When treating chronic pain patients, clinicians might focus primarily on the biomedical dimensions of pain care and management. Living with a chronic condition requires patients to find a path to living as full a life as possible. For some patients, an improved quality of life is achieved through spiritual practice. Incorporating spiritual discussions into patient visits may create an opportunity for increased clinical effectiveness in pain management. The FICA Spiritual History Tool© is a good starting point for a spirituality discussion with patients.
Obtaining a spiritual history
The FICA is a brief spiritual assessment developed for use in a clinical setting. Christina Puchalski, MD, and her colleagues developed the FICA tool to “provide a way for the clinician to efficiently integrate open-ended questions into a standard medical history.”1Providers may find that having spiritual discussions with chronic pain patients could help expand the pathway towards optimal pain management.
The tool includes four domains:2
- F: Faith and Belief – “Do you have spiritual beliefs that help you cope with stress?” If the patient responds “No,” the health care provider might ask, “What gives your life meaning?”
- I: Importance – “What importance does your faith or belief have in your life? Have your beliefs influenced how you take care of yourself in this illness? What role do your beliefs play in regaining your health?”
- C: Community – “Are you a part of a spiritual or religious community? Is this of support to you and how? Is there a group of people you really love or who are important to you?”
- A: Address in Care – “How would you like me, your healthcare provider, to address these issues in your healthcare?”
The tool is not a checklist; rather, it is intended to start a dialogue between the provider and the patient.
The importance of spiritual discussions with patients: What the research has to say
A 2012 Gallup Poll determined that seven out of 10 Americans are very or moderately religious.3 Research has shown that spiritual practices are in fact associated with positive health outcomes, and may improve one’s ability to cope with stress.4 Studies also indicate that prayer is well-utilized by patients for pain relief. In a survey of hospitalized pain patients, 76% of them cited personal prayer as their most commonly used non-pharmacologic method to control their pain.5 Clinicians could consider including a spiritual discussion along with their standard assessment. A 2004 study in The Annals of Family Medicine asked respondents whether spiritual discussions would be welcome in specific situations. Among respondents who sometimes or always wanted to discuss spirituality with their providers, 62% welcomed a spiritual conversation when talking about suffering from chronic pain.6
According to some researchers, it seems that patients want to be asked about their spiritual practices. In a 2010 study, Tami Borneman, RN, MSN, CNS, FPCN noted that 41 – 94% of patients and family caregivers want their clinicians to address their spiritual concerns.7 She also found that patients “…wanted physician-patient understanding and that information about their spiritual beliefs would affect the doctor’s ability to provide realistic hope, provide medical advice, and change medical treatment.” 8
By asking spiritual assessment questions, providers can:
- – Better understand how patients view their health challenges
- – Uncover patient attitudes or beliefs about pain
- – Learn about any religious restrictions that a patient may have
- – Get a sense for how patients arrive at healthcare decisions
- – Gain a broader understanding of patients’ coping resources
- – Make whole-person care central to the pain management process
Chronic pain patients often experience impaired functioning, decreased self-efficacy, and a perceived loss of control over their lives. Spiritual assessments and discussions can help providers gain important insight into dealing with these challenges and can improve overall pain care and management.
- 1. Borneman, T., Ferrell, B., & Puchalski, C. (2010). Evaluation of the FICA Tool for Spiritual Assessment. Journal of Pain and Symptom Management, 40(2), 163-173.
- 2. The George Washington Institute for Spirituality and Health. (n.d.) FICA Spiritual Assessment Tool. Retrieved from http://www.gwumc.edu/gwish/clinical/fica-spiritual/index.cfm
- 3. Newport, F. (2012). Seven in 10 Americans are very or moderately religious. Retrieved from http://www.gallup.com/poll/159050/seven-americans-moderately-religious.aspx
- 4. Puchalski, C. (2006). Spiritual assessment in clinical practice. Psychiatric Annals, Psychology Module, 36(3), 150-155.
- 5. McNeill, J.A., Sherwood, G.G., Starck, P.L., & Thompson, C.J. (1998). Assessing clinical outcomes: Patient satisfaction with pain management. Journal of Pain Symptom Management, 16, 29-40.
- 6. McCord, G., Gilchrist, V.J., Grossman, S.D., King, B.D., McCormick, K.F., Opranci, A.M.,…Srivastava, M. (2004). Discussing spirituality with patients: A rational and ethical approach. Annals of Family Medicine, 2(4), 356-361.
- 7. Borneman, T., Ferrell, B., & Puchalski, C. (2010). Evaluation of the FICA Tool for Spiritual Assessment. Journal of Pain and Symptom Management, 40(2), 163-173.
- 8. Borneman, T., Ferrell, B., & Puchalski, C. (2010). Evaluation of the FICA Tool for Spiritual Assessment. Journal of Pain and Symptom Management, 40(2), 163-173.
Registered PainEDU members may download a copy of the FICA Spiritual Assessment Tool ©, with permission of the author, C. Puchalski, MD, by scrolling to end of “Tools to Download” area
Puchalski, C., & Romer, A. L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3(1), 129-137.
Puchalski, C. (2006). Spiritual assessment in clinical practice. Psychiatric Annals, Psychology Module, 36(3), 150-155.
Borneman, T., Ferrell, B., & Puchalski, C. (2010). Evaluation of the FICA Tool for Spiritual Assessment. Journal of Pain and Symptom Management, 40(2), 163-173.