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临床医生是否应将积极的精神信仰融入他们的医疗实践中?证据说明了什么?

Should clinicians incorporate positive spirituality into their practices? What does the evidence say?

作者信息

Larimore Walter L, Parker Michael, Crowther Martha

机构信息

Department of Social Work, The University of Alabama, Tuscaloosa 35487-0348, USA.

出版信息

Ann Behav Med. 2002 Winter;24(1):69-73. doi: 10.1207/S15324796ABM2401_08.

Abstract

Most of the rhetoric decrying the incorporation of basic and positive spiritual care into clinical practice is not based on reliable evidence. We briefly review the current evidence, which demonstrates that (a) there is frequently a positive association between positive spirituality and mental and physical health and well being, (b) most patients desire to be offered basic spiritual care by their clinicians, (c) most patients censure our professions for ignoring their spiritual needs, (d) most clinicians believe that spiritual interventions would help their patients but have little training in providing basic spiritual assessment or care, (e) professional associations and educational institutions are beginning to provide learners and clinicians information on how to incorporate spirituality and practice, and (j) anecdotal evidence indicates that clinicians having received such training find it immediately helpful and do apply it to their practice. We point out the reasons that much more research is needed, especially outcome-based, clinical research on the effects of these spiritual interventions by clinicians. We conclude that the evidence to date demonstrates trained or experienced clinicians should encourage positive spirituality with their patients and that there is no evidence that such therapy is, in general, harmful. Further, unless or until there is evidence of harm from a clinician's provision of either basic spiritual care or a spiritually sensitive practice, interested clinicians and systems should learn to assess their patients' spiritual health and to provide indicated and desired spiritual intervention. Clinicians and health care systems should not, without compelling data to the contrary, deprive their patients of the spiritual support and comfort on which their hope, health, and well-being may hinge.

摘要

大多数谴责将基本和积极的精神关怀纳入临床实践的言辞并非基于可靠证据。我们简要回顾当前的证据,这些证据表明:(a) 积极的精神状态与身心健康和幸福感之间经常存在正相关;(b) 大多数患者希望临床医生提供基本的精神关怀;(c) 大多数患者谴责我们的职业忽视了他们的精神需求;(d) 大多数临床医生认为精神干预会帮助他们的患者,但在提供基本的精神评估或关怀方面几乎没有接受过培训;(e) 专业协会和教育机构开始为学习者和临床医生提供有关如何将精神关怀融入实践的信息;(f) 轶事证据表明,接受过此类培训的临床医生发现它立竿见影且确实将其应用于实践。我们指出需要进行更多研究的原因,尤其是基于结果的临床研究,以探究临床医生进行这些精神干预的效果。我们得出结论,迄今为止的证据表明,训练有素或经验丰富的临床医生应该鼓励患者保持积极的精神状态,而且没有证据表明这种治疗总体上是有害的。此外,除非或直到有证据表明临床医生提供基本精神关怀或具有精神敏感性的实践会造成伤害,否则感兴趣的临床医生和医疗系统应该学会评估患者的精神健康状况,并提供有针对性的、患者期望的精神干预。临床医生和医疗保健系统在没有令人信服的相反数据的情况下,不应剥夺患者可能赖以寄托希望、保持健康和幸福的精神支持与慰藉。

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