spirituality/religion & health research: a few introductory points chaplain john w. ehman

Spirituality/Religion & Health Research:Spirituality/Religion & Health Research:A Few Introductory PointsA Few Introductory Points

Chaplain John W. EhmanChaplain John W. EhmanPenn Presbyterian Medical CenterPenn Presbyterian Medical Center

Philadelphia, PAPhiladelphia, PA

6/3/14

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Number of Medline-Indexed English Articles by Year, Number of Medline-Indexed English Articles by Year, with Keywords: with Keywords: RELIGION and SPIRITUALITYRELIGION and SPIRITUALITY

[ Includes the variations: religious, religiosity, religiousness, and spiritual ] John Ehman, 2012

Number of Medline-Indexed English Number of Medline-Indexed English Articles by Year, with Keywords Articles by Year, with Keywords SPIRITUALSPIRITUAL or or SPIRITUALITYSPIRITUALITY

John Ehman, 6/30/09

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Among the factors Among the factors in the mid-1990sin the mid-1990s affectingaffectingthe study of spirituality/religion & health:the study of spirituality/religion & health:

• Greater attention paid to religious values, beliefs, and practices as key aspects of patient diversity (e.g., new emphasis by the Joint Commission)

• Growing sense among health care providers and researchers of religion’s role in health-pertinent behaviors and health care decision-making -- important for “knowing your patient”

• Research begins accumulating significant data that patients’ spirituality/religiosity may be important to medical outcomes and thus to the process of “healing your patient”

Two things to keep in mind about the Two things to keep in mind about the modern field of Spirituality & Health:modern field of Spirituality & Health:

1)1) It is still nascent in the current form It is still nascent in the current form

2)2) It has somewhat fluid terminology It has somewhat fluid terminology

In the health care literature, religion is associated with institutional systems of beliefs and practices, whereas spirituality is associated with personal experiences and an individual quest for meaning.

Spirituality is generally seen as a broad concept, going beyond the “limits” of religion.

The Two Most Common Views of the The Two Most Common Views of the Relationship of Relationship of SpiritualitySpirituality to to ReligionReligionin the Current Health Care Literaturein the Current Health Care Literature

Spirituality

Religion

Spirituality

Religion

‘‘Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.’’

A New and Important Definition of Spirituality:

— — p. 646 of Puchalski, C. M., et al., "Improving the Spiritual Dimension of p. 646 of Puchalski, C. M., et al., "Improving the Spiritual Dimension of Whole Person Care: Reaching National and International Consensus," Whole Person Care: Reaching National and International Consensus," Journal of Palliative MedicineJournal of Palliative Medicine 17, no. 6 (June 2014): 642-656 17, no. 6 (June 2014): 642-656

While the broad concept of spirituality holds strong appeal in the practice of health care and is prominent in the literature, religion tends to be favored as the focus of research because the concept highlights factors that can be more easily specified, observed, and quantified.

While the broad concept of spirituality holds strong appeal in the practice of health care and is prominent in the literature, religion tends to be favored as the focus of research because the concept highlights factors that can be more easily specified, observed, and quantified.

However, a growing problem with religion-focused research is that Americans are increasingly less likely to see themselves and fit themselves in traditional categories of religion.

Americans and Religious AffiliationAmericans and Religious Affiliation

A 2012 Pew Research Center survey found that one-fifth of the U.S. public – and a third of adults under 30 years old – now describe themselves as “religiously unaffiliated.” This is partly due to an increasing trend to drop all sense of connection to a specific religious tradition when there is not an active social involvement in a congregation.

Moreover, 18% of American adults describe themselves now as “spiritual but not religious.”

Pew Research Center’s Forum on Religion & Public Life, "'Nones' on the Rise…,” report issued October 9, 2012

Polls re: Religion/Spirituality in the USPolls re: Religion/Spirituality in the US

• 90-96% of adults in the US say they “believe in God”

• over 40% say they attend religious services regularly, usually at least once a week

• 50-75% say religion is “very important” in their lives

• 90% say they pray, and most (54-75%) say they pray at least once a day

• over 80% say that “God answers prayers”

• 79-84% say they believe in “miracles” and that “God answers prayers for healing someone with an incurable illness”

--These percentages are summary characterizations of numerous national surveys showing fairly consistent results across time

Religion-focused research remains the driving force Religion-focused research remains the driving force in the overall field of “Spirituality & Health” because in the overall field of “Spirituality & Health” because

it is conducive to drawing practical connections it is conducive to drawing practical connections with health issues. with health issues.

For example:

• fewer dangerous behaviors (e.g., less substance abuse, unsafe sex, or neglect of health screenings)

• less suicide and generally greater aversion to suicide

• less depression and faster recovery from depression

• greater sense of meaning/purpose in life, hopefulness

--See: Koenig, H.G, et al., Handbook of Religion and Health, 2001/2011; and Koenig, H.G., Testimony to the US House of Representatives Subcommittee on Research and Science Education, 9/18/08

• lower rates of coronary artery disease

• lower cardiovascular reactivity

• greater heart rate variability

• lower blood pressure and generally less hypertension

• tendency for better outcomes after cardiac surgery

• better endocrine function

• better immune function

• lower cancer rate and better outcomes

• lower mortality and longer survival generally --ibid.

Theoretical Model of How Religion Affects Physical Health --adapted from Koenig, et al., Hand- book of Religion and Health, 2001

Religion also affects Childhood Training,Adult Decisions, and Values & Character;which then in turn affect mental health, social support, and health behaviors.

Infection

Cancer

HeartDisease

Hyper-tension

Stroke

Stomach& Bowel

Liver& Lung

Accidents& STDs

StressHormones

ImmuneSystem

AutonomicNervousSystem

Disease Detection and Treatment

Compliance

High Risk Behaviors

(smoking, drugs)

MentalHealth

SocialSupport

HealthBehaviors

RELIGION

Recent health care literature largely Recent health care literature largely addresses religion/spirituality as…addresses religion/spirituality as…

… a ground for “religious” social support

… a value basis for personal meaning-making (and therefore understanding illness and coping with crises) and decision-making

… a context for behavior that can influence the way the body works (e.g., meditation that can affect physiological reactions to stress)

spirituality/religion & health research: a few introductory points chaplain john w. ehman

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