title: Effects of a 12-month educational intervention on outpatient clinicians' attitudes and behaviors concerning spiritual practices with patients.
abstract: OBJECTIVE
  We report here the impact of an educational training program on attitudes and practices of physicians (MDs) and mid-level practitioners (MLPs) toward controversial spiritual practices, such as practitioner-led prayer, sharing personal religious beliefs, and encouraging patients' religious beliefs.
  
  
  METHODS
  In this single-group experimental study, 427 physicians and 93 MLPs affiliated with the Adventist Health System agreed to complete a questionnaire assessing demographics, practice characteristics, religiosity, and attitudes and behaviors at baseline, 1 month, and 12 months. Changes in attitudes and practices over time were examined and baseline predictors were identified using mixed-effects regression models.
  
  
  RESULTS
  For the most part, attitudes regarding praying with patients, sharing faith with patients, and encouraging patients' own religious faith did not change much during the 12-month educational training program. However, significant increases were found in frequency of praying with patients (MDs and MLPs), willingness to pray with patients (MDs), sharing their faith with patients (MDs), and encouraging patient's own religious faith (MDs and MLPs). Among physicians, predictors of praying with patients across time were older age, Christian affiliation, and importance of religion, and among MLPs, they were older age, non-White race, and importance of religion. No interaction between time and religiosity was found.
  
  
  CONCLUSIONS
  Although attitudes toward these mostly controversial practices were largely unaffected, the frequency of praying with patients, sharing faith, and supporting patient's own religious faith increased over time in both religious and nonreligious clinicians. Educational programs of this type may be important in changing clinicians' behaviors regarding appropriate and sensitive engagement in such activities with patients.
authors.affiliation: Department of Psychiatry; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; School of Public Health, Ningxia Medical University, Yinchuan, People's Republic of China.
authors.forename: Harold G
authors.initials: HG
authors.lastname: Koenig
authors.affiliation: Medical Mission Integration, Adventist Health System, Orlando, FL, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Perno
authors.affiliation: Medical Mission Integration, Adventist Health System, Orlando, FL, USA.
authors.forename: Ted
authors.initials: T
authors.lastname: Hamilton
keywords: behavior; health professionals; physicians; prayer; religion; spirituality