To the Editor: In May 2006, the Oklahoma Health Center Clinical Pastoral Education Institute, Inc., offered for the first time an elective course concerning spirituality in medicine, since more patients are identifying this aspect of their life in coping with medical and psychiatric illness. We believe that some of our preliminary findings and experiences with this course might be of interest to the academy as new accreditation standards highlight the need to prepare future pharmacists to meet increasing expectations for the direct and preventive care of patients as part of interdisciplinary teams.1
The first offering of this interdisciplinary course, designed primarily for students in the University of Oklahoma College of Medicine, attracted 7 medical students and 13 pharmacy students. This 2-credit hour course, which required approximately 36 hours of direct contact, met daily during 1 week of our May intercession. Course content presented by medical and clergy professionals included first experience with the death of a patient, “do not resuscitate” orders, assessment of a patient's spiritual beliefs, a review of peer-reviewed literature on spirituality in medicine, and how practitioners from various faith traditions integrate their beliefs with their practice. Throughout the course, students were given opportunities to explore their faith tradition as well as those of others in the context of the provision of health care.
An informal survey instrument approved by the local institutional review board was offered to students at the end of the course and provides some insights into the perceptions of this small sample of pharmacy professional students. The overwhelming majority of the pharmacy students participating in the course were female and under 30 years of age. Approximately one third were Asian-Americans and one half were Caucasian. All were Christian by faith, with two thirds being Protestant Christian.
Most students stated they would ask patients about their spirituality, although none had ever been asked about their own spirituality by a health care practitioner. Students also stated being comfortable addressing the subject of spirituality with their patients in encounters ranging from a routine visit to a life-threatening, even terminal, illness. They anticipated spending as long as it took to address spiritual issues with patients, but were mindful in reality that they may have time limitations. Some students indicated the need for a cue from the patient before approaching the subject of spirituality.
Commonly cited reasons for not asking a patient about spirituality included feeling unprepared; feeling the patient might become angry, fearful, resentful, or uncooperative; and a lack of comfort with their own spirituality. Other barriers cited were lack of time and concerns that some patients might misinterpret questions about spirituality as advocacy for the pharmacist's personal spiritual values.
Only one article relating to spirituality assessments by pharmacists has appeared in the literature.2 Most of the articles on the topic of spirituality in medicine address physicians interacting with patients. Among these, a positive correlation appears to exist between addressing religiosity and spirituality needs, and better outcomes for patients' physical health, mental health, and coping skills, as well as willingness to access health services3-8; however, not every author agrees.9 A number of other articles refine descriptions of this relationship by addressing the level of congruence of practitioner's beliefs with their patients' beliefs, some of the negative effects of certain religious practices, and when, how, and why to address this issue with patients.10
It may be of value for pharmacists to be aware of the potential influence of spirituality in the health behaviors of the patients they serve, especially as the health benefits of addressing spiritual resources of some patients become better documented.11 Student responses from our informal survey indicate their willingness to address the issue of spirituality with their patients. Time constraints and the expected roles of pharmacy practitioners will clearly vary with the type of pharmacy practice environment and will impact the ability of pharmacists to be involved in matters of patients' spirituality.
Information gained from this group of students, self-selected to take this elective, may be of interest to those involved in pharmacy curriculum development and revision and may indicate a need for further education and training about spirituality, its effects on health, and the use of formal spirituality assessment tools.12 Additionally, information about when and how to make referrals for chaplaincy care may be helpful for pharmacy practitioners. Further evaluations of the perceptions and interests of a larger sample of pharmacy students and health care practitioners may be helpful in decisions about the inclusion of this content in the professional curriculum to facilitate student understanding of the many dimensions involved in patients' understanding of and response to disease and therapy.
John Campbell, PhD, MS, MBA
Kenneth Blank, MDiv
Oklahoma Health Center Clinical Pastoral Education Institute, Inc.
University of Oklahoma Health Sciences Center
Mark L. Britton, PharmD
College of Pharmacy
University of Oklahoma Health Sciences Center
REFERENCES
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