Whole person healthcare and spiritual factors

Outcome for Graduates. General Medical Practice. 2018
14 Newly qualified doctors must be able to work collaboratively with patients, their relatives, carers or other advocates to make clinical judgements and decisions based on a holistic assessment of the patient and their needs, priorities and concerns, and appreciating the importance of the links between pathophysiological, psychological, spiritual, religious, social and cultural factors for each individual.

Good Medical Practice. General Medical Practice. 2024
7a In providing clinical care you must: a adequately assess a patient’s condition(s), taking account of their history, including i. symptoms ii. relevant psychological, spiritual, social, economic, and cultural factors iii. the patient’s views, needs, and values

The RCGP Curriculum. Being a General Practitioner 2019
Demonstrate the holistic mindset of a generalist medical practitioner. Learning outcomes:
1. Appreciate the value of health in its broadest sense as being more than the absence of disease but also a resource that enables a person to adapt successfully to the challenges of living
2. Enquire routinely into physical, psychological and social aspects of the patient’s problem, integrating this information to form a holistic view
3. Interpret each patient’s personal story in his or her unique context, considering the effects of additional factors that are known to influence an individual’s health needs, including: educational and occupational factors, environmental and cultural factors, spiritual and other existential factors

World Health Organisation, Precis of discussion, 1948
Health is not just the absence of disease, it is a state of physical, psychological, social and spiritual wellbeing.

World Health Organisation (1998) WHOQOL and spirituality, religiousness and personal beliefs: report on WHO consultation. WHO. Geneva.
Until recently the health professions have largely followed a medical model, which seeks to treat patients by focussing on medicines and surgery and gives less importance to beliefs and to faith. This reductionism or mechanistic view of patients as being only a material body is no longer satisfactory. Patients and physicians have begun to realise the value of elements such as faith, hope and compassion in the healing process. The value of such ‘spiritual’ elements in health and quality of life has led to research in this field in an attempt to move towards a more holistic view of health that includes a non-material dimension, emphasising the seamless connections between mind and body.

American Medical Association Resolution 304 April 17th 2024
(1) Our AMA recognizes the importance of individual patient spirituality and its impact on health and encourages patient access to spiritual care services.
(2) Our AMA encourages the availability of education about spiritual health, defined as meaning, purpose, and connectedness, in curricula in medical school, graduate medical education, and continuing physician professional development as an integral part of whole person care

Guidance on Cancer Services. Improving Supportive and Palliative Care for Adults with Cancer. Spiritual Support Services. National Institute for Clinical Excellence. March 2004
Beliefs can be religious, philosophical or broadly spiritual in nature.  Formal religion is a means of expressing an underlying spirituality, but spiritual belief, concerned with the search for the existential or ultimate meaning in life, is a broader concept and may not always be expressed in a religious way.  It usually includes reference to a power other than self, often described as ‘God’, a ‘higher power’, or ‘forces of nature’. This power is generally seen to help a person to transcend immediate experience and to re-establish hope.

Improving the Spiritual Dimension of Whole Person Care: Reaching National and International Consensus. Christina M Puchalski, Robert Vitillo, Sharon K Hull, Nancy Reller, J Palliat Med. 2014 Jun 1;17(6):642–656. doi: 10.1089/jpm.2014.9427
Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.

Nolan S, Saltmarsh P, Leget C: Spiritual care in palliative care: Working towards an EAPC Task Force. Eur J Palliat Care 2011;18:86–89
The European Association of Palliative Care. Towards a European-appropriate definition of spirituality: Spirituality is the dynamic dimension of human life that relates to the way persons (individual and community) experience, express and/or seek meaning, purpose and transcendence, and the way they connect to the moment, to self, to others, to nature, to the significant, and/or the sacred.

Naryanasamy A (1991) Spiritual Care – A resource guide. Quay Publishing. Lancaster.
Spiritual needs are the need to give and receive love; the need to be understood; the need to be valued as a human being; the need for forgiveness, hope and trust; the need to explore beliefs and values; the need to express feelings honestly; the need to express faith or belief; the need to find meaning and purpose in life.

Spiritual care needs. NHS inform (Scotland)
Spiritual needs are different for everyone. They can change over time as you face new challenges in life or changes in your health. Spiritual care needs can include the need: to give and receive love; to be understood; to be valued as a human being; for forgiveness and trust; to explore beliefs and values; to find meaning, purpose and hope. If you experience illness or loss, you may have questions linked to meaning, purpose or hope. Many people welcome spiritual care when they have a serious illness, or their health is changing or getting worse.

Spiritual health. McKinsey Health Institute May 2024
A global survey of 41,000 people finds that spiritual health matters to many, regardless of age, country, or religious beliefs. Spiritual health encompasses having meaning in one’s life, a sense of connection to something larger than oneself, and a sense of purpose. Finding this meaning is associated with strong mental, social, and physical health.

Spiritual distress. The Palliative Care Project, a partnership between Community Care of Brooklyn and the MJHS Institute for Innovation in Palliative Care.
Spiritual pain or distress occurs when a person is unable to find sources of meaning, hope, love, peace, comfort, strength, or connection in life.

