Doctors discussing religion and spirituality: A systematic literature review
Abstract
Background Discussion of religion and/or spirituality in the medical consultation is desired by patients and known to be beneficial. However, it is infrequent. We aimed to identify why this is so. Aim We set out to answer the following research questions: Do doctors report that they ask their patients about religion and/or spirituality and how do they do it? According to doctors, how often do patients raise the issue of religion and/or spirituality in consultation and how do doctors respond when they do? What are the known facilitators and barriers to doctors asking their patients about religion and/or spirituality? Design A mixed qualitative/quantitative review was conducted to identify studies exploring the physician's perspective on discussion of religion and/or spirituality in the medical consultation. Data sources We searched nine databases from inception to January 2015 for original research papers reporting doctors' views on discussion of religion and/or spirituality in medical consultations. Papers were assessed for quality using QualSyst and results were reported using a measurement tool to assess systematic review guidelines. Results Overall, 61 eligible papers were identified, comprising over 20,044 physician reports. Religion and spirituality are discussed infrequently by physicians although frequency increases with terminal illness. Many physicians prefer chaplain referral to discussing religion and/or spirituality with patients themselves. Such discussions are f…
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Although several instruments were mentioned, there was little evidence that standardized tools were widely used.
“Although several instruments were mentioned, there was little evidence that standardized tools were widely used.”
A systematic review found that patients were more likely to spontaneously raise R/S issues only when they disagree with medical recommendations.
“A systematic review found that patients were more likely to spontaneously raise R/S issues only when they disagree with medical recommendations.33”
A systematic review of more than 20,000 medical reports found that R/S was rarely addressed in health care consultations.
“A systematic review of more than 20,000 medical reports found that R/S was rarely addressed in health care consultations.33”
Spiritual discussions occurred more frequently with psychiatrists, palliative care, and primary care physicians than with other medical specialties.
“Spiritual discussions occurred more frequently with psychiatrists, palliative care, and primary care physicians than with other medical specialties.”
The most frequently reported topics of discussion included encouraging patients in their own R/S beliefs, inquiring how faith influenced health care decisions, and concerns about death and dying.
“The most frequently reported topics of discussion included encouraging patients in their own R/S beliefs, inquiring how faith influenced health care decisions, and concerns about death and dying.”
Those who regularly took a SH preferred their own standard questions phrased in their own words.
“Those who regularly took a SH preferred their own standard questions phrased in their own words.”
Discussion of R/S was more likely in contexts of family crisis, medical emergencies, or end-of-life.
“Discussion of R/S was more likely in contexts of family crisis, medical emergencies, or end-of-life.”
SH-taking was reported by 16-34% of physicians (median 32%), with a higher frequency among psychiatrists (48-78%, median: 50%).
“SH-taking was reported by 16-34% of physicians (median 32%), with a higher frequency among psychiatrists (48-78%, median: 50%).”
The most commonly reported obstacles to addressing R/S included a lack of time, insufficient knowledge or training, concerns about ethical boundaries, cultural differences between patients and doctors, worries about colleague disapproval and, for a minority of doctors, the belief that R/S could have a negative effect on patient outcomes.
“The most commonly reported obstacles included a lack of time, insufficient knowledge or training, concerns about ethical boundaries, cultural differences between patients and doctors, worries about colleague disapproval and, for a minority of doctors, the belief that R/S could have a negative effect on patient outcomes.”
Doctors with stronger R/S beliefs were more likely to address R/S in a medical consultation, but prior training in discussing R/S in clinical settings was the strongest predictor of spiritual care discussions.
“Doctors with stronger R/S beliefs were more likely to address R/S in a medical consultation, but prior training in discussing R/S in clinical settings was the strongest predictor of spiritual care discussions.33”
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“Several studies have demonstrated that health providers neglect considering the spiritual and religious needs patients [87].”
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Self-citationThe Feasibility of Home Palliative Care for Cancer Patients: The Perspective of Iranian Nurses
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“33 A randomized clinical trial with palliative care patients showed that patients who were asked directly about their R/S concerns, especially during the first consultation, were much more likely to discuss spirituality than those who were not.”
