mostly business – answering clinical questions or following instructions, with maybe a little bit of small talk squeezed in between temperature measurements and pill swallowing. Deeper conversations of a religious or spiritual nature may be left to hospital chaplains or religious representatives visiting the patient. But with only about two-thirds of hospitals providing pastoral care – and with tightening hospital budgets potentially threatening to push that number even lower – is it possible to measure the value of these spiritual discussions?
That was the aim of a new study by the research group of Farr Curlin, associate professor of medicine at the University of Chicago Medical Center. In an analysis led by medical student Joshua Williams, the team measured how many of over 3,000 patients in a survey reported having a spiritual or religious discussion while they were in the hospital, who that conversation was with, and most importantly, how it affected the patient’s opinion of their experience in the hospital. Published recently in the Journal of General Internal Medicine, the study found that a little bit of attention to a patient’s spiritual concerns boosted patients’ satisfaction with doctors, confidence and trust in their physicians, their feelings about the teamwork between doctors and nurses, and their rating of the overall care received.
“Our data is the strongest data so far that having these issues addressed, even having them brought up, is something that people experience as very positive,” Curlin said. “What’s interesting is it didn’t matter whether the patient said they wanted it, just having had it was associated with higher rates of satisfaction across four different measures.”
Surprisingly, the source of the spiritual or religious conversation was less important than the content. The benefits were the same whether patients talked with a chaplain, a physician, or even a religious figure from outside the hospital, Curlin said. Furthermore, while most of spiritual discussions were originated by chaplains (61 percent), the patient satisfaction figures suggested the good vibes were contagious, spreading out to improve patients’ feelings about the other members of their health care team.
“It was the whole experience: the physicians, the clinical team that took care of them,” Curlin said. “The care they received at the hospital was rated more highly if someone talked to them about spiritual concerns.”
The effect was not limited to patients with strong religious beliefs, or even those who sought out a patient ear for their spiritual thoughts. Forty-one percent of patients said they wanted to discuss such concerns, but even patients who weren’t seeking spiritual counsel but were approached anyway demonstrated the same positive influence upon their experience in the hospital. Curlin said that a benefit even for non-religious patients indicated that the effects of talking to a chaplain (or a physician, or a friendly custodian) were more about being recognized as a person instead of a patient.
“I’m not surprised there is this kind of effect,” he said. “People feel like they’re a cog in the machine, so if someone breaks through and asks, ‘Hey, who are you, what’s going on, what’s this like?,’ they like to respond to that. As a patient, you want someone to recognize that you have your own history and issues you might be struggling with, and it makes a difference.”
While Curlin’s study couldn’t put a dollar value on the benefits of spiritual discussion, patient satisfaction scores are serious business for hospitals. Measures such as the Press Ganey indexes help hospitals determine how they are performing on measures of patient satisfaction – and high grades can bring in more patients. In Williams’ study, slightly less than one-third of patients reported having at least one spiritual discussion, leaving a lot of room for improvement. Whether that should happen through expanding pastoral care, providing more training for physicians and nurses in addressing patients’ spiritual concerns, or some other method remains to be examined. But simply taking the time to talk with patients about less material matters could be an inexpensive improvement for hospitals.
“Many more inpatients desire conversations about religious and spiritual concerns than actually experience such conversations,” the authors wrote. “Our findings suggest that physicians, nurses, healthcare organizations, and pastoral care departments may address an unmet need and simultaneously improve patient satisfaction by talking to patients about religious and spiritual concerns in the inpatient setting.”
Williams JA, Meltzer D, Arora V, Chung G, & Curlin FA (2011). Attention to Inpatients’ Religious and Spiritual Concerns: Predictors and Association with Patient Satisfaction. Journal of general internal medicine PMID: 21720904