AOSW Connections
Spirituality SIG: “Will You Pray with Me?” A Simple Question—a Nuanced Response
As oncology social workers we navigate our patients through both calm seas and stormy waters along their cancer journey. For patients with a prayer practice, their belief system also sustains and guides them. When a patient’s spiritual-based request, such as asking us to pray with them, intersects (or clashes) with our personal ethics and professional boundaries, how should we respond to what some may consider a “spiritual quandary”? Three physicians caution that this type of scenario can be complex, layered with meaning and deserves a “nuanced understanding of both the patient’s needs and the clinicians’ boundaries” (Christensen, Cook, & Arnold, 2018, p. 621).
Scenario
A devout Catholic patient, Mrs. C., asks her surgeon, Dr. Q, to pray with her on the eve of scheduled bypass surgery. Dr. Q knows that prayer is important to her patient. She considers “faking it” but doesn’t. She feels awkward but doesn’t want to be dishonest and disrespectful to Mrs. C. She offers to call the chaplain, however, Mrs. C. looks annoyed and says, “But Rev. P is not performing my surgery tomorrow morning. You are” (Christensen et al., 2018, p. 621).
Understanding Our Discomfort
The first recommendation for this situation is to dig deeper to understand our own comfort or discomfort in addressing the topic of religion with a patient so we can better respond to this type of request. We may fear saying the wrong thing, feel this topic is outside our area of expertise or be concerned about upsetting the patient because of our discordant beliefs. Christensen et al. (2018) cite studies that “In the setting of severe illness, religious and spiritual support from the medical community can significantly impact patient-reported quality of life” (p. 622). Avoiding a discussion of religion or spirituality can be perceived as abandonment by the patient rather than relationship-building with a clinician. Yet we may hold a firm belief that our personal life and beliefs are separate from our professional role and wish to avoid engaging in this type of conversation.
Anticipatory Self-Reflection and Intentional Pause
Preparing a response before these situations occur can permit time to formulate an authentic response that is true to our core beliefs. The benefits of self-reflection include “increasing insight into personal feelings, increasing capacity for empathy, and enhancing the ability to differentiate a patient’s and a [clinician’s] needs” (Christensen et al., 2018, p. 623). Social work supervision can help us prepare for or process our reaction to a prayer request. An intentional pause (in the moment) can permit us to assess our own emotional response to this request. Taking a deep breath can help us process our own anxiety, then slow the conversation down for the next step.
Explore, Listen and Reflect
These skills are already in our tool box. A simple request for prayer can be a comforting coping mechanism for a patient, or it may be layered with meaning. When we explore further, we may discover that Mrs. C. may be feeling myriad emotions, including fear, anxiety or lack of control. Open-ended questions are best, and taking the time to explore honors the significance of the request. For example, “I see that it’s important for me to be here with you; tell me more” (Christensen et al., 2018, p. 624). We know that active listening validates feelings and the empathic response of simply reflecting back a patient’s concerns allows our patients to feel acknowledged—for example, agreeing with the patient that “Yes, this is a scary situation” (Christensen et al., p. 624). This type of response is supportive, yet does not require us to agree with our patients’ religious beliefs.
Responding to the Request for Prayer: Options
Christensen et al. (2018) recommend that a clinician promote trust in the relationship and never lie about their religious beliefs. If a patient questions our own beliefs (“But don’t you pray?” p. 625), we can acknowledge that we understand that prayer is important to them and choose a response that aligns with our personal and professional values. If we are pressed for a response, we can say, “I am uncomfortable talking about my faith” (p. 625).
We can offer to be present while a patient prays, or to spend a few moments of silence together if that is in our comfort zone. If a patient asks us to pray with them, and we’re comfortable doing so, silent prayer is most appropriate due to differing beliefs in the purpose or practice of prayer. If a patient asks, and a clinician agrees to leading a prayer, it is best to use a general, nondenominational type of prayer even if they are of the same faith. For example, “We ask God for support and for presence with Mrs. C. during the time of surgery. May God ease her fears during this time of uncertainty,” (Christensen et al., 2018, p. 625).
A deficit of this article is that it does not address the feelings and needs of clinicians who may have a profound reluctance to praying, being present while a patient prays, sitting with someone for “silent prayer” or a few moments of silence. Holding atheist, agnostic or any other nonreligious beliefs is as valid as holding religious beliefs, and this should be honored in the clinical setting and our professional lives.
Ultimately, our response to a request for prayer is personal, dependent on our own beliefs about religion, our boundaries and our comfort level. Anticipatory self-reflection can prepare us for this type of request, and to acknowledge the needs of our patients while respecting our personal boundaries.
Reference
Christensen, A.R., Cook, T.E., & Arnold, R.N. (2018). How should clinicians respond to requests from patients to participate in prayer? AMA Journal of Ethics, 20(7): E621-629. DOI: 10.1001/amajethics.2018.621
About the Author
Sandra Blackburn, MSW, LSW
Oncology social workerAbramson Cancer Center
Philadelphia, PA
sandra.blackburn@pennmedicine.upenn.edu
Sandy Blackburn is a graduate of the University of Pennsylvania School of Social Policy and Practice and serves as an oncology social worker at the Abramson Cancer Center. She is a co-founder and co-facilitator of the Writing a Life program, as we...
Read Full Author Bio
Sandra Blackburn, MSW, LSW
Oncology social workerAbramson Cancer Center
Philadelphia, PA
sandra.blackburn@pennmedicine.upenn.edu
Sandy Blackburn is a graduate of the University of Pennsylvania School of Social Policy and Practice and serves as an oncology social worker at the Abramson Cancer Center. She is a co-founder and co-facilitator of the Writing a Life program, as well as two caregiver support groups and has served on the Patient Experience Committee of the Patient and Family Advisory Council for several years.
Sandy enjoys collaborating with colleagues and has presented at over a dozen national conferences on various topics including group facilitation, spirituality, and MSW student field work. She has been an active member of the Association of Oncology Social Work where she currently serves as the co-leader of the Spirituality Special Interest Group.
Articles
Mapping the JourneySpirituality SIG: “Will You Pray with Me?” A Simple Question—a Nuanced Response