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“…some HCPs do not have the personal resources required for such intimate conversations, which are known to require connecting with others (Daaleman et al., 2008; Rumbold, 2002) and being uncomfortable with uncertainty (Best et al., 2015a; Daaleman et al., 2008; Jones, 1999; Puchalski et al., 2006).”
BackgroundInfluentialSelf-citationDiscussing spiritual health in primary care and the HOPE tool—A mixed methods survey of GP views
Whitehead, I. O., Jagger, C., & Hanratty, B. (2022) · PLoS ONE · doi:10.1371/journal.pone.0276281 · Cited by 12 · see citing works
van der Stap, L., de Heij, A. H., van der Heide, A., Reyners, A. K. L., & van der Linden, Y. M. (2022) · Palliative & Supportive Care · doi:10.1017/s147895152200133x · Cited by 15 · see citing works
“…communication skills and lack the vocabulary for addressing nonphysical dimensions (Chibnall et al. 2004; Botti et al. 2006; Vermandere et al. 2011; Best et al. 2016b; Fan et al. 2017) and mentioned that they are unfamiliar with referring patients to clinicians like spiritual caregivers (Assing…”
Interprofessional spiritual care education in pediatric hematology‐oncology: A pilot study
Szilagyi, C., Lion, A. H., Varner-Perez, S. E., Koch, S. E., Oyedele, O. O., Slaven, J., Montz, K., Haase, J., & Puchalski, C. (2021) · Pediatric Blood & Cancer · doi:10.1002/pbc.29515 · Cited by 12 · see citing works
Ejem, D., Steinhauser, K., Dionne-Odom, J., Wells, R. D., Durant, R. W., Clay, O., & Bakitas, M. (2021) · Journal of Palliative Medicine · doi:10.1089/jpm.2021.0044 · Cited by 12 · see citing works
“6,7,9,11 An estimated 62–66% of physicians reported actively avoiding discussing R/S in clinical encounters.”
Peng-Keller, S., Moergeli, H., Hasenfratz, K., Naef, R., Rettke, H., Hefti, R., Ljutow, A., Rittmeyer, I., Sprott, H., & Rufer, M. (2021) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2021.02.021 · Cited by 12 · see citing works
Spiritual Beliefs of Jordanian Adult Patients Receiving Palliative Care
Fawares, F., Ibdah, R., Ammar, K., Alkhoulli, L., Khader, H., Muhareb, H., Habaseh, M., & Abu-Shanab, S. (2020) · Journal of religion and health · doi:10.1007/s10943-020-01054-z · Cited by 12
de Campos, R. J. D. S., Lucchetti, G., Lucchetti, A., Ribeiro, T. C. D. R., Chebli, L., Malaguti, C., Gaburri, P., Pereira, L. M. N., de Almeida, J. G., & Chebli, J. (2019) · Journal of religion and health · doi:10.1007/s10943-019-00801-1 · Cited by 12 · see citing works
Modderkolk, L., van Meurs, J., de Klein, V., Engels, Y., & Wichmann, A. B. (2023) · Cancer Nursing · doi:10.1097/ncc.0000000000001255 · Cited by 11 · see citing works
Sentidos de vida e morte: reflexões de pacientes em cuidados paliativos
Hoffmann, L. B., Santos, A., & Carvalho, R. T. (2021) · Psicologia USP · doi:10.1590/0103-6564e180037 · Cited by 11 · see citing works
Moral injury in Veterans with nonepileptic seizures
LaFrance, W. C., Jr., Vo, P., Baird, G. L., East, R., & Stein, N. R. (2019) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2019.106681 · Cited by 12 · see citing works
The influence of religiosity on depressive disorders and suicidal behavior
Kopeyko, G. I., Борисова, О. А., Гедевани, Е. В., & Kaleda, V. G. (2020) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro2020120011103 · Cited by 14 · see citing works
Impact of Religion and Spirituality in Older Persons
Lucchetti, G., Vitorino, L., Nasri, F., & Lucchetti, A. (2019) · Spirituality, Religiousness and Health · doi:10.1007/978-3-030-21221-6_8 · Cited by 11 · see citing works
van Meurs, J., Breedveld, R., van de Geer, J., Leget, C., Smeets, W., Koorneef, R., Vissers, K., Engels, Y., & Wichmann, A. B. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032154 · Cited by 10 · see citing works
Menegatti-Chequini, M. C., Loch, A., Leão, F., Peres, M. F., & Vallada, H. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02929-x · Cited by 10 · see citing works
Spirituality in geriatric psychiatry
Lucchetti, A., Barcelos‐Ferreira, R., Blazer, D., & Moreira-Almeida, A. (2018) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000424 · Cited by 10 · see citing works
Franzen, A. B. (2018) · Journal of religion and health · doi:10.1007/s10943-018-0638-7 · Cited by 10 · see citing works
“Recent reviews of research on patients and their desire for religion to be a dimension of medical care highlight the fact that this is not uncommon (Best et al. 2015).”
