Spirituality and health for women of color.
Spirituality among African American and Hispanic women has been associated with a variety of positive health outcomes. The purposes of this commentary are (1) to define spirituality, comparing it with religiosity, and briefly examine the historical, cultural, and contextual roots of spirituality among women of color; (2) to explore research data that support a relationship between spirituality and health, particularly among women of color; and (3) to present several examples of how spirituality may enhance public health interventions designed to promote health and prevention. (+info)
Faith, identity, and leukemia: when blood products are not an option.
Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital, founded the Kenneth B. Schwartz Center. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and sustenance to the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers and gain insight and support from fellow staff members. When a competent adult patient refuses lifesaving treatment for religious or personal reasons, caregivers have a legal obligation to respect this decision. A patient's refusal of treatment adds particular challenges to the delivery of compassionate care. The case of a 50-year-old Jehovah's Witness with acute myelocytic leukemia who declined blood product support is presented. Respecting her religious beliefs during chemotherapy required balancing risk and benefit, watching her suffer while unable to intervene with what the staff saw as simple treatment, and eventually undertaking a complicated grief process. Jehovah's Witness beliefs regarding blood products are reviewed. Caregiver roles and responsibilities are discussed in the context of psychosocial, legal, familial, and ethical issues. (+info)
Use of mind-body medical therapies.
OBJECT: Research demonstrating connections between the mind and body has increased interest in the potential of mind-body therapies. Our aim was to examine the use of mind-body therapies, using data available from a national survey. DESIGN: Analysis of a large nationally representative dataset that comprehensively evaluated the use of mind-body therapies in the last year. SETTING: United States households. PATIENTS/PARTICIPANTS: A total of 2055 American adults in 1997-1998. INTERVENTIONS: Random national telephone survey. MEASURES AND MAIN RESULTS: We obtained a 60% weighted overall response rate among eligible respondents. We found that 18.9% of adults had used at least 1 mind-body therapy in the last year, with 20.5% of these therapies involving visits to a mind-body professional. Meditation, imagery, and yoga were the most commonly used techniques. Factors independently and positively associated with the use of mind-body therapies in the last year were being 40 to 49 years old (adjusted odds ratio [AOR], 2.03; 95% confidence interval [CI], 1.33 to 3.10), being not married (AOR, 1.78; 95% CI, 1.34 to 2.36), having an educational level of college or greater (AOR, 2.21; 95% CI, 1.57 to 3.09), having used self-prayer for a medical concern (AOR, 2.53; 95% CI, 1.87 to 3.42), and having used another complementary medicine therapy in the last year (AOR, 3.77; 95% CI, 2.74 to 5.20). While used for the full array of medical conditions, they were used infrequently for chronic pain (used by 20% of those with chronic pain) and insomnia (used by 13% of those with insomnia), conditions for which consensus panels have concluded that mind-body therapies are effective. They were also used by less than 20% of those with heart disease, headaches, back or neck pain, and cancer, conditions for which there is strong research support. Mind-body therapies were generally used concomitantly with conventional care: 90% of those using a mind-body therapy in the last year had seen a physician and 80% of mind-body therapies used were discussed with a physician. CONCLUSIONS: Although mind-body therapies were commonly used, much opportunity exists to increase use of mind-body therapies for indications with demonstrated efficacy. (+info)
Seeking and managing hope: patients' experiences using the Internet for cancer care.
PURPOSE/OBJECTIVES: To describe the experiences of patients with cancer using the Internet for information and support to manage the self-care aspects of illness and treatment, including symptom management. RESEARCH APPROACH: Heideggerian hermeneutics branch of phenomenology. SETTING: The interviews took place in outpatient settings in the northeastern United States, including clinics, patients' homes, and the researchers' office. PARTICIPANTS: 20 patients self-identified as users of the Internet for cancer care. METHODOLOGIC APPROACH: Data were collected by informal interviews that provided the narrative stories for hermeneutic analysis. MAIN RESEARCH VARIABLES: Internet use for cancer care and patient-provider relationship. FINDINGS: Five related themes and one constitutive pattern described patients' experiences. The themes were retrieving and filtering Internet information according to personal situation by Internet-savvy people in patients' support networks, seeking hope from the newest treatment options while coping with fear in manageable "bytes," self-care for personal illness situations with meaningful information regarding symptom management, empowering patients as partners when Internet information served as a second opinion in decision making and validating treatment decisions, and Internet as providing peer support. The constitutive pattern was Internet use as assisting patients in discovering ways to live with cancer as a chronic illness instead of a death sentence. CONCLUSIONS: Patients with cancer are incorporating Internet use into their cancer care. They perceive changing provider-patient relationships when they participate in treatment decisions. INTERPRETATION: Computer-savvy patients and their personal support networks will avail themselves of Internet information, creating the need for new interaction patterns and relationships with providers. (+info)
Just another drug? A philosophical assessment of randomised controlled studies on intercessory prayer.
