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John W. Ehman, MDiv; Barbara B. Ott, RN, PhD; Thomas H. Short, PhD; Ralph C. Ciampa, STM; John Hansen-Flaschen, MD

Arch Intern Med. 1999;159:1803-1806.

Background  Recognizing that many Americans draw on religious or spiritual beliefs when confronted by serious illness, some medical educators have recommended that physicians routinely ask about spirituality or religion when conducting a medical history. The most appropriate wording for such an inquiry remains unknown.

Objective  To examine patient acceptance of including the following question in the medical history of ambulatory outpatients: "Do you have spiritual or religious beliefs that would influence your medical decisions if you become gravely ill?"

Methods  Self-administered questionnaires were completed by 177 ambulatory adult patients visiting a pulmonary faculty office practice at a university teaching hospital in 1997 (83% response rate).

Results  Fifty-one percent of the study patients described themselves as religious and 90% believe that prayer may sometimes influence recovery from an illness. Forty-five percent reported that religious beliefs would influence their medical decisions if they become gravely ill. Ninety-four percent of individuals with such beliefs agreed or strongly agreed that physicians should ask them whether they have such beliefs if they become gravely ill. Forty-five percent of the respondents who denied having such beliefs also agreed that physicians should ask about them. Altogether, two thirds of the respondents indicated that they would welcome the study question in a medical history, whereas 16% reported that they would not. Only 15% of the study group recalled having been asked whether spiritual or religious beliefs would influence their medical decisions.

Conclusion  Many but not all patients surveyed in a pulmonary outpatient practice welcome a carefully worded inquiry about their spiritual or religious beliefs in the event that they become gravely ill.

From the Department of Pastoral Care, Hospital of the University of Pennsylvania, Philadelphia (Dr Ehman and Mr Ciampa), Villanova University, Villanova, Pa (Drs Ott and Short), and the Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia (Dr Hansen-Flaschen).

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