Harvard Research: How Are Spirituality and Health Linked?

Spirituality improves medical care for those facing serious illness. And it increases overall health outcomes, even at the population level.

Those claims are based on a review of more than two decades of high-quality studies showing the benefits of seeing and nurturing a patient’s spirituality as part of medical care or public health.

The findings, led by researchers from Harvard University Human Flourishing Program and college friends Initiative on Health, Religion and Spiritualityamong others, were published earlier this month in JAMA, the Journal of the American Medical Association.

The link between body and soul is not a new discovery, according to Dr. Tracy A. Balboni, co-director of the Harvard initiative and a professor of radiation oncology and lead author of the study. She said the association is especially well known between community-based forms of spirituality and key outcomes such as reductions in all-cause mortality, suicide, depression and substance abuse, as well as increased recovery from substance use disorders.

“There is actually quite a bit of research both in the health arena (healthy populations) and in the serious illness arena that demonstrates clear ways in which spirituality interacts with well-being, showing many remarkable associations with very rigorous research,” said Balboni, who also directs Harvard’s radiation oncology program.

Spirituality in Serious Illness and Health” is a detailed look at hundreds of studies with thousands of patients to see what research has shown about the link between spirituality and health. Expert panels then analyzed the findings to create recommendations for ways to use that relationship to benefit both the very sick and public health.

The goal, they said, is “values-sensitive, person-centered care.”

Clinicians, public health experts, researchers, health system leaders and medical ethicists made up the panels. The top priorities generated by the panel when treating people with serious illnesses include:

  • Routinely incorporate spiritual care into medical care.
  • Include education for spiritual care in the training of members of the interdisciplinary medical team.
  • Including specialized spiritual practitioners, such as chaplains in patient care.

In the field of public health, they suggest:

  • That clinicians consider beneficial associations between the religious/spiritual community and health to provide better person-centered care.
  • Increase public health professionals’ awareness of the evidence that religious/spiritual community involvement is associated with health protection.
  • Recognize spirituality as a social factor that is linked to health.

Balboni said that spirituality can manifest itself in many ways, not just as religion. “At least the early data would suggest that a community where there is a shared purpose, value and connection with each other could have something similar. It’s just that religious communities tend to do that, that’s the core of what they do in general. So I think those are the most common ways.”

He added, “Finding that community that helps nurture and maintain a framework of meaning, purpose, and value is critical to our health, well-being, and flourishing as human beings.”

Definition of the need

In a blog about research in psychology today and in the Human Flourishing newsletter, Tyler J. VanderWeele, director of that program, noted “strong evidence that religious service attendance was associated with a lower risk of mortality; less consumption of tobacco, alcohol and drugs; better mental health; better life quality; Fewer subsequent depressive symptoms and less frequent suicidal behavior.

He wrote that the deep dive in longitudinal studies suggests that those who attend religious services frequently enjoy a 27% lower risk of dying at follow-up and a 33% lower chance of later depression.

“Spirituality or spiritual community seemed to be important in both illness and health,” VanderWeele said.

The researchers considered high-quality studies published since 2000. “High-quality” criteria included having large sample sizes and validated measures. For health outcomes, the studies also needed a longitudinal design. They removed studies with ‘serious or critical’ risk of bias.

The panels discussed the implications for health care based on the evidence from the studies, calling the strongest evidence inconclusive for recommendations.

By the time they went through the elimination process, they had narrowed nearly 9,000 articles to 371 on serious illnesses. Of nearly 6,500 articles on health outcomes, they included 215.

They found clear evidence that spirituality is important to most patients and that spiritual needs are common, while spiritual care is not. They also found that patients often want spiritual care, but spiritual needs are rarely addressed as part of medical care, although spirituality often influences the medical decisions patients make.

Finally, the research review showed that when spiritual needs are not addressed, the patient’s quality of life is not as good, while providing spiritual care provides better end-of-life outcomes.

In real life

The Rev. Amy Ziettlow has often seen the interplay of faith and medicine in her role as pastor of Holy Cross Lutheran Church in Decatur, Illinois. She said the JAMA study “resonates with my daily experience of congregational ministry.”

Any congregation has members who are homebound and seriously ill, said the Rev. Ziettlow, who was not involved in the study. “They live with chronic or acute pain, experience loss of memory and physical mobility, and are vulnerable to infections, especially COVID-19, the flu, and pneumonia. By definition, ‘homebound’ means they are separated from their faith communities, and my role as pastor is to remind them that they are still connected to their church and to the presence of God,” he told the Deseret News by mail. electronic.

His example is Mary, who at 96 had trouble walking and was living in a memory care unit when she started hospice last April. Amid COVID-19 restrictions, only family members and Reverend Ziettlow were allowed to visit.

During weekly and then daily visits as death neared, “I was a bridge between her isolated room and our bustling sanctuary of the faithful, between her life defined by medications, doctor visits and physical boundaries and her life defined by her relationship. with God,” Reverend Ziettlow told her. “I wore a collar, my worship uniform, which signaled to her and the care center staff that ritual words and actions would take place that would connect Mary with her ultimate meaning, the story of God’s love and grace” .

Despite her poor memory, Mary still knew the liturgical elements that had nurtured her spirit throughout her life, the Rev. Ziettlow said. She “recited the Lord’s Prayer, the Apostles’ Creed and sang along with her favorite hymns, such as ‘Jesus Loves Me’ and ‘Amazing Grace’”.

Each visit ended with the sacrament of communion. “Mary kept a special plate and napkin that she liked for me to use as we marked this ritual meal together. We ate, we drank and we remembered that the presence of God is really with us always”, the pastor recalled. “His last words from him to me were: ‘God bless you.'”

Baldoni hopes that the medical community, public health workers, and all those they serve will pay attention to the connection between spirituality and health.

Spirituality, he said, “can actually nurture the soul of medicine itself. I believe that as we better embrace the spiritual aspects of our patients, we are embracing the spiritual aspects of what it means to be patient caregivers.”

On the public health side, he said, “As health systems at all levels recognize that humans are spiritual beings and that is an important aspect of flourishing, we can harness better care for human populations or for communities taking advantage of the resources of spirituality”.

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