What interventions have been used to improve patients’ spiritual health in UK primary care, a realist review? Part of the ‘SHARP’ (spiritual health assessment and recommendation in primary care) project.

Problem

Spiritual health is an important part of holistic health in terms of patient care, but also care of ourselves as doctors. Spiritual health includes self-actualisation, being true to our ethical code, identity, culture, meaning and purpose; relationships with others, our communities, our wider culture and sometimes a deity or a sense of something greater; spiritual and religious practices and activities. There are multiple barriers to embedding spiritual health within primary care, including lack of training, concerns about regulator (the GMC) and peer disapproval, and discordance between clinician and patient beliefs. However, spiritual wellbeing is associated with better health and longevity. There is evidence from the point of view of spiritual and religious community support that there can be barriers to a useful relationship with clinicians to improve patient care. Taking a realist approach to synthesising the evidence so far will allow us to understand what has been tried to improve spiritual health, what has worked well, what could be better, and how could spiritual health be better embedded in UK primary care?

Approach

We are undertaking a realist review of current or previous interventions used in the UK to improve spiritual health care in primary care. This will review and synthesise the evidence around initiatives such as primary care chaplaincy trials, and the relationship between spiritual community workers and primary care. This methodology allows a wider appreciation of evidence, and an open minded, iterative approach that will best elicit the evidence needed on this topic.

Findings

This review is in its early scoping stages. Primary care chaplaincy services have been trialled in areas of Scotland and England to improve patient access to spiritual health care. The use of primary care chaplaincy may reduce demand on GP appointments, and they could be viewed as an integral part of the multi-disciplinary team. However, primary care chaplains are small in number, and this service is offered in very few areas, so access is the main limitation. Where spiritual care has been trialled in Europe (Germany and Switzerland) it has showed some benefit to patients, however there are limitations on long term funding.

Consequences

This review is crucial to understand how spiritual health has been addressed in primary care so far, and allow us to progress the conversation on the topic in a useful, pragmatic way. The next stages of the SHARP project involves a mixed method study with social prescribers, to understand barriers and facilitators to discussing spiritual health. The review and study, together with our previous work, will allow us to co-design a training package to embed the discussion of spiritual health within the holistic care offered by primary care in the UK.