Spirituality and Religion in the Care of Surgical Oncology Patients with Life-Threatening or Advanced Illnesses Monica L. Woll, BA, 1 Daniel B. Hinshaw, MD, FACS, 2 and Timothy M. Pawlik, MD, MPH, MTS, FACS 1 1 Department of Surgery, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Halsted 614, Baltimore, MD 22187-6681, USA 2 Department of Surgery, The University of Michigan School of Medicine and Section of Geriatrics, GRECC, and Palliative Care Program, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA Spiritual and religious concerns often become of central importance in the care of surgical oncology patients confronted with their mortality. Unfortunately, surgeons are often ill pre- pared or reluctant to address the spiritual and religious needs of their patients. In this article, working definitions of spirituality versus religiosity will be developed in the context of the three largest monotheistic religions in America: Christianity, Islam, and Judaism. Disease, dying, and death will be explored with respect to these faiths and examples of how to address religious beliefs in practical clinical settings will be given. Finally, specific suggestions will be made for surgeons to better understand, empathize with, and address the needs of their seriously ill patients in a holistic manner. The majority of Americans identify themselves as adherents of one of the three monotheistic religions: Christianity, Islam, and Judaism. A secular human- istic perspective (‘‘American civic religion’’) is also pervasive within popular American culture and at times borrows from these religious traditions. When surgical oncology patients are confronted with their mortality, either preoperatively before a major operation with uncertain outcome or when surgical therapy will not prevent the progression of an ad- vanced incurable cancer, spiritual and religious con- cerns often become of central importance in their care. Unfortunately, surgeons are often ill prepared to even be aware of, let alone address, the spiritual and religious concerns of their patients. In this article, practical working definitions of spirituality versus religiosity will be developed in the context of the three monotheistic religions in America. The relationship of these religions to the popular culture’s view of health, disease, and death will be explored. Examples of the application of religious beliefs from the major expressions of the three faiths in practical clinical settings will be given to help surgical oncologists better understand, empathize with, and address the needs of their seriously ill patients in a holistic man- ner. Assessing the religious and spiritual dimensions of a patient provides a more in-depth understanding of the patient as a unique human being with distinct beliefs and values, which ultimately enables the surgeon to better serve that patient’s needs. As objectivity and ‘‘distance’’ are often stressed in medical school and postgraduate training programs, many surgeons are reluctant to address patient-related spiritual or reli- gious issues. While this mode of thinking was previ- ously acceptable, and even encouraged in years past, it is now clear that approaching the patient from mul- tiple perspectives—biomedical, spiritual, sociological, Published online September 5, 2008. Address correspondence and reprint requests to: Timothy M. Pawlik, MD, MPH, MTS, FACS; E-mail: tpawlik1@jhmi.edu Published by Springer Science+BusinessMedia, LLC Ó 2008 The Society of Surgical Oncology, Inc. Annals of Surgical Oncology 15(11):3048–3057 DOI: 10.1245/s10434-008-0130-9 3048