In considering how much religious and spiritual beliefs impact health care decision making and ACP, it is important to examine a recent Gallup Poll that indicates 92% of respondents (N = 1,018 adults nationwide) in the United States believe in God (Gallup Poll, 2011). In addition, 58% (N = 2,973 adults nationwide) consider religion to be very important in their lives, and more than 40% of adults in the United States attend religious services weekly (Pew Research Center, 2012). These high percentages indicate that there is good reason to consider how religious and spiritual needs impact ACP.

Research in health care practices provides evidence to indicate many people also believe there is value in health care professionals addressing spiritual issues. Surveys of people receiving health care have found that more than two-thirds of inpatients (e.g., King & Bushwick, 1994) and outpatients (e.g., Ehman Ott, Short, Ciampa, & Hansen-Flaschen, 1999; McCord et al., 2004) would like their physicians to ask about their spiritual beliefs and/or needs in at least some circumstances. However, even when people may be willing to discuss ACP and spirituality with health care professionals, research indicates the provider must initiate the conversation (Pautex, Herrmann, & Zulian, 2008). Moreover, the ability to talk with health care professionals about health care decisions becomes increasingly important as illnesses progress and become more complex. Thus, it is imperative that medical, nursing, social work, chaplain and other healthcare professionals are able to help patients and their families explore the religious and spiritual dimensions that guide their health care decision making and ACP.

As medical, nursing, social work, and chaplaincy professionals have worked to improve palliative and end-of-life (EOL) care, there has been increasing attention to the importance of spiritual and religious dimensions of individuals. In more recent medical literature, Sulmasy (2002) described the biopsychosocial-spiritual model for comprehensive medical care of individuals and families, which recognizes that people experience health and illness in many dimensions, including religious and spiritual domains (also see Katerndahl, 2008).


While many health care professionals may recognize religion and spirituality as important, several reasons have been identified to explain why health care professionals may not provide spiritual care to patients and their loved ones. First, professional caregivers do not feel they have the training, knowledge, or skills to be able to talk with patients and their families about these topics (Balboni et al., 2010; Brush & Daly, 2000; Draper & McSherry, 2002). Another reason is that professional caregivers anticipate that patients and their loved ones may interpret conversations about spiritual matters as proselytizing, or conversely, that the patient or members of the patient's support network may try to proselytize them.

Many health care professionals do not talk with those for whom they provide care about spiritual matters because they, like many people (including patients and their loved ones), view spiritual care as the realm of clergy, pastors, and other spiritual leaders. Indeed, the topics of religion and spirituality are widely discussed among theologians. However, being a theologian or member of the clergy is not a requirement for supporting patients and their loved ones as they integrate religion and spirituality into health care decision making and ACP. It is important for all professional caregivers to see their role as members of a team providing care that includes spiritual care. This may be likened to the management of pain for a person with cancer. All members of the health care team and family play a role in relieving pain, for example, recognition and reporting, ordering medication, providing medications and comfort care, or addressing spiritual concerns that may cause or exacerbate physical symptoms and pain.

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