Often overlooked, religion and spirituality (R/S) are among the most important aspects of coping with serious illness. In the United States, Black Americans with kidney failure have openly discussed the importance of R/S in their coping process. Read more about the existing data supporting the need to incorporate R/S into routine dialysis care.* 

Do Black Americans practice R/S more?

Multiple studies support the notion that R/S is more essential to Black Americans than to White Americans. One study found Black Americans were more likely than White Americans to report:

• Higher spirituality,
• A high degree of comfort from religion, and
• A greater frequency of religious service attendance.

Moreover, Black women on dialysis reported R/S strengths, such as perceptions of God’s concern for them, God’s help with loneliness, and a sense of life’s purpose. Studies also show that Black Americans wish to discuss R/S with their medical care team. 

Should R/S be incorporated into medical care?

With the racial and ethnic disparities among Black patients, could understanding and addressing R/S be a small stepping stone to being more culturally humble and antiracist? The study authors believe it could, as a previous study found the misunderstanding of the role of R/S has resulted in racial stereotypes and inequitable treatment. 

The scientists support incorporating R/S as a standard aspect of patient-centered kidney care, and urging lawmakers to consider changes that would support a more comprehensive approach to that care. Health providers welcoming discussions of R/S with patients in a safe, individualized, non-judgemental manner can positively impact:

• Quality of life, 
• Resilience,  
• Mental health, 
• Ability to cope, and
• Adherence to medical recommendations.

R/S can also influence end-of-life care preferences involving code status, dialysis continuation, and organ transplantation. 

Incorporating R/S into clinical practice

The study authors recommend the following methods to begin incorporating R/S into routine clinical care.

• Implement R/S screening for all patients. R/S distress and well-being can be assessed and measured like other factors of physical and mental health. Screenings for R/S needs can take place in CKD clinics, dialysis centers, and other locations. Patients’ own R/S advisors can also be consulted. 
• Make chaplain services a requirement of interdisciplinary care in dialysis units through Medicare and Medicaid, similar to the monthly rounds made by social workers and dieticians. Chaplains could also provide support for patients distressed by their declining health or grieving the death of a fellow patient.

Further research

Further research is necessary, the authors write, to determine the most effective R/S screening and assessment tools, as well as optimal communication and intervention protocols. What is clear now, however, is that asking patients about their R/S needs, and paying respectful attention to racial/ethnic and other cultural differences, can strengthen patient-provider relationships, increase quality of care, and improve quality of life for dialysis patients.

*Gelfand, S. L., Fitchett, G., & Moss, A. H. (2022). Recognizing the Potential Importance of Religion and Spirituality in the Care of Black Americans with Kidney Failure. Journal of the American Society of Nephrology, 33(7), 1255–1257. https://doi.org/10.1681/asn.2021101367