The empirical results from recent randomised controlled studies on remote, intercessory prayer remain mixed. Several studies have, however, appeared in prestigious medical journals, and it is believed by many researchers, including apparent sceptics, that it makes sense to study intercessory prayer as if it were just another experimental drug treatment. This assumption is challenged by (1) discussing problems posed by the need to obtain the informed consent of patients participating in the studies; (2) pointing out that if the intercessors are indeed conscientious religious believers, they should subvert the studies by praying for patients randomised to the control groups; and (3) showing that the studies in question are characterised by an internal philosophical tension because the intercessors and the scientists must take incompatible views of what is going on: the intercessors must take a causation-first view, whereas the scientists must take a correlation-first view. It therefore makes no ethical or methodological sense to study remote, intercessory prayer as if it were just another drug. (+info)
Use of complementary and alternative therapies by rural African Americans with type 2 diabetes.
The prevalence of type 2 diabetes among non-Hispanic African American adults aged 20 years and older is 11.4%, compared to 8.4% non-Hispanic whites. Given the high rate of diabetes in this population, it is important to determine whether African Americans use complementary and alternative medicine (CAM), and if so, what kind. Such information is important to healthcare professionals who prescribe therapies and make self-care recommendations to those with diabetes. The use of CAM by African Americans with diabetes has not been well studied, however, particularly among those living in rural areas. This descriptive study was conducted in 2 rural communities in Central Virginia to explore the use of CAM therapies and the role of religion and spirituality in dealing with diabetes among adult African Americans with type 2 diabetes. Sixty-eight participants attended 1 of 8 focus group sessions in various community settings and described their use of alternative therapies. According to these sessions, the most common alternative therapies used are prayer, diet-based therapies, and natural products. The participants' descriptions enhance our understanding of CAM use among rural African Americans with diabetes. (+info)
Science, medicine, and intercessory prayer.
Among the many recent attempts to demonstrate the medical benefits of religious activity, the methodologically strongest seem to be studies of the effects of distant intercessory prayer (IP). In these studies, patients are randomly assigned to receive standard care or standard care plus the prayers or "healing intentions" of distant intercessors. Most of the scientific community has dismissed such research, but cavalier rejection of studies of IP is unwise, because IP studies appear to conform to the standards of randomized controlled trials (RCTs) and, as such, would have a significant advantage over observational investigations of associations between religious variables and health outcomes. As we demonstrate, however, studies of IP fail to meet the standards of RCTs in several critical respects. They fail to adequately measure and control exposure to prayer from others, which is likely to exceed IP and to vary widely from subject to subject, and whose magnitude is unknown. This supplemental prayer so greatly attenuates the differences between the treatment and control groups that sample sizes are too large to justify studies of IP. Further, IP studies generally do not specify the outcome variables, raising problems of multiple comparisons and Type 1 errors. Finally, these studies claim findings incompatible with current views of the physical universe and consciousness. Unless these problems are solved, studies of IP should not be conducted. (+info)
Authentic community as an educational strategy for advancing professionalism: a national evaluation of the Healer's Art course.
BACKGROUND: Efforts to promote medical professionalism often focus on cognitive and technical competencies, rather than professional identity, commitment, and values. The Healer's Art elective is designed to create a genuine community of inquiry into these foundational elements of professionalism. OBJECTIVE: Evaluations were obtained to characterize course impact and to understand students' conceptions of professionalism. DESIGN: Qualitative analysis of narrative course evaluation responses. PARTICIPANTS: Healer's Art students from U.S. and Canadian medical schools. APPROACH: Analysis of common themes identified in response to questions about course learning, insights, and utility. RESULTS: In 2003-2004, 25 schools offered the course. Evaluations were obtained from 467 of 582 students (80.2%) from 22 schools participating in the study. From a question about what students learned about the practice of medicine from the Healer's Art, the most common themes were "definition of professionalism in medicine" and "legitimizing humanism in medicine." The most common themes produced by a question about the most valuable insights gained in the course were "relationship between physicians and patients" and "creating authentic community." The most common themes in response to a question about course utility were "creating authentic community" and "filling a curricular gap." CONCLUSIONS: In legitimizing humanistic elements of professionalism and creating a safe community, the Healer's Art enabled students to uncover the underlying values and meaning of their work--an opportunity not typically present in required curricula. Attempts to teach professionalism should address issues of emotional safety and authentic community as prerequisites to learning and professional affiliation. (+info)