Prevalence and patterns of physician referral to clergy and pastoral care providers.

BACKGROUND There is a heightened interest in spiritual and religious interventions in clinical settings, an area marked by unease and lack of training by physicians. A potential resource for generalists is specialty consultation and referral services, although little is known about the prevalence and patterns of involvement of clergy or pastoral professionals in patient care. OBJECTIVES To identify the prevalence and patterns of physician-directed patient referral to or recommended consultation with clergy or pastoral care providers and to describe attitudinal and demographic variables that can predict referring and nonreferring physicians. DESIGN A mailed anonymous survey. SETTING Family physicians in the United States. PARTICIPANTS Active members of the American Academy of Family Physicians whose self-designated professional activity is direct patient care. Of the 756 randomly selected physicians for participation in the study, 438 (57.9%) responded. MAIN OUTCOME MEASURES Physician reporting on their attitudes and referral behaviors, including referral frequency, and conditions or reasons for referral or nonreferral to clergy and pastoral care providers. RESULTS More than 80% of the physicians reported that they refer or recommend their patients to clergy and pastoral care providers; more than 30% stated that they refer more than 10 times a year. Most physicians (75.5%) chose conditions associated with end-of-life care (ie, bereavement, terminal illness) as reasons for referral. Marital and family counseling were cited by 72.8% of physicians; however, other psychosocial issues, such as depression and mood disorders (38.7%) and substance abuse (19.0%), were less prevalent. Physicians who reported a greater degree of religiosity had a small increased tendency to refer (r = 0.39, P<.05) to these providers. In addition, physicians who were in practice for more than 15 years were more likely to refer to clergy (P<.01). CONCLUSIONS Most family physicians accept clergy and pastoral professionals in the care of their patients. In medical settings, the providers of religious and spiritual interventions have a larger and more expanded role than previously reported.