Throughout much of human history, spirituality and religion played a central role in medical care. Medical practitioners focused on an interconnectedness of physical, mental, and spiritual well-being. Until the last 2 centuries, prayer and spiritual rituals were an integral part of patient care (1). As advances in technology were made and modern medicine evolved, medicine transitioned to a more secular approach in Western cultures. This diminished the connectedness between spirituality, religion, and healthcare. Recently, there has been a push to shift back to holistic, person-focused care. Most regulatory bodies in medicine have made statements in the last 40 years to urge clinicians to focus on whole-person care (2). This type of care addresses patients’ goals and values in shared medical decision-making. The implication of such recommendations suggests we should include spirituality and/or religiosity as part of medical practice—again.

Medical institutions are indeed increasingly recognizing the importance of addressing a patients’ spiritual needs as a part of comprehensive care (2). Incorporating spiritual care is especially important in critical illness and when approaching death and end-of-life experiences (3). Despite these positive developments, challenges abound in the modern-day provision of spiritual care, including how to do it, who should do it, which patients want it, and where to find the time (4,5).

As these questions persist in the current landscape, Stevens et al (6) surveyed pediatric fellows (Pediatric Critical Care, Cardiology, and Neonatology) working in ICUs about their experience. They asked them to reflect on their training in spiritual care and how that may affect their confidence in obtaining a spiritual/religious history from their patients’ families. Their results corroborate the growing body of literature emphasizing the significance of spiritual care in healthcare settings broadly, confirming that fellows generally feel spiritual care in the critical care setting is important regardless of their personal spiritual orientation.

Of the 720 fellows surveyed, 245 responded (34%). Although this response rate is suboptimal and suggests caution regarding generalizability of the study by Stevens et al (6), this is the largest such survey of pediatric trainees to date. Perhaps unsurprisingly, 91% indicated that they never or rarely take a spiritual history. Stevens et al (6) specifically focused on the importance of training and how that shapes these fellows’ attitudes and behaviors regarding spiritual care. The group of fellows who self-reported spiritual care training (the methods of training were not specifically defined) is small, at only 17% of 245 respondents. They found that formal training in spiritual care improved fellows’ perceived competence and confidence in taking a spiritual history. Prior training also increased the likelihood of reporting taking a spiritual history and referring to spiritual care resources.

In the study by Stevens et al (6), fellows’ attitudes about the physician’s role in spiritual care for their patients were split. The survey asked, “How important is it that specifically physicians ask about the spiritual beliefs of patients and their families.” Thirty percent of fellows felt that this was either not all important or only slightly important, while 39% felt that this was quite important or extremely important. Further understanding of fellows’ attitudes about who on the medical team should take primary responsibility for spiritual care in the ICU may have been an interesting supplement to their results.

The survey used by Stevens et al (6) primarily refers to discussions of spirituality as “taking a spiritual history.” Language can be tricky. This is the appropriate terminology to refer to the discussion of spirituality with patients and families, but it may seem intimidating to physicians who do not really understand what this phrase means. Pediatric fellows may find themselves discussing spirituality and/or religion with their patients and families without identifying that they are, to some extent, taking a spiritual history. In other words, this survey may underestimate the number of fellows who are addressing spirituality with their patients’ families because they may not recognize what they are doing as “taking a spiritual history.”

The study reinforces the call for integrating spiritual care curriculum into medical education. Such recommendations are echoed in various guidelines and recommendations by medical associations and institutions (7,8). Stevens et al (6) offer an initial proposal for this type of curriculum, teaching pediatric critical care trainees how to address spiritual care. Given the apparent association between formal training and provision of spiritual care that was reinforced by their findings, our field would benefit from increased availability of this training. They suggest a spiritual care curriculum should follow a generalist-specialist model, proposed by Puchalski et al (9) in adult medicine; this involves teaching how to explore patients’ and families’ spiritual needs and then referring to hospital-based spiritual care services. Their proposed curriculum also includes general education about popular world religions and spiritual influences on medical care. How the fellows themselves would feel about such training might be limited; only 37% reported being quite or extremely interested in receiving spiritual care training in this survey.

The curriculum proposed hinges on the results of their needs assessment of fellows (but perhaps not their “wants”). This addresses physicians’ perspectives about importance of and barriers to the provision of spiritual care, just like most other available evidence in this realm. However, there is still a lack of understanding in pediatric critical care about what patients and families want from their physicians when it comes to spiritual care. When families of pediatric patients in the ICU are asked about spirituality generally, it plays a strong role in the patient-family experience and medical decision-making (10). Their preferences about how we discuss it and who starts the discussion are still unclear. For the Stevens et al (6) proposal to be successful, it is essential to incorporate the needs of patients and families in curriculum development.

Improving the quality and access to spiritual care in the PICU is important to providing holistic, comprehensive care. The ongoing barriers identified by physicians and other healthcare workers demonstrate that there is still significant work to be done. Stevens et al (6) contribute to the existing literature by offering insights into the perspectives and practices of pediatric critical care, neonatology, and cardiology fellows regarding spirituality. It underscores the need for formal training and highlights the positive impact of prior training on healthcare providers’ perceived ability to approach spiritual needs more effectively. Before steps can be taken to develop a curriculum targeting this group, further research is needed to explore spiritual care preferences from the patients’ and families’ perspectives. As physicians and healthcare providers become more competent incorporating spiritual care in their practice, the marriage of spirituality and modern medicine offers the hope of a “rediscovering” a holistic healing experience for patients and families.

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