A longitudinal qualitative study exploring how workplace factors impact family physicians' provision of spiritual care during comprehensive patient care: implications for burnout prevention and policy

Background Family physicians (FPs) endorse the value of spiritual care (SC) as part of comprehensive, patient-centered care. However, a mismatch exists between patients' desire to have spiritual needs addressed and physicians' SC provision. Studies explore physician barriers, but few examine workplace barriers/facilitators. Qualitative and longitudinal studies are rare. The objective is to gain an in-depth understanding of how workplace factors affect FPs' SC provision. Methods This was a longitudinal, qualitative, and individual interview study; a secondary analysis of a dataset collected over 20 years. All 38 residents in a USA FM residency were invited to participate; the longitudinal study-group (PGY-1 subset) was interviewed four times over 20 years. The data were collected through semi-structured interviews, audio-recorded, and transcribed. Researchers analyzed interviews, using grounded theory, with workplace factors as the central topic of interest. Iterative analysis cycles involved researchers individually coding transcripts followed by group analysis meetings until they reached consensus. Results Thirty-four FPs participated with 13 interviewed longitudinally; 66 interviews analyzed. While diverse in personal importance of spirituality, all FPs endorsed SC as part of whole-person care. Workplace SC facilitators/barriers include: practice setting/patient population; doctor-patient relationships; resources available; workplace demands; and workplace culture. Throughout 20 years, FPs readily identified patients needing SC. Workplaces that lacked SC referral resources or undervalued comprehensive care and/or physician wellness negatively impacted SC provision for patients and physician job satisfaction. Conclusions While FPs value SC provision as part of whole-person care, workplace factors have a profound impact on physicians' SC provision. Misalignment of physician and workplace values could contribute to physician burnout.