Background Spirituality is defined as “the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred” (1). Taking a spiritual history is an important patient assessment skill, and most American patients report they want medical professionals to be aware of the importance of religion or spirituality to them (2). Fast Fact #19 presents one approach to taking a spiritual history. This Fast Fact discusses the FICA Spiritual History Tool© (Faith, Importance/Influence, Community, Action/Address in care).
Spirituality & Health There is a large body of evidence that demonstrates a relationship between spirituality, religion and healthcare 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 & the Healthcare 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 biopsychosocialspiritual 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
- 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 wellbeing.
- Address spirituality at each new visit, at annual examinations, and at follow-up visits if appropriate.
- Respect a patient’s privacy regarding spiritual beliefs.
- Be aware of your own beliefs; don’t impose your spiritual/religious beliefs on others.
- Make referrals to chaplains, spiritual directors, or community resources as appropriate.
FICA The FICA Spiritual History Tool© was developed to help healthcare 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 were correlated to many aspects of quality of life. Healthcare professionals are encouraged not to use the FICA tool as a checklist, but rather to rely on it as a guide to aid and open the discussion to spiritual issues.
F – Faith, Belief, Meaning Do you consider yourself spiritual or religious? Do you have spiritual beliefs 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. Meaning might be found in family, career, nature, arts, humanities or other spiritual, cultural or religious beliefs and practices.
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 healthcare team?
C – Community Are you part of a spiritual or religious community? 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 healthcare? This is also to remind clinicians to develop a plan to address patient spiritual distress or other spiritual issues.
Further Resources More information and educational materials about FICA are available at http://www.gwish.org/.
- Puchalski CM, Ferrell B, Viriani R, et al. Improving the quality of spiritual care as a dimension of palliative care: Consensus conference report. J Palliat Med. 2009;12(10): 885-903.
- Puchalski CM, Romer AL. Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med. 2000; 3:129-37.
- Cohen SR, Mount BM, Tomas JJ, Mount LF. Existential well-being is an important determinant of quality of life. Evidence from the McGill quality of life questionnaire. Cancer. 1996; 77:576-586.
- Gall TL and Comblatt MW. Breast cancer survivors give voice: a qualitative analysis of spiritual factors in long-term adjustment. Psycooncol. 2002; 11:524-535
- George LK, Larson DB, Koenig HG, McCullough ME. Spirituality and health: what we know, what we need to know. J Soc Clin Psychol. 2000; 19:102-116.
- Jenkins RA, Pargament KI. (1995). Religion and spirituality as resources for coping with cancer. J Psychosocial Oncol. 1995; 13: 51-74.
- Koenig HG. A commentary. The role of religion and spirituality at the end of life. Gerontologist. 2002; 42(suppl 3):20-23.
- Puchalski CM. Addressing the spiritual needs of patients. Ethical issues in cancer patient care, 2nd edition. Can Treat Research. 2008; 140:79-91.
- Tsevat J, Sherman SN, McElwee JA, et al. The will to live among HIV-infected patients. Ann Int Med. 1999;131(3):194–198.
- Balboni TA, Vanderwerker LC, Block SD, et al. Religiousness and spiritual support among Advanced cancer patients and associations with end-of-life treatment preferences and quality of life. J Clin Oncol. 2007;25:555-560.
- Delgado-Guay MO, Hui D, Parsons HA, et al. Spirituality, religiosity, and spiritual pain in advanced cancer patients. J Pain Symptom Manage. 2011; 41:986-994.
- Pargament KI. The Psychology of Religion and Coping. New York: Guilford Press; 1997.
- Balboni T, Balboni M, Paulk, ME, et al. Support of cancer patients’ spiritual needs and associations with medical care costs at the end of life. Cancer. 2011; 117: 5383–5391.
- Sulmasy DP. A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist. 2002; 42(Spec No 3): 24-33.
- Borneman T, Ferrell B, Puchalski CM. Evaluation of the FICA Tool for Spiritual Assessment. J Pain Symptom Manage. 2010; 40:163-173.
Author’s Affiliation: George Washing Institute for Spirituality and Health, George Washington University Medical Center, Washington, DC.
Conflict of Interest Statement: The author has disclosed no relevant conflicts of interest.
Version History: First published November 2013. Re-copy-edited in September 2015.
Fast Facts and Concepts are edited by Sean Marks MD (Medical College of Wisconsin) and associate editor Drew A Rosielle MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact’s content. The full set of Fast Facts are available at Palliative Care Network of Wisconsin with contact information, and how to reference Fast Facts.
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