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End of Life

Addressing Spiritual and Religious Needs in Advanced IllnessA Teachable Moment

Educational Objective
To describe the benefits of addressing patients' spiritual and religious needs in patient care, particularly at the end of life.

1 Credit CME

JAMA Internal Medicine

Published Online: November 23, 2020

Teachable Moment

Article Information and Disclosures

Christian K. Alch, MD¹;

Kristin M. Collier, MD¹;

Raymond Y. Yeow, MD²

Author Affiliations

¹Department of Internal Medicine, Michigan Medicine, Ann Arbor
²Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor

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A 70-year-old man with a history of cirrhosis, ascites, and hepatic encephalopathy was admitted for abdominal pain and shortness of breath. He had been recently hospitalized for the same symptoms. This admission was for a liver transplant evaluation. Several days after admission, he developed acute hepatic encephalopathy, secondary to Streptococcus mitis bacteremia. Advance care planning had not yet occurred.

Over the next several days, his encephalopathy gradually improved with antibiotics and lactulose treatment, and the possibility of liver transplant was again discussed with the patient and his wife. At that time, the couple raised questions regarding the risks and benefits of such an invasive procedure. Understanding he was at high risk for mortality, surgical complications, and poor quality of life, the patient and his wife struggled to process through the next steps.

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Article Information

Corresponding Author: Raymond Y. Yeow, MD, Division of Cardiovascular Medicine, Michigan Medicine, 1500 East Medical Center Dr, Ann Arbor, MI 48109 (yeowr@med.umich.edu).

Published Online: November 23, 2020. doi:10.1001/jamainternmed.2020.6564

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient’s spouse for granting permission to publish this information.

References

MacLean CD , Susi B , Phifer N , et al. Patient preference for physician discussion and practice of spirituality. J Gen Intern Med. 2003;18(1):38-43. doi:10.1046/j.1525-1497.2003.20403.x PubMed Google Scholar Crossref

Williams JA , Meltzer D , Arora V , Chung G , Curlin FA . Attention to inpatients’ religious and spiritual concerns: predictors and association with patient satisfaction. J Gen Intern Med. 2011;26(11):1265-1271. doi:10.1007/s11606-011-1781-y PubMed Google Scholar Crossref

Choi PJ , Curlin FA , Cox CE . Addressing religion and spirituality in the intensive care unit: a survey of clinicians. Palliat Support Care. 2019;17(2):159-164. doi:10.1017/S147895151800010X PubMed Google Scholar Crossref

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(23):5383-5391. doi:10.1002/cncr.26221 PubMed Google Scholar Crossref

Anandarajah G , Hight E . Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. Am Fam Physician. 2001;63(1):81-89.PubMed Google Scholar

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.