title: Limits and responsibilities of physicians addressing spiritual suffering in terminally ill patients.
abstract: BACKGROUND
  Many patients experience spiritual suffering that complicates their physical suffering at the end of life. It remains unclear what physicians' perceived responsibilities are for responding to patients' spiritual suffering.
  
  
  OBJECTIVE
  To investigate U.S. physician opinions about the impact patients' unresolved spiritual struggles have on their physical pain, physicians' responsibilities for treating patients' spiritual suffering compared with patients' physical pain, and the number of patients in the past 12 months whose suffering the physician was unable to relieve to an acceptable point.
  
  
  METHODS
  The study was based on a mailed survey to 2016 practicing U.S. physicians from clinical specialties that care for significant numbers of dying patients.
  
  
  RESULTS
  Of 1878 eligible physicians, 1156 (62%) responded. Most physicians agreed that patients with unresolved spiritual struggles tend to have worse physical pain (81%) and that physicians should seek to relieve patients' spiritual suffering just as much as patients' physical pain (88%). Compared with physicians who strongly disagreed that physicians should seek to relieve patients' spiritual suffering just as much as patients' physical pain, those who strongly agreed were less likely to report being unable to relieve patients' suffering to a point the physician found acceptable (27% vs. 54% reported three or more such patients in the previous 12 months, adjusted odds ratio [95% CI] = 0.3 [0.1, 0.8]).
  
  
  CONCLUSIONS
  Most physicians believe that spiritual suffering tends to intensify physical pain and that physicians should seek to relieve such suffering. Physicians who believe they should address spiritual suffering just as much as physical pain report more success in relieving patient's suffering.
authors.affiliation: Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA. Electronic address: smyre@uchicago.edu.
authors.forename: Chris L
authors.initials: CL
authors.lastname: Smyre
authors.affiliation: Sections of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, Illinois, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Yoon
authors.affiliation: General Internal Medicine, Department of Medicine, The University of Chicago, Chicago, Illinois, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Rasinski
authors.affiliation: Trent Center for Bioethics, Humanities & History of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Farr A
authors.initials: FA
authors.lastname: Curlin
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain; D010819:Physician's Role / Q000523:psychology*; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D012068:Religion and Medicine; D029181:Spirituality; D011795:Surveys and Questionnaires; D019452:Terminally Ill; D014481:United States
keywords: Religion; end-of-life care; spiritual suffering; suffering