Spirituality in Serious Illness and Health.
Level 3 - non-randomized controlled study
Systematic review synthesizing heterogeneous study designs including RCTs, prospective cohorts, and cross-sectional studies combined with a Delphi expert consensus process.
PubMed 35819420 · doi:10.1001/jama.2022.11086
What was done
Searches of PubMed, PsycINFO, and Web of Science (January 2000 to April 2022) identified studies on spirituality in serious illness and health outcomes. Serious illness studies required validated spirituality measures, sample sizes of 100 or more, and prospective cohort, cross-sectional, meta-analytic, or randomized trial designs. Health outcome studies required validated measures and samples of at least 1,000 for prospective cohorts, case-control studies, or meta-analyses, or at least 100 for randomized trials. Studies with serious or critical Cochrane risk of bias were excluded. Multidisciplinary Delphi panels rated synthesized evidence statements on a 9-point scale and ranked health care implications.
What was found
For serious illness, 371 of 8,946 identified articles met criteria, with 76.9% having low to moderate risk of bias; the Delphi panel generated 8 evidence statements categorized as strong and prioritized 3 implications: incorporating spiritual care into serious illness care, integrating spiritual care education into training, and including specialty spiritual care practitioners. For health outcomes, 215 of 6,485 articles met criteria, with 66.0% having low to moderate risk of bias; the panel yielded 8 evidence statements categorized as strong and prioritized 3 implications: adopting evidence-based approaches regarding spiritual community associations with health, increasing clinician awareness of protective associations, and recognizing spirituality as a social factor in health research and practice. No pooled effect sizes or numerical outcome statistics were reported in the abstract.
Why it matters
This study provides an evidence-based consensus framework supporting the formal integration of spiritual care and spiritual community assessment into clinical practice and public health.
Limits
The abstract provides consensus statement ratings rather than quantitative pooled effect sizes, confidence intervals, or heterogeneity metrics. The underlying literature includes substantial observational and cross-sectional designs where confounding cannot be fully ruled out. A meaningful portion of identified literature (23.1% in serious illness and 34.0% in health outcomes) carried serious or critical risk of bias and was excluded.
Cited by
- supports Engaging in acts of faith, such as prayer and active rituals, provides positive health benefits.