Influence of physicians’ religiosity and spirituality on their clinical practice: An international comparative study

Alex Kappel Kørup

Research output: ThesisPh.D. thesis

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Abstract

Background
It is generally accepted that physician values and attitudes are an important part of delivering care to patients suffering from existential and/or spiritual crises (i.e., spiritual care). This has led to an increased attention to religious and/or spiritual (R/S) values of physicians. Results from previous studies report a religiosity gap between physicians and their patients; the physicians being less religious than the background population, but still informed by personal religious values if present. These traits have been reported to be accentuated for psychiatrists. Previous studies have shown mixed results, albeit mainly positive correlations between degree of religiosity and willingness to include patient R/S-values into the clinical encounter. Still, most studies have been of low methodological quality and have not used common comparable outcome measures, which have made it very difficult to interpret results on a larger scale.

The aim of this project was to strengthen the methodological quality in the field and test existing hypotheses in an international and cross-cultural meta-analysis design.


Methods
We developed an international data pool of health professionals’ attitudes and values regarding R/S. Raw datasets were collected from the research community using a three-tier model: 1) Searching the international Network for Research in Spirituality and Health, 2) Structured citation search, and 3) Systematic literature searches using Google Scholar, Web of Science, Embase + Embase Classic (Ovid®), Medline (Ovid®) and PsycInfo. We searched for studies based on either the RSMPP or NERSH Questionnaire. Individual participant data meta-analyses (IPDMA) were used to test two existing hypotheses: a) The religious values of physicians influence their clinical practice, and b) Degree of personal R/S is positively associated with behavior regarding R/S in clinical practice (R/S-B). IPDMAs were performed with random weights in a two-step design using sample-wise multiple regression analyses controlling for age, gender, and medical specialty.


Results
Three versions of the NERSH Data Pool were built from 2016 to 2021, the latest comprising 4,872 physicians including 1,071 psychiatrists. A new scale measuring the ‘Religiosity of Health Professionals’ was suggested and validated. Degree of religiosity varied largely between samples. Half of the physicians reported that their religious beliefs influenced their clinical practice (50%). R/S was found to exert an overall effect on R/S-B of 0.65 (0.48 to 0.83). While psychiatrists had equal R/S and higher R/S-B scores compared to non-psychiatrists, the effect of R/S on R/S-B was the same for both groups. Heterogeneity between samples were high.


Conclusions
We confirmed the two hypotheses about physician R/S-values and found no reason to suspect that the effect of R/S on R/S-B was different for psychiatrists. The interplay between subjective values and clinical practice continues to be paramount for high quality health care. Further education and transparency in the clinical encounter seem viable approaches if we are to honor patient needs and expectations.

The use of IPDMA made it possible to enforce equal and high standards for the outcome measures across the included samples. Researchers are strongly encouraged to share more data within established research networks.
Translated title of the contributionIndflydelse af lægers religiøsitet og spiritualitet på deres kliniske praksis: Et internationalt sammenligningsstudie
Original languageEnglish
Awarding Institution
  • University of Southern Denmark
Supervisors/Advisors
  • Hvidt, Niels Christian, Principal supervisor
  • Søndergaard, Jens, Co-supervisor
  • Nielsen, Connie Thurøe, Co-supervisor
Publisher
DOIs
Publication statusPublished - 20. Apr 2022

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