Meeting Spiritual Needs: What Is an Oncologist to Do?

The original report by Balboni and colleagues regarding spiritual support is not a subtle message about a possible need for a few patients with cancer. It is a strong statement of a seriously unmet need in the vast majority of patients in our care. The authors found that 47% of the study patients with advanced cancer reported unmet spiritual needs by religious communities and 72% reported unmet spiritual needs by the health care system. If these figures were reported for any other dimension of patient care, cancer care settings concerned with quality would respond. How should we respond to patient needs for spiritual support? The topic of spirituality is a reminder of another topic raised in the 1970s to 1980s in oncology, which was also a subject to be avoided—that of sexuality in cancer patients. Controversies of that era asked similar questions: do patients really care about this? Do they want us to talk about it? What if their preferences are different from my own? If I ask about it, what do I do when they voice concerns? The authors of this research are to be commended for providing a comprehensive discussion about the implications of their findings. They conclude that physicians can participate in improved care by recognizing spiritual needs and by advocating for attention to religious and spiritual needs as a routine part of cancer care. This global recommendation is indisputable. Spiritual needs, like sexuality needs, will exist regardless of if we elect to address or ignore them. So what is an oncologist to do? At a time of unprecedented time constraints and demands of complex patients, diminished staff resources, managed care demands, and the struggle to address even the most basic of disease and treatment concerns—where do spiritual concerns fit in? To build on the general recommendations provided by Balboni and colleagues, I offer three specific suggestions.