Taking a Spiritual History Allows Clinicians to Understand Patients More Fully

Abstract

Dr. Christina Puchalski is an internist and geriatrician who has recently designed a Spiritual Assessment consisting of four basic questions that physicians or others can integrate into patient interviews. The assessment is remembered by the acronym PICA, for the four domains it touches on: Faith, Importance, Community, and Address. In this interview with Innovations associate editor Anna L Romer, Dr. Puchalski explores how she came to develop the spiritual history, how she sees it as distinct from a careful psychosocial history, and what she has learned as she has trained physicians across the United States to incorporate it into their medical interviews. This interview is excerpted from a thematic issue, Spirituality and End-of-Life Care, Vol. 1, No. 6, 1999 of the online journal Innovations in End-of-Life Care at http:/www. edc.org/lastacts/. First, let's review how you understand spirituality and the context for using the spiritual history or assessment. I see spirituality as that which allows a person to experience transcendent meaning in life. This is often expressed as a relationship with God, but it can also be about nature, art, music, family, or community—whatever beliefs and values give a person a sense of meaning and purpose in life. So, a spiritual history is a beliefs or values history that explicitly opens the door to a conversation about the role of spirituality and religion in the person's life. This conversation is extremely important for patients who are gravely ill and for dying patients. Spiritual questions that come up for these patients include: What gives my life meaning? Why is this thing happening to me? How will I survive this loss? What will happen to me when life ends? We as clinicians don't know the answers, but I do see it as our role to support and encourage people as they search for their own answers to these questions. Their spiritual beliefs, religious faith and values are resources, and it is also important to see this work as a team effort and to refer patients to chaplains and spiritual directors as needed. How do spirituality and healthcare