Abstract
Background
S
Spirituality and Health
There is a large body of evidence that demonstrates a relationship between spirituality, religion, and health care outcomes.3–9 Spirituality and religion are strong contributors to how people cope with illness and suffering.10–12 Providing for spiritual and religious needs benefits both patients and the health care system. 13
Spiritual History and the Health Care Team
A National Consensus Conference (NCC) developed models and guidelines for interprofessional spiritual care. 1 While the conference highlighted the importance of board-certified or board-eligible chaplains as the spiritual care experts and essential members of palliative care and other care teams, it recommended that all members of the health care team be responsible for addressing patients' spiritual issues within the biopsychosocial/spiritual framework. 14 The NCC recommended that all patients should have a spiritual screening or history, that spiritual distress should be diagnosed and attended to, and that validated assessment tools should be used.
Taking a Spiritual History: Key Principles
1. Consider spirituality as a potentiality important component of every patient's life. Spirituality can impact a patient's quality of life; it is an inherent part of most people's well-being.
2. Address spirituality at each new visit, at annual examinations, and at follow-up visits if appropriate.
3. Respect a patient's privacy regarding spiritual beliefs.
4. Be aware of your own beliefs; don't impose your spiritual/religious beliefs on others.
5. Make referrals to chaplains, spiritual directors, or community resources as appropriate.
FICA
The FICA Spiritual History Tool© was developed to help health care professionals address spiritual issues with patients. FICA serves as a guide for conversations in the clinical setting. It is also used to help identify spiritual issues patients face, spiritual distress, and patients' spiritual resources of strength. The FICA tool has been evaluated in cancer patients. 15 This study suggests FICA is a feasible tool for the clinical assessment of spirituality, and responses to the FICA tool were correlated to many aspects of quality of life. Health care professionals are encouraged not to use the FICA tool as a checklist, but rather to rely on it as a guide to invite the discussion of a patient's spirituality.
F—Faith, Belief, Meaning
Do you consider yourself spiritual or religious? Do you have spiritual beliefs, values, or practices that help you cope with stress?* If the patient responds No, the health care provider might ask, What gives your life meaning?**
*It is important to contextualize these questions to the reason for the visit—e.g., wellness, stress management, breaking bad news, the end of life. So instead of saying cope with stress you might say that it has helped you in difficult times before.
**Meaning might be found in family, career, nature, arts, humanities, or other spiritual, cultural, or religious beliefs and practices. The question What gives your life meaning? should be asked of everyone and not just those who say they are not spiritual.
I—Importance and Influence
What importance does your faith or belief have in your life? Have your beliefs influenced you in how you handle stress? Do you have specific beliefs that might influence your health care decisions? If so, are you willing to share those with your health care team?
C—Community
Are you part of a spiritual or religious community? This community can be church, temple, mosque, or like-minded friends, family, etc. Is this of support to you and how? Is there a group of people you really love or who are important to you?
A—Address/Action in Care
How should I address these issues in your health care? This is also to remind clinicians to develop a plan to address patient spiritual distress or other spiritual issues.
More information and educational materials about FICA are available at www.gwish.org/.