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God is touchy topic in ICU, Pitt study finds

Ben Schmitt

The religious declaration came from the family member of a critically ill person to a treating physician: “I know my God's a big God. And I know he can even guide your hands to do the right thing.”

The doctor responded, “We'll do the best with what we've got.”

The scenario is cited in a new study by the University of Pittsburgh School of Medicine that indicates religious and spiritual conversations rarely occur during family meetings with physicians about potentially fatal situations. And when those conversations do occur, doctors and nurses rarely know how to respond to religious concerns, according to findings published in JAMA Internal Medicine, a publication of the Journal of the American Medical Association,

“This might be a little bit of a blind spot for clinicians to know how important this is to some of their patients,” said the study's senior author, Dr. Douglas White, associate professor of critical care medicine at the School of Medicine. “It's definitely tricky terrain, and I know doctors have good intentions.”

Researchers analyzed audio of 249 conversations between family decision-makers and health care professionals between 2009 and 2012 in 13 intensive care units at six medical centers across the country.

During those conversations — in which decision-makers for the patients consented to be recorded — religious or spiritual matters arose on 40 occasions or 16 percent of the time. Doctors or nurses involved rarely attempted to inquire further about religious beliefs of families or patients involved.

Additionally, 78 percent of 457 surrogate decision-makers said in a survey that religion or spirituality played “fairly or very important” roles in their lives.

Dr. Robert Arnold, medical director of UPMC's Palliative and Supportive Institute, said the findings didn't surprise him.

“Doctors and nurses are good at having factual or cognitive conversations,” he said. “But it's hard to have conversations about personal issues and things that might take us out of our comfort zone. These are tough conversations for anyone to have, and when we're nervous, we revert to what we're comfortable with, which is science.”

The study concluded that medical providers need to explore strategies to better incorporate religious and spiritual matters when they care for patients in ICUs.

White, who is a critical care doctor at UPMC, said the findings don't mean clinicians should study up on all religions — they just need to find ways to be more accommodating and sensitive.

Arnold agreed.

“Families don't expect me, and most would not like it if I tried, to speak as an expert on various religions,” he said. “But that doesn't mean they don't want me to talk about it as a fellow human being. I need to acknowledge it and say to them something like, ‘I can tell that religion is very important in your life.' ”

Ben Schmitt is a staff writer for Trib Total Media. He can be reached at 412-320-7991 or bschmitt@tribweb.com.