Pancreas cancer is the worst, just the worst. And I mean that not only in the colloquially hyperbolic sense but in the literal as well: although it may not be the most common or most aggressive cancer, it has the worst combination of being common and very aggressive.
I see a lot of patients facing this diagnosis and the potentially life-threatening prospect of needing a major operation, often both. And although I am indeed not, sometimes it seems like I am the first person to sit down and sort through such a weighty diagnosis with patients. These are not visits to be rushed. They require time and rapport.
Maybe due to my early experience with such consultations and the unique glimpses they provide into the otherwise private spiritual life of people I just met, and due also to an awareness of the perceived impropriety of talking about religion, I have often felt a certain tension in myself during these visits over the years. On the one hand, I was aware that religion — like politics — is something that you “don’t talk about at Thanksgiving,” as the adage goes, and much less so with strangers who have come for help in confidence. Religion and spirituality occupy such a privileged place in our inner lives that it can seem disrespectful to look into that private space.
On the other hand, even though at first glance it may seem safer or more respectful to skirt around religion and spirituality, this skirting felt disingenuous. It is primarily such patients as these who are in such a life crisis and for whom religion and spirituality are often so central, of such pithy importance: something called upon or revisited in their process of coping with this new life-altering and -threatening diagnosis.
This is where my interest in religious literacy and my journey toward interfaith leadership began. We all know what it feels like to be on familiar ground, in one’s wheelhouse, and know the relevant background, terminology, typical cases, etc.; in other words, to be literate. There are many kinds of “literacy” other than the ability to read and write; such competencies include digital literacy, financial literacy, wine literacy, and one that I see often — all too often in its absence — health literacy. At some point, I realized that I needed religious literacy to resolve my tension.
I realized that I needed religious literacy to resolve my tension.
According to a survey by the “Annals of Surgical Oncology,” most patients want and need their religion/spirituality incorporated into their care plan. Unfortunately, research also shows that healthcare providers need more religious literacy to address this need.
Although people in the US are far more religious than people in other wealthy, industrialized countries, and although there is a great diversity of religious traditions in the US, religious illiteracy here is widespread. And just like the health illiteracy that I see impeding good healthcare, religious illiteracy among healthcare providers hampers their ability to develop the rapport with patients that is needed to care for them optimally.
As I became increasingly aware of all of this, I decided to study how to understand religious literacy better as applied to healthcare settings, which became the topic of my master’s thesis, one outgrowth of which was a book for lay audiences of all ages on religious literacy.
The intersection of healthcare and spirituality has received much overdue attention in the medical literature, with increasingly convincing evidence that clinicians must proactively incorporate spiritual care in our practice.
This could not ring more accurately for me in my interactions with pancreas cancer patients. Although it was common knowledge before the Renaissance that spiritual health was, along with physical, psychological, and social health, one of the main domains of being a healthy person, we collectively forgot this vital fact. Not until relatively recently, in 1948, did the World Health Organization redefine health as not merely the absence of physical disease but rather as a state of complete physical, mental, and social well-being. By the 1980s, increasing attention to spiritual care became more evident in the medical literature. Several major medical systems have dedicated centers focused on spirituality and health today.
Despite these advances, it is apparent to those of us who work in the field that much work remains to be done.
As my religious literacy developed, I began appreciating the power of a religiously literate interfaith approach to healthcare. In our increasingly diverse healthcare population, it is not uncommon to find oneself caring for or being cared for by a person of a different religion or worldview. However, the stakes are much higher in healthcare than in the general population for at least three reasons:
- There is a power differential between the provider and the patient needing care.
- Unlike the general population, where people are freer to choose with whom to associate, in healthcare settings, one cannot usually choose whom to care for or from whom to receive care.
- Patients are an at-risk population, statistically likely to be of lower socioeconomic status, and often in a vulnerable state due to illness or injury.
For these reasons, my work in healthcare is interfaith: the work of increasing understanding and cooperation between individuals who likely orient differently around religion. The key individuals in this interfaith healthcare setting are the patient and the provider, but also important are their communities: the provider’s colleagues, office, and hospital staff, trainees, etc., and the patient’s family, friends, and advocates. And the work at hand is the healthcare of the patient.
What has become increasingly clear to me after years of seeing patients not only with pancreas cancer but also other health threats, after studying in-depth religious literacy as applied to healthcare, and after completing my certificate in interfaith leadership at Interfaith America — is that optimal care must include spiritual care, constitute interfaith work, and that the more religiously literate I am as a provider, the better I can do the work of providing that care.
Steven Clark Cunningham, MD, MLA, FACS currently serves as Director of Pancreatic and Hepatobiliary Surgery and Director of Research at Ascension Saint Agnes Hospital in Baltimore, MD, and has recently completed his master’s degree in religion at Harvard University, focusing on religious literacy among healthcare providers. He has just published a new book on religious literacy for lay audiences aged 12 to adult, called “It’s Considerate to Be Literate about Religion.”