Study Suggests Need for Spiritual Bridge-Building between Pediatric Oncologists and Patients, Families

BUFFALO, N.Y. -- Results of a new study by sociologist Elaine Howard Ecklund, Ph.D., of the University at Buffalo and researchers at Brandeis University and Harvard University suggest that pediatric oncologists -- most of whom describe themselves as "spiritual" -- might help their young patients and their families more by learning ways to engage them on a spiritual basis.

Ecklund is principal investigator for the study, "The Religious and Spiritual Beliefs and Practices of Academic Pediatric Oncologists in the United States," whose results may have implications for the education of pediatric oncologists and the spiritual care of seriously ill children and their families.

The study documents a discrepancy between the spiritual and religious beliefs of pediatric oncologists and those of the general public that may negatively influence medical care.

It was published in the most recent issue of the Journal of Pediatric Hematology/Oncology (Volume 29, Number 11, November 2007). Co-authors are Wendy Cadge, Ph.D. (Brandeis University), Elizabeth A. Gage, M.A. (University at Buffalo), and Elizabeth A. Catlin, M.D. (Harvard Medical School and Massachusetts General Hospital for Children).

A copy of the study and invited commentary by Gary A. Walco, Ph.D., of New Jersey Medical School and Hackensack University Medical Center may be obtained by contacting the University at Buffalo Office of News Services, pdonovan@buffalo.edu

Ecklund says, "Religion and spirituality are increasingly recognized as important tools in the care of seriously ill patients, and many parents, as well as young patients, draw on such resources to cope with the child's serious illness."

"We have known for some time," she says, "that to provide the best care, an assessment of the spiritual and religious perspectives of patients and families might be necessary. In fact, one study of the parents of pediatric cancer patients found that it is centrally important for doctors to understand the belief system of caregivers when designing a care plan for those patients."

Previous research also suggests that the ability of physicians to relate to such patients and families on a spiritual level has implications for both their physical and emotional healing. Cadge says studies have also shown that many patients do not feel that the medical  system adequately meets their spiritual needs.

"This study sheds more light on how religion and spirituality connect to the practice of medicine," Ecklund says, "and is a first step toward addressing needs of patients and their families in this area during a profoundly threatening chapter of life.

"We can see from our results that many pediatric oncologists do not come to the bedside with the same spiritual interests, capabilities or understandings as their patients and their families," she says.

"We found that although some respondents consider themselves spiritual, and that about a quarter of them believe in God with no reservation, the percentage of pediatric oncologists who hold these views is considerably lower than that of the general public," Ecklund says.

"These discrepancies are important because such differences between the religio-spritual attitudes and practices of physicians and those of their patients may make it difficult for physicians to relate to patients and families on a level families repeatedly say is important to them for purposes of coping and healing," she says.

The study evaluated religious and spiritual beliefs and practices of 74 physicians, a sample derived from pediatric oncology faculty, including pediatric hematologists, working in 13 hospitals that have been cited by U.S. News and World Report as "honor roll" hospitals, those it considers the best in the country.

The physicians' responses were then compared to the beliefs and practices of the general public as recorded by the General Social Survey (GSS), through the use of frequency distributions, descriptive crosstabs and tests of statistical significance.

"Eighty-five percent of the physicians described themselves as slightly-to-very spiritual," Ecklund says, "and 27 percent said they believed in God with no doubts while about 28 percent believe with some doubts.

"Most claimed some traditional religious identity, but only 24.3 percent reported attending religious services two to three times a month or more in the past year, and 12.2 percent said they do not believe in God," she says.

"Among the general public, however, 40.1 percent report attending religious services two to three times a month or more in the preceding year and 60.4 percent said they believed in God with no doubts. Only 3.1 percent of the general public said they do not believe in God."

Ecklund says, "And although 53 percent of academic pediatric oncologists said they believed their spiritual or religious beliefs influence their interactions with both patients and colleagues, almost 39 percent believed they did not."

Given these findings, the authors conclude that even if most academic pediatric oncologists are not engaged in organizational forms of religion, and many do not believe in God at all, a significant proportion of them may be open to forming bridges with families around issues related to religion and spirituality. In particular, an implication of the analyses is that fruitful connections might be made with families through a discussion of spirituality rather than traditional religion.

Further, because the majority of these physicians -- 53 percent -- think their religious or spiritual beliefs influence interactions with colleagues and patients, there is potential for them to bring up such issues themselves or connect families with spiritual care when it seems appropriate.

Ecklund and co-authors' findings also suggest that there is a potential for teaching to occur in the kinds of elite academic medical settings examined in this research -- important when they note that the majority of pediatric oncologists report a lack of medical coursework in palliative care, an area to which religion and spirituality are central.