Objectives The overall study aim was to synthesise understandings and experiences regarding the concept of spiritual care (SC). More specifically, to identify, organise and prioritise experiences with the way SC is conceived and practised by professionals in research and the clinic. Design Group concept mapping (GCM). Setting The study was conducted within a university setting in Denmark. Participants Researchers, students and clinicians working with SC on a daily basis in the clinic and/or through research participated in brainstorming (n=15), sorting (n=15), rating and validation (n=13). Results Applying GCM, ideas were identified, organised and prioritised online. A total of 192 unique ideas of SC were identified and organised into six clusters. The results were discussed and interpreted at a validation meeting. Based on input from the validation meeting a conceptual model was developed. The model highlights three overall themes: (1) ‘SC as an integral but overlooked aspect of healthcare’ containing the two clusters SC as a part of healthcare and perceived significance; (2) ‘delivering SC’ containing the three clusters quality in attitude and action, relationship and help and support, and finally (3) ‘the role of spirituality’ containing a single cluster. Conclusion Because spirituality is predominantly seen as a fundamental aspect of each individual human being, particularly important during suffering, SC should be an integral aspect of healthcare, although it is challenging to handle. SC involves paying attention to patients’ values and beliefs, requires adequate skills and is realised in a relationship between healthcare professional and patient founded on trust and confidence.

Background: Observational studies indicate that religious values of physicians influence clinical practice. The aim of this study was to test prior hypotheses of prevalence of this influence using a meta-analysis design. Methods: Based on a systematic literature search we performed individual participant data meta-analysis (IPDMA) on data based on 2 preselected questionnaires. Ten samples from 7 countries remained after exclusion (n = 3342). IPDMA was performed using a random-effects model with 2 summary measures: the mean value of the scale “Religiosity of Health Professionals”; and a dichotomized value of the question “My religious beliefs influence my practice of medicine.” Also, a sensitivity analysis was performed using a mixed-models design controlling for confounders. Results: Mean score of religiosity (95% confidence interval [CI]) was significantly lower in the European subgroup (8.46 [6.96–9.96]) compared with the Asian samples India (10.46 [9.82–10.21]) and Indonesia (12.52 [12.19–12.84]), whereas Brazil (9.76 [9.54–9.99]) and USA (10.02 [9.82–10.21]) were placed in between. The proportion of the European physicians who agreed to the statement “My religious beliefs influence my practice of medicine” (95% CI) was 42% (26%–59%) compared with Brazil (36% [29%–43%]), USA (57% [54%–60%]), India (58% [52%–63%]), and Indonesia (91% [84%–95%]). Conclusions: Although large cross-cultural variations existed in the samples, 50% of physicians reported to be influenced by their religious beliefs. Religiosity and influence of religious beliefs were most pronounced in India, Indonesia, and a European faith-based hospital. Education regimes of current and future physicians should encompass this influence, and help physicians learn how their personal values influence their clinical practice.

Modern healthcare research has only in recent years investigated the impact of health care workers’ religious and other moral values on medical practice, interaction with patients, and ethically complex decision-making. Thus far, no international data exist on the way such values vary across different countries. We therefore established the NERSH International Collaboration on Values in Medicine with datasets on physician religious characteristics and values based on the same survey instrument. The present article provides (a) an overview of the development of the original and optimized survey instruments, (b) an overview of the content of the NERSH data pool at this stage and (c) a brief review of insights gained from articles published with the questionnaire. The questionnaire was developed in 2002, after extensive pretesting in the United States and subsequently translated from English into other languages using forward-backward translations with Face Validations. In 2013, representatives of several national research groups came together and worked at optimizing the survey instrument for future use on the basis of the existing datasets. Research groups were identified through personal contacts with researchers requesting to use the instrument, as well as through two literature searches. Data were assembled in Stata and synchronized for their comparability using a matched intersection design based on the items in the original questionnaire. With a few optimizations and added modules appropriate for cultures more secular than that of the United States, the survey instrument holds promise as a tool for future comparative analyses. The pool at this stage consists of data from eleven studies conducted by research teams in nine different countries over six continents with responses from more than 6000 health professionals. Inspection of data between groups suggests large differences in religious and other moral values across nations and cultures, and that these values account for differences in health professional’s clinical practices.

Research to date has shown that health professionals often practice according to personal values, including values based on faith, and that these values impact medicine in multiple ways. While some influence of personal values are inevitable, awareness of values is important so as to sustain beneficial practice without conflicting with the values of the patient. Detecting when own personal values, whether based on a theistic or atheistic worldview, are at work, is a daily challenge in clinical practice. Simultaneously ethical guidelines of tone-setting medical associations like American Medical Association, the British General Medical Council and Australian Medical Association have been updated to encompass physicians’ right to practice medicine in accord with deeply held beliefs. Framed by this context, we discuss the concept of value-neutrality and value-based medical practice of physicians from both a cultural and ethical perspective, and reach the conclusion that the concept of a completely value-neutral physician, free from influence of personal values and filtering out value-laden information when talking to patients, is simply an unrealistic ideal in light of existing evidence. Still we have no reason to suspect that personal values, whether religious, spiritual, atheistic or agnostic, should hinder physicians from delivering professional and patient-centered care.

Collaboration within the recently established Network for Research on Spirituality and Health (NERSH) has made it possible to pool data from 14 different surveys from six continents. All surveys are largely based on the questionnaire by Curlin “Religion and Spirituality in Medicine, Perspectives of Physicians” (RSMPP). This article is a methodological description of the process of building the International NERSH Data Pool. The larger contours of the data are described using frequency statistics. Five subscales in the data pool (including the already established DUREL scale) were tested using Cronbach’s alpha and Principal Component Analysis (PCA) in an Exploratory Factor Analysis (EFA). 5724 individuals were included, of which 57% were female and the mean age was 41.5 years with a 95% confidence interval (CI) ranging from 41.2 to 41.8. Most respondents were physicians (n = 3883), nurses (n = 1189), and midwives (n = 286); but also psychologists (n = 50), therapists (n = 44), chaplains (n = 5), and students (n = 10) were included. The DUREL scale was assessed with Cronbach’s alpha (α = 0.92) and PCA confirmed its reliability and unidimensionality. The new scales covering the dimensions of “Religiosity of Health Professionals (HPs)” (α = 0.89), “Willingness of Physicians to Interact with Patients Regarding R/S Issues” (α = 0.79), “Religious Objections to Controversial Issues in Medicine” (α = 0.78), and “R/S as a Calling” (α = 0.82), also proved unidimensional in the PCAs. We argue that the proposed scales are relevant and reliable measures of religious dimensions within the data pool. Finally, we outline future studies already planned based on the data pool, and invite interested researchers to join the NERSH collaboration.