Background   Illness raises fundamental questions – For what may I hope forth?  Why do I suffer? Does my suffering have meaning?  What happens after I die?  When a clinician stands with a patient as they face death, the clinician inevitably plays a role in supporting the patient’s inquiry into these spiritual questions (see Fast Fact #31 Confronting Personal Mortality). In addition, some patients have specific preferences regarding medical care, death and dying that are based upon their religious beliefs. The clinician often plays an important role in supporting a patient’s exploration of these issues. Taking a spiritual history is one way to support the patient in this exploration. Maugans (1997) presents a framework for taking a spiritual history; the interview below comes primarily from this article with some modification based upon other sources.  See Fast Fact #274 for information on the FICA which is another spiritual history tool.  

Taking a Spiritual History 

S—Spiritual belief system 

• Do you have a formal religious affiliation?  Can you describe this? 
• Do you have a spiritual life that is important to you? 
• What gives your life meaning?  

P—Personal spirituality 

• Describe your beliefs. 
• Describe those beliefs and practices that you do not accept or follow.  
• In what ways is your spirituality/religion meaningful for you? 
• How is your spirituality/religion important to you in daily life? 
• What in your life do you feel gratitude for even though you are seriously ill? 
• When you are afraid or in pain, how do you find comfort? 

I—Integration with a spiritual community 

• Do you belong to any religious or spiritual group or community? How do you participate?  What is your role? 
• What importance does this group have for you?  
• In what ways is this group a source of support for you?  
• How does this group provide help in dealing with health issues? 

R—Ritualized practices and restrictions 

• What specific practices do you carry out as part of your religious and spiritual life (e.g. prayer, meditation, services, etc.) 
• Are there lifestyle activities or practices that your religion encourages, discourages, or forbids? What do you think?  
• What significance do these practices and restrictions have for you?  

I—Implications for medical care 

• Are there specific elements of medical care that your beliefs discourage or forbid?   
• What aspects of your religion/spirituality would you like me to keep in mind as I care for you?  

• What knowledge or understanding would strengthen our relationship as physician and patient? 
• Are there barriers to our relationship based upon religious or spiritual issues?  
• Would you like to discuss religious or spiritual implications of health care?  

T—Terminal events planning 

• Are there religious or spiritual practices or rituals that you would like to have available in the hospital or at home?   
• Are there religious or spiritual practices that you wish to plan for at the time of death, or following death? 
• As we plan for your medical care near the end of life, in what ways will your religion and spirituality influence your decisions?  

References: 

1. Maugans TA. The SPIRITual History.  Arch Fam Med.  1997; 5:11-16. 
2. Ambuel B, Weissman DE.  Discussing spiritual issues and maintaining hope.  In: Weissman DE, Ambuel B, eds. Improving End-of-Life Care: A Resource Guide for Physician Education, 2nd Edition.  Milwaukee, WI: Medical College of Wisconsin; 1999. 
3. Griffith JL, Griffith ME.  Hope in suffering/pain in health: Talking with patients about spiritual issues. Presented at The 18th Forum for the Behavioral Sciences in Family Medicine, Chicago, Illinois, October 1997.

Version History:  This Fast Fact was originally edited by David E Weissman MD.  2nd Edition published August 2005; 3rd Edition May 2015; 4th Edition January 2024, edited by James Deming MD.