Study, review and editorial focus on religion, spirituality and medicine

December 11, 2001

ROCHESTER, MINN. -- A study that appears in the December issue of Mayo Clinic Proceedings outlines the importance of religion and spirituality in medicine with many patients, but notes it is difficult to prove that the result is better health from intercessory prayer -- prayer by one or more people on behalf of another.

Mayo Clinic researchers found that their study of intercessory prayer had no significant effect on patients' medical outcomes after hospitalization in a coronary care unit.

The single-center, randomized, double-blind, controlled trial was conducted at Mayo Clinic in Rochester, Minn., between July 4, 1997 and Oct. 21, 1999, among 799 male and female patients aged 18 years or older, who were admitted to Saint Marys Hospital coronary care unit and were discharged with a cardiovascular diagnosis.

Although a number of published studies have assessed the effects of spiritual factors on health care outcomes -- 75 percent report a positive effect, 17 percent report no effect and 7 percent report a negative effect -- few have evaluated the effects of intercessory prayer on health outcomes.

"We sought to improve on the design of earlier studies of intercessory prayer through the application of standard experimental methods with the hope of obtaining scientific evidence to elucidate the potential role of intercessory prayer in medical care," said Stephen L. Kopecky, M.D., Mayo Clinic cardiologist and the senior author of the study.

The patients were randomized into the intercessory prayer group and the control group. Intercessory prayer was administered at least once a week for 26 weeks by five intercessors per patient.

No significant differences were found between the intercessory prayer group and the control group. At 26 weeks, a primary end point, such as death, cardiac arrest, rehospitalization for cardiovascular disease, coronary revascularization or an emergency department visit for cardiovascular disease occurred in 25.6 percent of the prayer group and 29.3 percent of the control group. Among high-risk patients, the primary endpoint occurred in 31 percent of the prayer group and 33 percent of the control group. Among low-risk patients, the difference between the groups was 17 percent for the prayer group and 24 percent for the control group.

"In light of its widespread use in conjunction with illness, intercessory prayer deserves further exploration," says Dr. Kopecky. "It should be noted that, in part due to the study's many limitations, this study did not measure the 'power of God,' nor should prayer offered for patients by loved ones, relatives and friends be interpreted not to play a potentially important role in the healing process."

In an article also published in this issue of Mayo Clinic Proceedings, Mayo Clinic researchers reviewed published studies, meta-analyses, systematic reviews and subject reviews that examined the association between religious involvement and spirituality and physical health, mental health, health-related quality of life and other health outcomes.

The authors report a majority of the nearly 350 studies of physical health and 850 studies of mental health that have used religious and spiritual variables have found that religious involvement and spirituality are associated with better health outcomes.

The Mayo Clinic researchers said most patients have a spiritual life and regard their spiritual health and physical health as equally important. People may have greater spiritual needs during illness and are looking to have those needs met.

A large and growing number of studies have shown a direct relationship between religious involvement and spirituality and positive health outcomes, including mortality, physical illnesses, mental illness, health-related quality of life and coping with illness. Studies also suggest that addressing the spiritual needs of patients may facilitate recovery from illness.

"Although the relationship between religious involvement and spirituality and health outcomes seems valid, it is difficult to establish causality," said Paul S. Mueller, M.D., a Mayo Clinic internal medicine specialist and primary author of the study. "The benefits of religious and spiritual involvement are likely conveyed through complex psychosocial, behavioral and biological processes that are incompletely understood."

Mueller and his colleagues also suggest physicians take a spiritual history of their patients, which can help the physician discern the spiritual needs of patients.

In the issue's editorial, Harold G. Koenig, M.D., MHSc, of Duke University Medical Center, outlines the strengths and weaknesses of the review and study. He also calls for physicians to address spiritual issues in their practice, but to do so with caution and training.

"In the majority of cases, the physician should not attempt to address complex spiritual needs of patients," Dr. Koenig writes. "However, when the patient is reluctant to talk with clergy and prefers to discuss spiritual matters with a trusted physician, taking a little extra time to listen and be supportive is usually all that is required. Providing support for religious beliefs and practices that do not conflict with medical care is appropriate. When beliefs conflict with medical care, however, it is important not to criticize the belief, but rather to listen, gather information, enter into the patient's world view, and maintain open lines of communication, perhaps enlisting the help of the patient's clergy. Religious beliefs may have a powerful influence on the health of our patients, and we need to know about them."
Mayo Clinic Proceedings is a peer-reviewed and indexed general internal medicine journal, published for 75 years by Mayo Foundation, with a circulation of 130,000 nationally and internationally.

John Murphy
507-284-5005 (days)
507-284-2511 (evenings)

Mayo Clinic

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