INTRODUCTION

Throughout the 20^th century, more than 1,200 studies have assessed the relationship between religion and a variety of physical and mental health conditions. In the last two decades, in particular, the results of a growing number of studies show that, in most cases, religious beliefs and practices are related to better quality of life and health².

In the United States, there has been an increase in the number of medicine and spirituality courses in medical schools. In 1994, 17 schools offered the course³, and in 2004, this number increased to 84, of a total of one-hundred and twenty-six existing schools⁴. There is also a growing number of studies, increasingly more research and development of curricula related to the area of medicine, religion and spirituality in medical schools^3),(5, such as, for instance, those developed by The George Washington Institute for Spirituality and Health.

Perhaps the best reason to point out the spiritual aspects of patients in medical practice is that the majority of patients are religious. Religious beliefs and practices are common among patients seeking medical care and even those who present themselves as non-religious often identify themselves as a spiritual being in some way⁶.

As a result, some studies have sought to verify what patients think about how doctors approach their religious and spiritual aspects. In a study published in the Journal of General Internal Medicine⁷, 66% of the interviewed patients considered that doctors should be more attentive to their patients’ religious and spiritual beliefs. Maugans and Wadland, in a study of 135 outpatients in Vermont, found that 30% of the participants considered that their doctors should discuss religious matters with them⁸. Daaleman and Nease, in a study of 80 patients treated by clinicians or family doctors in Kansas, found that 41% of the sample considered that doctors should deal with issues of religion and faith together with their patients⁹.

In the field of studies involving the importance or the use of prayer by patients, it is interesting to note that some patients believe that prayer can influence the cure of their illnesses. Moreover, some patients would like their doctors to also be willing to pray with them^10),(11.

Medicine and spirituality courses in medical schools and reading books or articles in the medical literature on this subject are examples of ways that provide better training for health professionals on the role of the patient’s faith/religion in coping with diseases, the impact of religion on medical decisions and the social support that religious communities offer patients in restoring health¹².

Overcoming the discomfort in addressing spiritual issues with patients will be achieved through training and experience, through which it is possible to come to the understanding that “obtaining the spiritual history” of the patient can contribute to more thorough medical care.

The aim of the present study was to describe the profile of conceptions, difficulties, demands and knowledge of medical students and doctors regarding issues involving medicine and spirituality.

METHODS

A descriptive cross-sectional study was carried out by applying questionnaires to students from the 2^nd to the 6^th year of the medical course and doctors at a Brazilian public medical school. The study was approved by the local ethics committee. All volunteers signed the free and informed consent form.

A specific questionnaire prepared by the authors and the DUREL questionnaire (DUKE Religiosity Scale)¹³ were applied. For the students, the questionnaires were administered in the classroom so as not to disrupt the students’ routine (during breaks or after class). All students from the 2^nd to 6^th year of the Undergraduate Medicine course were invited to participate.

A sample of randomly chosen doctors was invited to participate in the research. They were approached to answer the questionnaires in their department rooms, in the medical cafeteria or after care activities in outpatient clinics. The average time needed to answer the questionnaires was five minutes.

The questionnaires were applied from March to December 2019. Groups: comparisons were made between groups of doctors and medical students.

RESULTS

A total of 169 students and 65 doctors participated in the study, with 66% of the participants being female (Table 01). Of the students, 21% were aged between 17 and 20 years and 79% were 21 years old or over. Among the students, 69% and 85% of doctors said they believed in God or in some “higher force”. Moreover, 70% of the students and 83% of the doctors believe that the human being is made up of the union between a body and a soul/spirit.

Graphic 1 Comparative DUREL questionnaire between students and doctors. 

Organizational religiosity and spirituality were higher among doctors when compared to students (Graphic 1 and Table 1).

Applying Poisson Regression to the results obtained by the DUREL scale, we observed greater spirituality (increase of 14%) among female participants (0.86, CI: 0.79 - 0.94; p < 0.001 for males). Moreover, we also found a higher level of spirituality (increase of 25%) in doctors when compared to students (1.25, CI: 1.14 - 1.37; p < 0.001).

There was no difference among students when comparing the years of undergraduate school (Graphic 2).

Graphic 2 Spirituality Score by year of undergraduate school (p>0.9). 

Regarding medical practice and the training they received from the educational institution, 86% of the students and 80% of the doctors believe that the current university training does not provide satisfactory training for an adequate approach to the topic with patients. Despite this, 86% of the students and 69% of the doctors said they had already discussed this topic with patients. (Table 2).

Among the participants who stated they did not feel prepared to address this topic with patients, the reasons reported were: fear of imposing religious views on patients (28% of students and 12% of doctors), lack of training (19% of students and 6% of doctors) and lack of knowledge (17% of students and 3% of doctors).

