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Praying with Your Patients Before Surgery

Discussion in 'Doctors Cafe' started by Hadeel Abdelkariem, Jun 23, 2019.

  1. Hadeel Abdelkariem

    Hadeel Abdelkariem Golden Member

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    Some time ago I started asking my surgical patients if they would like to say a prayer in the preoperative holding area before they went back to the operating room. I consider myself a spiritual individual, and wondered if my patients would like the opportunity to pray with their health care providers before their operation.

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    I thought they might find it comforting to pray with their anesthesiologist and anesthesia care team. My thought was that it might, in some way, allow them the chance to appeal to a higher spiritual being for help during their surgery.

    I was surprised by what I found.

    Though my experience is not a detailed compilation or statistical analysis of patient responses, I discovered that most patients appreciated the opportunity to pray and seemed genuinely surprised by my offer. Some even acknowledged that this was a first for them in any hospital or medical setting. For many of them, their closest experiences had been when a member of the clergy or their pastor had visited them while hospitalized.

    Before going into the operating room, my customary approach with a patient in the preoperative area has been to ask them, typically with the family/friends present, if they would like to say a prayer with my team and me. If they agree, I ask if they would like to lead the prayer or have me say it for them. They have often asked me to lead the prayer.

    As a Catholic, I would often say a Hail Mary and include at the end of the prayer a phrase such as: “And we pray for the safe intraoperative course for [patient name], for the medical team caring for them, and a speedy and successful recovery. Amen.” Many patients and family members became tearful. Since starting this process, I have recently modified my approach and created a more generic, non-denominational prayer that addresses the same concerns but doesn’t risk offending patients of other faiths.

    The type of patient interested in prayer has been interesting. Most Christians thanked me for the chance to pray, although many admitted they had prayed before arriving in the preoperative area or had said prayers on their own while awaiting surgery. Some, of course, declined the offer. Others had met with their clergy or attended church before surgery and had their spiritual needs satisfied. The only Muslim patient I encountered in the last year, and to whom I offered the same chance to pray, requested that the surgeon come to the OR to pray with him.

    Not surprisingly, most young patients (30 years and younger) declined the offer to pray unless encouraged to do so by their parents or significant other. In contrast, older patients, (60 and older) welcomed the chance to pray.

    Interestingly, almost all African-American patients were not only agreeable to saying a prayer with my team and me — usually holding hands with the team and their family members — but they enthusiastically welcomed the chance to pray, especially when other family members were present. The prayer has been led by the patient or often by a family member or clergy. They prayed for a good outcome, but they also invariably prayed for God to guide the medical team, including doctors, nurses, and the surgeon, through the procedure. It was and continues to be, very gratifying for me. It is often an eye-opening experience for the young residents I train as well.

    Apparently, my experience is not unusual regarding African-Americans and spirituality. In the Huffington Post article, “Are Black Americans the Most Religious — and Virtuous — of All?” David Briggs noted that some studies and surveys revealed that black Americans retain remarkably strong levels of religious beliefs and practices. This observation has been consistent with my experience in the operating room environment. However, a recent poll of 1,025 United States adults of various ethnicities established that 75% considered religion to be very or fairly important in their lives. Eighty-nine percent believed in God or a universal spirit.

    A recent study reinforced the overall concept of spirituality influencing health. In an evaluation of 74,000 individuals observed for 16 years, it established that those women who attended regular religious services had a lower overall mortality compared to those who never attended services. A recent meta-analysis of 10 studies encompassing 136,235 patients determined that patients believing in a higher purpose in life had a lower overall mortality and specifically less frequent cardiac events.

    Regarding specifically prayer and outcomes after surgery, several studies have examined this relationship. In measuring the impact of prayer immediately before surgery in a Muslim population, one study suggested that pain scores three and six hours after surgery were improved in the prayer vs. no prayer group. Relaxation and nausea also appeared to be less.

    Another study examined neurosurgical patients and discovered that religion was an effective coping mechanism for patients before, during, and after craniotomy.

    Most reports have shown that religious involvement and spirituality are associated with better health outcomes, including greater longevity, coping skills, health-related quality of life, less anxiety, less depression, and enhanced recovery from illness.

    Of 212 published studies assessing the effects of spiritual factors on health care outcomes, 75 percent reported a positive effect, 17 percent reported no effect, and 7 percent reported a negative effect.

    A captivating 1999 study published by the National Institutes of health evaluated 990 patients admitted to a coronary care unit and examined the impact of intercessory prayer — defined as prayer by other individuals in a remote location for a four-week period — on the ICU course of patients. Those randomized to prayer had a more favorable ICU course than those without prayer, suggesting that prayer may be an effective supplement to traditional medical care for patients in an ICU.

    Despite the above positive findings, there are also several studies showing no positive relationship between prayer and medical outcomes. Overall, however, these results suggest that many, if not most of our patient population, may be open to the idea of praying with their doctors. Unfortunately, a recent Journal of the American Medical Association (JAMA) review of health and spirituality noted that despite the desire of patients to receive spiritual care, few received it.

    I think the most important conclusion from these scientific studies and my own experience is the potential importance of spiritual care and support before and after surgery and the impact it may have on favorable outcomes. I certainly believe that for myself as a physician, prayer contributes to the bonding experience with my patients before surgery. Hopefully, it helped them feel some peace before a very significant life event. Of course, different personalities, religious beliefs and affiliations, and varied surgeries — for example, cancer surgery or open-heart surgery — could influence the experience of individual patients and physicians.

    If you find this concept and approach to patient care appealing, I encourage you to consider asking your patients and their families to pray with you. Although your patients may be surprised to hear your request, they may also be grateful that you asked.

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