Religion rarely part of ICU conversation

In less than 20 percent of family meetings in the intensive care unit do doctors and other health care providers discuss religion or spirituality a new study finds.

For many patients and families, religion and spirituality are important near the end of life, and understanding these beliefs may be "important to delivering care that is respectful of the patient as an individual," said senior author Dr. Douglas B. White of the University of Pittsburgh School of Medicine, in email to Reuters Health.

Researchers used audio recordings to analyze 249 meetings between health care professionals and an ICU patient's surrogate decision maker at six medical centers between 2009 and 2012.

Three-quarters of the decision makers rated religion or spirituality as fairly or very important in their lives.

Religion or spirituality came up in 40 of the 249 conversations. More than half of the time, the surrogate decision maker, rather than the doctor, brought up the subject, the authors reported in JAMA Internal Medicine.

Surrogates most often mentioned their religious beliefs, practices or community, or that the doctor is a healing instrument of god, or that the end of life will be a new beginning for the patient.

Doctors frequently redirected these conversations to medical considerations, referred surrogates to other hospital providers or expressed empathy, but very rarely asked further questions about the patient's religion or opened up about their own religious beliefs.

"Regardless of whether the patient has decision making capacity, clinicians should try to determine whether patients' religious and spiritual beliefs may affect the kind of medical care that is respectful of what is important to the patient as a person," White said. "Separately, many family members of critically ill patients find solace in their religious or spiritual beliefs and it may be helpful for clinicians to understand this to better support them."

Doctors seem not to address these concerns even when surrogate decision makers raise them, he said.

"In my view, it is less important that doctors ask in a standardized way, and more important that they have a basic comfort talking with patients and families about these issues and are able to adapt to the needs of the individual patient and family," he said.

When a patient brings up a spiritual concern, their doctors should start by simply asking questions and listening carefully, White said.

Whether or not the doctor's religious views are discussed will depend on the situation, and there is no right or wrong answer, he said.

"If doctors start to attend more carefully to religious and spiritual concerns of patients and surrogates, I suspect they may get into very human conversations in which at times it will be appropriate to frankly discuss their own views," White said. "As a starting point, clinicians should focus on developing skills to understand the families' religious or spiritual concerns."

It is unclear if health care providers will develop these skills, as Dr. Tracy A. Balboni of the Dana-Farber Cancer Institute, Boston, and coauthors write in an accompanying editorial.

"Our patients and families who face serious illness typically find themselves in spiritual isolation in the medical setting; their medical caregivers do not hear the spiritual reverberations of illness on their well-being and medical decisions," they write. "The question remains whether we who care for dying persons and their families will learn how to be present and listen."