BackgroundJones, K., Washington, J., Kearney, M., & Best, M. (2022) · Journal of Health Care Chaplaincy · doi:10.1080/08854726.2022.2095779 · Cited by 9 · see citing works
Self-citationExamining Factors Associated with Utilization of Chaplains in the Acute Care Setting
White, K. B., Jennings, J. C., Karimi, S., Johnson, C., & Fitchett, G. (2021) · Journal of religion and health · doi:10.1007/s10943-021-01460-x · Cited by 9 · see citing works
“The current healthcare workforce has limited time and training to provide the spiritual support desired by patients (Best et al., 2016; Chibnall et al., 2004).”
BackgroundThe religious/spiritual beliefs and needs of cancer survivors who underwent cancer-directed surgery
Kelly, E. P., Paredes, A., DiFilippo, S., Hyer, M., Tsilimigras, D., Rice, D. R., Bae, J., & Pawlik, T. (2020) · Palliative & Supportive Care · doi:10.1017/s1478951520000772 · Cited by 9 · see citing works
Brenner, A. B., Skolarus, L., Perumalswami, C. R., & Burke, J. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.04.010 · Cited by 9
Australian doctors' perspectives on spiritual history-taking skills
Rombola, T. (2019) · Focus on Health Professional Education A Multi-Professional Journal · doi:10.11157/fohpe.v20i1.227 · Cited by 9
“This is quite different to the reported approach from studies of American doctors, where 5–42% would recommend chaplain referral (Best et al., 2016).”
BackgroundResultInfluentialShah, S., Frey, R., Shipman, K., Gardiner, F., & Milne, H. (2018) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2018.07.006 · Cited by 9 · see citing works
Cruz, J., Reyes, R., Colet, P. C., Estacio, J. C., Caldeira, S., Vitorino, L., & Koenig, H. (2017) · Journal of religion and health · doi:10.1007/s10943-016-0355-z · Cited by 9 · see citing works
“…have been highlighted as the most important barriers for both nurses and doctors but personal maturity and professional experiences may help nurses to develop competence in spirituality and spiritual care toward a higher level of specialized competencies (Best et al. 2015; Giske and Cone 2015).”
BackgroundAnandarajah, G., Sleeth, G., Mennillo, M. R., & Srinivasan, A. (2025) · BMC Medical Education · doi:10.1186/s12909-025-06788-6 · Cited by 8 · see citing works
“However, most studies of physicians focus on barriers to addressing patients’ spiritual needs, rather than the spiritual wellbeing of physicians themselves, as they routinely confront suffering and death [56–65].”
Spiritual Care in PICUs: A U.S. Survey of 245 Training Fellows 2020–2021*
Stevens, P. E., Rassbach, C. E., Qin, F., & Kuo, K. (2023) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000003429 · Cited by 8 · see citing works
“Our findings align with previously published needs assessments from other specialties (21–23) and with a systematic review of literature up to 2015 that demonstrated prior training was the strongest predictor of whether physicians incorporated spiritual care into their clinical practice (22).”
ResultLaranjeira, C., Benito, E., Dixe, M., Dones, M., Specos, M., & Querido, A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043505 · Cited by 8 · see citing works
Mächler, R., Straßner, C., Sturm, N., Krisam, J., Stolz, R., Schalhorn, F., Valentini, J., & Frick, E. (2022) · Journal of religion and health · doi:10.1007/s10943-022-01536-2 · Cited by 8 · see citing works
“Patients might have a very different view on their doctors’ competence in this field (Baumann et al., 2011; Best et al., 2016; Marquardt & Demling, 2016).”
