What do family physicians think about spirituality in clinical practice?

To describe the context in which physicians address patients' spiritual concerns, including their attitudes toward this task, cues to discussion, practice patterns, and barriers and facilitators.

This was a qualitative study using semistructured interviews of 13 family physicians.

We selected board-certified Missouri family physicians in a nonrandom fashion to represent a range of demographic factors (age, sex, religious background), practice types (academic/community practice; urban/rural), and opinions and practice regarding physicians' roles in addressing patients' spiritual issues.

We coded and evaluated transcribed interviews for themes.

Physicians who reported regularly addressing spiritual issues do so because of the primacy of spirituality in their lives and because of the scientific evidence associating spirituality with health. Respondents noted that patients' spiritual questions arise from their unique responses to chronic illness, terminal illness, and life stressors. Physicians reported varying approaches to spiritual assessment; affirmed that spiritual discussions should be approached with sensitivity and integrity; and reported physician, patient, mutual physician-patient, and situational barriers. Facilitators of spiritual discussions included physicians' modeling a life that includes a spiritual focus.

These physicians differ in their comfort and practice of addressing spiritual issues with patients but affirm a role for family physicians in responding to patients' spiritual concerns. Factors that form a context for discussions of spiritual issues with patients include perceived barriers, physicians' role definition, familiarity with factors likely to prompt spiritual questions, and recognition of principles guiding spiritual discussions.