Guidance on Cancer Services. Improving Supportive and Palliative Care for Adults with Cancer. Spiritual Support Services. National Institute for Clinical Excellence. March 2004
Ensure that spiritual care is offered as an integral part of an holistic approach to health, encompassing psychological, spiritual, social and emotional care, and within the framework of the patient’s beliefs or philosophy of life.

Spiritual Care Matters. An Introductory Resource for all NHS Scotland Staff 2009
Spiritual care is that care which recognises and responds to the needs of the human spirit when faced with trauma, ill health or sadness and can include the need for meaning, for self-worth, to express oneself, for faith support, perhaps for rites or prayer or sacrament, or simply for a sensitive listener. Spiritual care begins with encouraging human contact in compassionate relationship, and moves in whatever direction need requires.

Discovering meaning, purpose and hope through person-centred well-being and spiritual care. A national framework. The Scottish Government.2023
The framework reflects the considerable developments resulting from the increased professionalism in spiritual care over the last twenty years. It firmly establishes the role of spiritual care as an integral part of health and social care provision.

Koening, H. K., McCullough, M.E., Larson, D.B. Handbook of Religion and Health. Oxford: Oxford University Press, 2001.
A comprehensive analysis of over 1,200 studies and 400 reviews of empirical research found statistically significant benefits of spiritual care in terms of prevention of ill-health, aiding recovery and encouraging equanimity.

Koenig H G, Religion, Spirituality, and Health: The Research and Clinical Implications. International Scholarly Research Notices. Dec 2012
This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010.

Whitehead O, Jagger C, Hanratty B. What do doctors understand by spiritual health? A survey of UK general practitioners. BMJ Open 2021;11:
Understanding of spiritual health fitted into three themes: self-actualisation and meaning, transcendence and relationships beyond the self, and expressions of spirituality. A full range of views were expressed, from a minority who challenged their role in spiritual health, through to others enthusiastic about its place in healthcare.

Appleby A, Swinton J, Wilson P. What GPs mean by “spirituality” and how they apply this concept with patients: a qualitative study. BJGP Open. 2018 Apr 17;2(2):bjgpopen18X101469.
GPs have varying views on what spirituality is, and these relate partly to individual beliefs and experiences. These create considerable variation in the delivery of spiritual care.

Best M, Butow P, Olver I. Do patients want doctors to talk about spirituality? A systematic literature review. Patient Educ Couns. 2015 Nov;98(11):1320–8.
While a majority of patients express interest in discussion of religion and spirituality in medical consultations, there is a mismatch in perception between patients and doctors regarding what constitutes this discussion.

Hasenfratz K, Moergeli H, Sprott H, Ljutow A, Hefti R, Rittmayer I, Peng-Keller S and Rufer M (2021) Do Chronic Pain Patients Wish Spiritual Aspects to Be Integrated in Their  Medical Treatment? A Cross-Sectional Study of Multiple Facilities.  Front. Psychiatry 12:685158.  doi: 10.3389/fpsyt.2021.685158
Conclusions: These results confirm that the majority of chronic pain patients wish spiritual aspects to be considered in their treatment. Additionally, the finding that these patients had more spiritual resources underlines the importance of integrating spiritual aspects in a resource-oriented, patient-centered care approach for this condition.

Miller, W. R., & Thoresen, C. E. (2003). Spirituality, religion, and health: An emerging research field. American Psychologist, 58(1), 24–35. https://doi.org/10.1037/0003-066X.58.1.24
The investigation of spiritual/religious factors in health is clearly warranted and clinically relevant. This introduction provides an overview of this field of research and addresses 3 related methodological issues: definitions of terms, approaches to statistical control, and criteria used to judge the level of supporting evidence for specific hypotheses. The study of spirituality and health is a true frontier for psychology and one with high public interest.

Why Spirituality Matters in Medicine. Spirituality plays a role in both health and illness for many. VanderWeele T J, Psychology Today June 2022
Spiritual or religious community is an important health resource for many people. Many patients want their spirituality to be taken into account when they receive medical care. Many clinicians, however, lack training in spiritual care. To determine a patient’s spiritual needs, or lack thereof, clinicians can take a brief spiritual history of patients.

Spirituality in Serious Illness and Health. Tracy A. Balboni, MD, Tyler J. VanderWeele, PhD Stephanie D. Doan-Soares, DrPH5; et al Journal of the American Medical Association. 2022;328(2):184-197.  
How can considerations of spirituality guide health care and health outcomes? The 3 top-ranked implications of this evidence for health outcomes were:  (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; and (3) recognize spirituality as a social factor associated with health in research, community assessments, and program implementation.

Appleby A. Science and spirituality in primary Care: Is there common ground? BJGP Life. 31 March 2025
Many general practitioners consider spirituality to be relevant to their patients’ health and important to primary care. However, our research showed that a number of GPs worry that addressing this issue is unscientific. Alongside this, an increasing amount of research points to links and associations between spirituality and health. An important question is whether it is possible to think about spirituality and science in a way that does justice to both concepts.