Discussing spirituality with patients

Recently, I received a compliment on my “listening skills” from a family member of a patient.

Although I like compliments, this one was not deserved. I was listening and quiet because I did not know what to say. Her uncle, my patient, is an 86-year-old who I had met more than a year ago. He had been diagnosed with lung cancer. After discussing his quality-of-life goals, we chose palliative radiotherapy for hemoptysis and then hospice.

I continued to see him on a monthly basis, and during that time, he educated several of my students on how to discuss “death and dying” with a patient. He was a great teacher and these students will always remember the encounter. Eventually, he was taken off hospice and continued on palliative care services.

Biren Saraiya

At a visit in March, he complained that he was more fatigued; we reinstated hospice services. He missed his monthly appointment in April, so I called him and decided to meet with him at his home.

At our meeting, he seemed his normal self, except a bit more short of breath. He told me that he had lost interest in his daily routine such as keeping up with politics, and the news, and that he could not do other things he found interesting, such as gardening and meeting with his friends, because of his symptoms.

My concerns for depression was alleviated when he told me that he was not depressed but was focused on a new thing in life. He has known about his impending death for a year now and has had the time to complete his life review and “find peace with his loved ones,” as he had told my students several months ago. He was waiting to meet his loved ones in the afterlife.

Spirituality

He told me that a local priest had stopped by last week and they had discussed spirituality and God. He asked me about my thoughts on the subject.

Here, I was lost. I had never discussed this topic with my patients.

I am, by birth and upbringing, a Hindu and believe in things such as reincarnation and good karma. I was taught that the last quarter of the life was supposed to be devoted to relinquishing the worldly possessions and focusing on being one with our maker. But these are my thoughts, and I was not comfortable interjecting my thoughts at this point.

Stunned, I did what I could. I asked him to tell me more about what he had been thinking and hoping for. I focused on him instead of my discomfort.

I listened to him, without ever giving my thoughts or opinions, and after several minutes of discussion, he said that he has just found a church that was accepting of him and vice versa. Now, he was trying to reconcile with his maker. To me, that was the ultimate point of his story. Nothing of the worldly possessions or issues made a difference to him because he was concerned about different things.

When I returned to my office, I asked some of my colleagues about their thoughts on spirituality, and although most believed in one thing or another, no one actually discussed it.

So, I looked up several articles (referenced below). A summary of recommendations about discussing/addressing spirituality are provided in the sidebar.

Once again, this patient has taught me something more about being a doctor. I am going to try to be proactive and use the first two sentences in the sidebar about spirituality and faith earlier in my relationship with my patients.

Biren Saraiya, MD, is an Assistant Professor at the Cancer Institute of New Jersey at UMDNJ-Robert Wood Johnson Medical School and is a member of the HemOnc Today Editorial Board.

For more information:

• Lo B. Ann Intern Med. 1999;130:744-749.
• Rosseau P. J Clin Oncol. 2003;21:54s-56s.
• Storey P, Knight CF. UNIPAC Two: Alleviating Psychological and Spiritual Pain in the Terminally Ill. Gainesville, Fla., American Academy of Hospice and Palliative Medicine; 1997.