Abstract
Guidance for medical staff reminds employees of the responsibility to deliver spiritual care in its broadest sense, respecting the dignity, humanity, individuality and diversity of the people whose cultures, faiths and beliefs coexist in society. This is no small or simple task, and although GPs (family practitioners) have been encouraged to deliver spiritual care, we suggest this is proving to be challenging and needs further careful debate. This literature review critiques and analyses existing studies and points to four categories of attitude to spiritual care, and two related but distinct concepts of spirituality in use by GPs. Our aims were to search for, summarise and critique the qualitative literature regarding general practitioners’ views on spirituality and their role in relation to spiritual care. An integrative review was made by a multidisciplinary team using a critical realism framework. We searched seven databases and completed thematic and matrix analyses of the qualitative literature. A number of good-quality studies exist and show that some but not all GPs are willing to offer spiritual care. Four patterns of attitude towards delivering spiritual care emerge from the studies which indicate different levels of engagement with spiritual care: embracing, pragmatic, guarded and rejecting. Further research is needed to identify whether these four views are fixed or fluid, whether training in spiritual care modifies these and whether they relate to patterns of care in practice, or patient outcomes. The authors suggest that some of the difference in viewpoint relate to the lack of clear philosophical framework. The authors suggest critical realism as having potential to facilitate interdisciplinary research and create clearer concepts of spiritual care for GPs.
Highlights
Qualitative and quantitative research studies have demonstrated that there are likely to be associations between certain religious and spiritual variables and health outcomes (Ellison and Levin 1998; Koenig 2011)
Concern has been expressed from more than one perspective that research which treats religious experience and belief purely as a health variable are limited as they rely on a reductionist position and in this respect there are no multidisciplinary studies which include the humanities. We argue this may be due to the difficulty that clinical sciences and the humanities experience in dialogue. We propose from both the practical experience of our research team and from the arguments of critical realism that this difficulty arises from the use of incompatible epistemologies, ways of discerning truth
There is a good deal in common with the concept of spirituality which GPs use in practice but we argue that two differently focussed but not mutually exclusive concepts of spirituality are represented by GPs: exocentric and anthropocentric
Summary
Qualitative and quantitative research studies have demonstrated that there are likely to be associations between certain religious and spiritual variables and health outcomes (Ellison and Levin 1998; Koenig 2011). These relationships may not be simple, and many of the studies are methodologically imperfect, but as more sophisticated research proceeds, these associations have persisted though there is some discussion about causality (Sloan 2006). General practitioners in the UK more widely have been encouraged to think about incorporating spiritual care into their provision for patients (NHS Education for Scotland 2009). There is limited evidence that GPs are delivering effective spiritual care in any explicit way, or in one that effects outcomes
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