Addressing Religion in Secular Healthcare: Existential Communication and the Post-Secular Negotiation

The Cultural Formulation Interview as a clinical tool in the assessment of eating disorders: a pilot study

Background

The Cultural Formulation Interview (CFI) in the DSM-5 is a person-centered instrument for systematically appraising the impact of sociocultural factors in psychiatric assessment. The CFI has been shown to be feasible, acceptable, and useful in various clinical contexts. However, to this date there is only one published report describing the use of the CFI with patients with eating disorders.

Aims

To explore the potential benefits and challenges of utilizing the CFI in the assessment of eating disorders.

Methods

As an addendum to an ongoing qualitative study about barriers to treatment for eating disorders for individuals with a migration background in Sweden, we utilized the CFI in the assessment of adult patients (n=8) in specialist eating disorder treatment. Interview data were analyzed employing a thematic analysis framework. Participants provided feedback using a standard form for evaluation of the CFI.

Results

Certain CFI questions proved especially meaningful in this context. In response to the CFI question about patient explanatory models, previously unrecognized ideas about causation emerged. These included perfectionism-a known risk factor for eating disorders-based on immigrant parents' career expectations and experiences of strict family control over life choices. In response to the CFI questions on cultural identity and its impact, the participants provided rich descriptions including important themes such as religion, racism, and ambiguities associated with being a second-generation immigrant. The final CFI question, eliciting concern about the patient-clinician relationship, revealed numerous examples of prejudice and unfamiliarity with migrant groups among healthcare providers.

Implications

The CFI can be useful in the assessment of patients with eating disorders and should be further explored as a standard tool in specialist eating disorder services.

Training Researchers in the Field of Religion, Spirituality, and Health: Experiences from a Workshop in the United States and Recommendations for Future Workshop Curricula

Although a substantial amount of research has been conducted in the field of religion, spirituality, and health, much still needs to be done. Training of researchers to conduct studies in the field of religion, spirituality, and health is essential for continued academic and methodological rigor. Such training should be globally oriented to ensure both representation and evidence from non-western cultures which is currently lacking. While little attention is given to this area in mainstream contemporary academic curricula, some researchers in the field have provided exceptional leadership in designing programs to train future researchers. In this commentary, the authors who participated in one such training program at Duke University, offer their insights based on a qualitative descriptive analysis of survey responses from a sample of participants. These insights relate to participants' perceptions of the most valuable experiences from a workshop on religion, spirituality, and health, and include recommendations for future content in training programs in this field. The multicultural aspect of the program with researchers, clinicians, and other professionals from 17 different countries was the most enriching aspect of the workshop. One of the key recommendations for future training efforts is to dedicate workshop time for participants to work collaboratively in the design and plan for international and interdisciplinary research projects with guidance from faculty.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Tobias Anker] Last name [Stripp]. Also, kindly confirm the details in the metadata are correct.They are correct.

Regaining Autonomy in a Holding Environment: Patients' Perspectives on the Existential Communication with Physicians When Suffering from a Severe, Chronic Illness: A Qualitative Nordic Study

Patients experience existential themes as pivotal in their lives, in order to be able to live with a severe, chronic illness; however, physicians report a hesitative approach to existential communication. The current study investigated Nordic patients' experiences of existential communication with their physicians related to the treatment of multiple sclerosis or chronic pain. Semi-structured interviews with 23 patients were analyzed following Interpretative Phenomenological Analysis. Physicians focusing on medical aspects at the expense of psychological and existential aspects of being ill was experienced by patients as challenging their treatment and well-being. For making a shared decision with the physician on their treatment, patients needed a transition from being dependent to being autonomous. A holding environment and existential communication about transitional objects such as relationships with something bigger than themselves, as nature or religion, supported this autonomy. The analysis showed that existential communication not only supported patients in developing and regaining autonomy but also functioned as a moderator for illness-related distress, as a prevention of withdrawal from treatment, and as significant for patients in relation to living with chronic illness. Further education in existential communication is desirable, to support physicians integrating existential dimensions in consultations and shared decision-making with patients suffering from a severe, chronic illness.

Experiences Related to Patients and Families' Expression of Spiritual Needs or Spiritual Support Within Healthcare Settings During the COVID-19 Pandemic: A Scoping Review

The aim of this review was to explore the evidence surrounding patients and families' expression of spirituality, spiritual needs or spiritual support within healthcare settings during the COVID-19 pandemic from the perspective of nursing practice. While there is a plethora of research and publications related to COVID-19 and there are reports of increasing attention to nurses' psychological distress, there is little understanding of experiences related to patients' expression of spirituality, spiritual needs or spiritual support within healthcare settings during the COVID-19 pandemic. A scoping review was conducted to search and select potential studies and undertake data extraction and synthesis. Twenty-one studies published between March 2020 and August 2021 were identified. Themes and subthemes that emerged from analysis of the studies included spiritual needs, new awareness of spiritual needs and spiritual interventions, chaplaincy referrals, and improved well-being. The potential requirement for spiritual care during these times has anecdotally never been greater. At the same time the existent ethical challenges persist, and nurses remain reticent about the topic of spirituality. This is evident from the clear lack of attention to this domain within the published nursing literature and a limited focus on spiritual care interventions or the experiences and spiritual needs of patients and their families. Greater attention is needed internationally to improve nurses' competence to provide spiritual care and to develop and advance nursing and research practice in the field of spiritual care.