BackgroundInterconexão entre saúde, espiritualidade e religiosidade
Teixeira, M. Z. (2020) · Revista de Medicina · doi:10.11606/issn.1679-9836.v99i2p134-147 · Cited by 25 · see citing works
Kienle, G., Mussler, M., Fuchs, D., & Kiene, H. (2018) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2018.04.012 · Cited by 8 · see citing works
Wirawan, H., Jufri, M., & Patak, A. A. (2018) · doi:10.1108/ijlls-10-2016-0040 · Cited by 8
Koenig, H., Perno, K., Erkanli, A., & Hamilton, T. (2017) · Southern medical journal (Birmingham, Ala. Print) · doi:10.14423/smj.0000000000000657 · Cited by 8 · see citing works
“Best and colleagues hypothesized that clinician spirituality made them more comfortable in discussing this subject andmore open to the patient’s spirituality.(14) Note, however, that an increase in SSH taking was independent of clinician religiosity, suggesting that the ETP increased this practice for religious and no…”
BackgroundResultInfluentialPhysicians’ Religious Topic Avoidance during Clinical Interactions
Villagran, M., MacArthur, B. L., Lee, L., Ledford, C., & Canzona, M. (2017) · Behavioral Science · doi:10.3390/bs7020030 · Cited by 8 · see citing works
“Although many physicians believe it is preferable for a patient to initiate R/S conversations [14], physicians may also feel uncertain about discussing R/S topics with patients and families, especially when the patient is at the end of life.”
BackgroundInfluentialSpirituality in Primary Care Settings: Addressing the Whole Person through Christian Mindfulness
Cooper, Z. (2022) · Religions · doi:10.3390/rel13040346 · Cited by 7 · see citing works
Gavaza, P., Rawal, B., & Taylor, E. (2021) · Journal of the American Pharmacists Association · doi:10.1016/j.japh.2021.03.008 · Cited by 7 · see citing works
Yahya, F. B., Hassan, H. C., Panduragan, S. L., & Mat, S. (2024) · Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) · doi:10.54133/ajms.v6i1.481 · Cited by 6 · see citing works
“In contexts where discussing spirituality might be restricted, the term "existential care" is recommended as an alternative to spiritual care [8].”
BackgroundWenham, J., Best, M., & Kissane, D. W. (2023) · Journal of religion and health · doi:10.1007/s10943-023-01897-2 · Cited by 6 · see citing works
Self-citationAndersen, A., Illés, Z., & Roessler, K. (2022) · Journal of religion and health · doi:10.1007/s10943-022-01658-7 · Cited by 6 · see citing works
- Authors
- Best, M., Butow, P., & Olver, I.
- Affiliations
- The University of Sydney (AU)
- University of South Australia (AU)
- Venue
- Palliative Medicine
- Publisher
- SAGE Publications
- Published
- 2015-08-12
- Volume
- 30
- Issue
- 4
- Pages
- 327-337
- ISSN
- 0269-2163 (ISSN-L)
- 1477-030X
- OpenAlex
- W1620651998
- Cited by
- 216
- References
- 0
- Citations by year
- 2026: 14 · 2025: 14 · 2024: 24 · 2023: 23 · 2022: 19 · 2021: 26 · 2020: 24 · 2019: 17 · 2018: 25 · 2017: 15 · 2016: 10 · 2015: 1
- FWCI
- 3.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Palliative Medicine (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Topics
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Social Sciences › Demography › Workplace Spirituality and Leadership
- Keywords
- religion, spirituality, physician-patient communication, medical consultation, physician attitudes, barriers to discussion, terminal illness, palliative care
- MeSH terms
- Attitude of Health Personnel, Chaplaincy Service, Hospital, Communication, Communication Barriers, Humans, Physician-Patient Relations, Practice Patterns, Physicians', Physicians, Referral and Consultation, Religion and Medicine, Databases, Bibliographic, Terminally Ill, Spirituality
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