Most participants (65%) believe that medical students should be trained, during undergraduate medical school, to discuss the topic of faith/spirituality with patients, with 26% believing that it should be in the form of a curricular subject (28% of students and 22% of doctors) and 39% as extracurricular (28% of students and 42% of doctors).

DISCUSSION

This study assessed a total of 234 people, including doctors and undergraduate medical students, showing that the majority believe in a superior being. Spirituality was higher among doctors and among females. Most of those interviewed believe that university education does not prepare doctors to address the topic with patients. Despite this limitation, perhaps precisely because they realize the importance of this aspect for the patient, often as an instrument for coping with illnesses, most have already discussed spirituality with their patients.

Although for centuries science and religiosity have followed different and often divergent paths, the last two decades have shown a clear tendency towards rapprochement between these two areas of human knowledge¹⁷.

Studies disclose a high level of religious involvement and a tendency towards religiosity in the Brazilian population. This is a striking characteristic of the Brazilian people, as 95% of the population have a religion, 83% consider it very important in their lives, interest in the study of religiosity and its relationships with physical and mental health has progressively increased and 37% participate of some religious service at least once a week^18),(19. Specifically in times of serious health impairment, patients, especially elderly ones, express the great need for religious assistance. In this sense, for these aspects to be covered, it is essential that health professionals have acquired communication and intervention skills in the area of religion and spirituality, as this can be considered another instrument of assistance to sick individuals²⁰.

The present study also showed a high degree of spirituality among its participants (students and medical professionals), with more than 70% saying they believed in God or “some higher being”.

The assessment of organizational religiosity (frequency at religious meetings) showed that 44% of all participants attended religious services once a month or more. This score, in addition to that of intrinsic religiosity (spirituality), was higher among the interviewed doctors compared to the students.

A study conducted by Anadarajah assessed, through the application of questionnaires, the attitudes and skills of medical students regarding the interaction of spirituality and medical practice, aiming at helping to develop the curricular grid in this area. Although 88.5% of the students were aware of the relationship between spirituality and medicine and 40% of the students reported having had experience in clinical practice involving spiritual matters, only 23% had prior training or instruction for this purpose²¹.

Also in this same study, it was found that, although 77% of the students are aware that spirituality is important for many patients, only 53% are aware of the evidence in the medical literature about the association between spirituality and physical and mental health. For 80% of them, doctors must take into account the physical, mental and spiritual well-being of their patients. At the conclusion of the study, the author emphasizes that the assessed medical students have positive attitudes towards the inclusion of spirituality into medical practice and that many students, as well as many doctors, show a lack of specific knowledge and skills regarding spirituality in medical care.

Curlin et al. conducted a study that aimed to understand the religious characteristics of 2000 American doctors through a questionnaire. He found that 55% of respondents (n=1144) reported that their religious beliefs influence medical practice and 76% said they believe in God. Around 49% of the doctors said they had never discussed religious or spiritual issues with patients and 10% did it frequently or always. When asked about the barriers that prevented them from addressing these issues with patients, 48% reported the lack of time, 40% were concerned about the possibility of offending the patient, 26% claimed insufficient training or knowledge, and 23% felt uncomfortable when discussing religious issues. However, 73% of the doctors encouraged patients in their religious beliefs and practices²².

The lack of time is something to really be considered, requiring careful management to fulfill responsibilities. However, it is not the main factor that inhibits doctors from evaluating their patients’ spiritual history. In our study, only 6% of the students and 11% of the doctors reported lack of time as a reason for not addressing this issue. The spiritual history does not need to be taken from every patient and at every appointment. It can be partially assessed in one appointment and completed in another. When time is restricted, the spiritual history may consist of “How are you doing spiritually? Is there any interest or problem in this subject?”²³. This way, the patient would already feel an “openness” on the part of the professional to explain a need in this area. Eventually, the “Hospital Chaplaincy” team (in hospitals that have this service) could also be mobilized to provide care to patients who signal this need²⁴.

A 2011 publication, which evaluated the opinion of 53 medical professors, also through the application of questionnaires, showed that 72% of the professors believed that faith or spirituality could influence patient treatment, 62% reported that they already felt the desire to address spirituality aspects of patients they had followed, although only 43% reported feeling prepared for this approach. A total of 50% believed that it would be important for medical schools to prepare students for this approach. Only 27.8% said they had already mentioned this subject in their classes and 92.3% considered that Brazilian medical schools are not offering the necessary information in this field²⁵.

CONCLUSION

Students and trained doctors have a high level of spirituality and recognize this aspect as being important for patients, despite considering that they did not receive adequate training in medical school.

The conclusions of the present study can contribute to provide support for an educational proposal that aims to guide students, and future doctors, not to neglect such an important aspect in patients’ lives. In addition to teaching, in an ecumenical and respectful manner, the most appropriate way to approach the patient’s spirituality.