Spirituality enhances medical care for those coping with serious illness. And it boosts overall health outcomes, even at a population level.
Those assertions are based on a review of more than two decades of high-quality studies that show benefits of seeing and nurturing a patient’s spirituality as part of medical care or public health.
The findings, led by researchers from Harvard University’s Human Flourishing Program and colleagues from the university’s Initiative on Health, Religion and Spiritualityamong others, were published earlier this month in JAMA, the Journal of the American Medical Association.
The link between body and soul is not a new discovery, according to Dr. Tracy A. Balboni, co-director of the Harvard initiative and a professor of radiation oncology and the study’s lead author. She said the association is especially known between communal forms of spirituality and key outcomes like reductions in all-cause mortality, suicide, depression and substance abuse, as well as greater recovery from substance use disorders.
“There’s actually quite a bit of research work both in the setting of health — healthy populations — and in the setting of serious illness demonstrating clear ways that spirituality interfaces with wellbeing, showing many notable associations with very rigorously done research,” said Balboni, who also directs the Harvard radiation oncology program.
“Spirituality in Serious Illness and Health” is a detailed look at hundreds of studies with thousands of patients to see what research has shown about the link between spirituality and health. Expert panels then dissected findings to create recommendations of ways to use that relationship to benefit both very ill individuals and public health.
The goal, they said, is “person-centered, value-sensitive care.”
Clinicians, public health experts, researchers, health system leaders and medical ethicists made up the panels. The panel-generated top priorities when treating those with serious illness include:
- Routinely incorporating spiritual care into medical care.
- Including spiritual-care education in the training of interdisciplinary medical team members.
- Including specialty spiritual practitioners such as chaplains in patient care.
In the public health realm, they suggest:
- That clinicians consider beneficial associations between religious/spiritual community and health to provide better person-centered care.
- Increasing public health professionals’ knowledge of evidence that religious/spiritual community participation is associated with protecting health.
- Recognizing spirituality as a social factor that is linked to health.
Balboni said spirituality can manifest in many ways, not just as religion. “At least early data would suggest that a community where there’s a shared purpose, value and connection with one another might have something similar. It’s just that religious communities tend to do that — that’s the core of what they do in general. So I think those are the most common forms.”
She added, “Finding that community that helps to nurture and sustain a framework of meaning, purpose and value is critical to our health, our well-being and our flourishing as human beings.”
Defining the need
In a blog about the research in Psychology Today and in the Human Flourishing newsletter, Tyler J. VanderWeele, director of that program, noted “strong evidence that religious service attendance was associated with lower mortality risk; less smoking, alcohol and drug use; better mental health; better quality of life; fewer subsequent depressive symptoms and less frequent suicidal behaviors.”
He wrote that the deep dive into longitudinal studies suggests those who attend religious services frequently enjoy a 27% lower risk of dying in follow-up and 33% lower odds of subsequent depression.
“Spirituality or spiritual community thus appeared to be important both in illness and in health,” said VanderWeele.
The researchers considered high-quality studies published since 2000. Criteria for “high quality” included having large sample sizes and validated measures. For health outcomes, studies also needed a longitudinal design. They eliminated studies with “serious or critical” risk of bias.
The panels debated implications for health care based on the evidence in the studies, rating them from inconclusive to the strongest evidence to settle on the recommendations.
By the time they went through the elimination process, they had narrowed nearly 9,000 articles to 371 on serious illness. Of nearly 6,500 health-outcome articles, they included 215.
They found clear evidence that spirituality is important for most patients and that spiritual needs are common, while spiritual care is not. They also found patients often want spiritual care, but spiritual needs are seldom addressed as part of medical care — even though spirituality often influences the medical decisions patients make.
Finally, the research review showed that when spiritual needs aren’t addressed, patient quality of life is not as good, while providing spiritual care provides better end-of-life outcomes.
in real life
The Rev. Amy Ziettlow has often seen the interplay of faith and medicine in her role as pastor of Holy Cross Lutheran Church in Decatur, Illinois. She said the JAMA study “resonates with my day-to-day experience of congregational ministry.”
Any congregation has homebound, seriously ill members, said the Rev. Ziettlow, who was not involved in the study. “They live with chronic or acute pain, experience losses in memory and physical mobility and are vulnerable to infection, especially COVID-19, the flu and pneumonia. By definition, ‘homebound’ means they are separated from their faith communities, and my role as pastor aims to remind them that they are still connected to their church home and still connected to God’s presence,” she told Deseret News by email.
Her example is Mary, who at age 96 had trouble walking and was living in a memory care unit when she started hospice last April. Amid COVID-19 restrictions, only family members and the Rev. Ziettlow were allowed to visit.
During weekly, then daily visits as death approached, “I was a bridge between her isolated room and our bustling sanctuary of worshippers, between her life defined by medications, medical visits and physical limits and her life defined by her relationship to God,” the Rev. Ziettlow said. “I wore a clerical collar, my worship uniform, which signaled to her and to the staff of the care center that ritual actions and words would be happening that connect Mary to her ultimate meaning, the story of God’s love and grace.”
Despite her failing memory, Mary still knew the liturgical elements that had nourished her spirit over a lifetime, the Rev. Ziettlow said. “She recited the Lord’s Prayer, the Apostle’s Creed and sang along with favorite hymns, like ‘Jesus Loves Me’ and ‘Amazing Grace.’”
Each visit ended with the sacrament of communion. “Mary kept a special plate and napkin she liked me to use as we marked this ritual meal together. We ate, drank and remembered that God’s presence is really with us always,” the pastor recalled. “Her last words to me were, ‘God bless you’.”
Baldoni hopes that the medical community, public health workers and all those they serve will pay attention to the connection between spirituality and health.
Spirituality, she said, “can actually nurture the soul of medicine itself. I believe that as we better embrace the spiritual aspects of our patients, we embrace the spiritual aspects of what it means to be caregivers of patients.”
On the public health side, she said, “As health systems at all levels recognize that human beings are spiritual beings and that’s an important aspect of flourishing, we can tap into better care for human populations or for communities by drawing on spirituality’s resources.”