Thursday, January 12, 2006
The current Archives of Internal Medicine has a piece about discussing spiritual issues at the end of life. It's a survey study of 78 patients with life-limiting illnesses. The authors decided to ask the simple question "To what extent are you at peace?" to patients, choosing not to specify further (eg, at peace with God or with oneself etc.). A whole bunch of other quality of life factors were also measured. They found that a sense of peace was not related to patient demographics (with the exception of age), but was related to reported "faith" and "purpose." This is not very surprising, and, in a move that I whole-heartedly endorse, the authors pretty much skim over the results of their survey (they didn't bother to even make a table or graph of their findings) to go right into the meat of the article--the "comments" section which involves discussing spirituality with patients. One gets the impression that the point of the article is this discussion, not so much presenting any results from their study.
What the authors propose is using "Are you at peace?" as a screening question for spiritual/existential needs for patients at the end of life (along the lines of using "Are you depressed?" as a screening tool for depression). They note that some patients may be suspicious of docs asking about spirituality and that this more neutral question is less threatening. This may be true, however by the authors' own acknowledgment most studies show patients really want us to ask about spirituality. That being said, I personally like the question, don't currently use it, and will probably try it out. The niche for this question, though, may well be for non-palliative care docs who perhaps have less time for & skill in asking about spirituality: it's short, covers a lot of territory, and less-threatening (for physicians, if not patients) than a direct inquiry about spirituality.