Mrs X

Mrs X is an 87 year old widow who despite being faced with many struggles in
the past 15 years, has remained steadfast and maintains a positive outlook in
life, with her faith in God contributing greatly to this. Since her husbands death
5 years ago, her independence has become ever more important to her despite
the ongoing hip problem she suffers from.
Her joint problems began when she was diagnosed with osteoarthritis of the
knee in 1991, which progressively got worse, resulting in a knee replacement in
2001. However, with her positive and active lifestyle she mentions that its just
part of getting old I guess, why should I let that stop me doing what I enjoy? In
her spare time she regularly goes on walks with a ramblers group where she has
made many friends whom she also goes to the theatre and sees concerts with.
Cousins and nieces living in Nottingham also visit her often. Mrs X placed great
importance on strong family ties, especially as she has gotten older, viewing
them as a safety net. Additionally, she has 2 sons who live in Canada, one of
whom was diagnosed with a brain tumour 15 years ago and was only given 6
months to live at the time. Mrs X says he is a living miracle as 15 years on,
although severely handicapped, has astonished doctors by his survival. Despite
living so far away from her son and thinking about him every day she is assured
that he is in good hands in the company of her second son who takes good care
of him.
During a trip to Canada in 2003 to visit her sons, Mrs X collapsed suddenly. She
was taken to hospital where they found that she had developed a malignant
tumour in her small bowel. An operation to remove the tumour was successful
and she has not had any recurrent problems since. I was fascinated by how little
a diagnosis of cancer seemed to have affected Mrs X. It highlighted to me how
the attitudes of a patient towards disease are greatly influenced by how it is
perceived.
In 2005, Mrs X unfortunately suffered a hip fracture after tripping and landing on
the edge of a kerb. Surgery was performed, where screws were inserted to hold
the bone in place while it healed. This was evidently a difficult period for the
usually active Mrs X, as she felt she had lost important aspects of her
independence due to limited mobility. Even everyday tasks such as cleaning,

dressing herself and using the toilet became a chore. However, the
determination to get back on her feet and not letting it affect her psychologically
was a key aspect of her recovery period. Six months down the line, her mobility
had greatly improved; however, the knee replacement put in previously had
come apart and so she had to undergo a second operation to fit a new one.
A few years passed and it became clear that her hip had not gone back to how it
was prior to the fracture and a combination of hip and knee pain caused her
many problems with mobility she was more prone to falling. The hip pain
became unbearable at times and she was prescribed medication to relieve the
pain but it hardly helped. An x-ray was also done but it came out all-clear and
she was eventually diagnosed with ligament damage. After referral to a pain
clinic she was again prescribed a number of drugs to relieve the pain. These
included amitriptyline, cortisone injections, buprenorphine patches - which she
reacted violently to - and paracetamol. To Mrs X these were all just a cocktail of
drugs, and although she was frustrated that nothing was helping the pain, she
constantly mentioned how she still had strong faith in the doctors.
In 2013 however, during an ultrasound guided cortisone injection, unexpectedly
the scan revealed that there was in fact a hip fracture which had gone
undetected. Within a few weeks Mrs X was offered a hip replacement. She
reiterated how her optimism and faith in God was the one thing that had kept her
going through the struggles and she felt that the hip replacement would give her
renewed hope of being able to go on long walks again and regain
independence. Despite the ordeal she had been through she still had lots of
praise for the NHS. Through interviewing her and gaining such a unique insight
into her life, I was quite touched when she mentioned that its the least I can
give back to the NHS, helping them train doctors like you.
A year since her operation she is now much happier and for her it was like being
born again this was the extent of the severe pain she had been putting up
with for many years prior to the hip replacement. She was also pleased with the
home adjustments she now had such as a stair lift and a walk-in bath, which
made her life a lot easier. She had not fulfilled the criteria to receive funding
from social services, so the adaptations had in fact been paid for by her son.

The Role of Religion in Affecting Patient Outcomes

Mrs X placed great importance on her faith in God in everyday life; it seemed to
positively influence her outlook on anything she was faced with. The social
support she received from family and friends also formed a key part of her life.
With these aspects in mind, the role of religion on patient outcomes and coping
mechanisms will be explored in more detail with reference to the relevant
literature.

With almost 70% of the UK population identifying themselves as belonging to a

particular religion1, it is important to consider patients religious beliefs during
consultations and encounters as it may influence their decisions on treatment,
compliance and other factors. The Department of Health has set out a document
providing guidance (to NHS staff) on the consideration of religious beliefs of
patients in an NHS setting, emphasising that attention to the religious and
cultural needs of patients can greatly contribute to their wellbeing 2.
Religion can form the basis of meaning and purpose for many patients, helping
them in both managing and coping with illness

3, 4

. A diagnosis of cancer in

particular can often lead patients to use religion as a coping strategy. Some
studies have shown the effectiveness of religious coping mechanisms in allowing
patients to adjust to their diagnosis and its associated symptoms, as well as
reducing end of life despair5, 6. For instance, a study examining the role of
spirituality in the cancer experience of 16 patients found that the belief in God
as the source of healing and the value of prayer as an instrumental practice
were some of the responses given by participants. Mrs Xs perception of her
bowel cancer diagnosis was of a similar nature as she felt it was Gods plan
and did not let it affect her. From this, it is clear that religion can impact the lives
of patients with a cancer diagnosis and this should therefore not be overlooked
during patient encounters. The National Institute for Clinical Excellence (NICE)
also makes recommendations for doctors and health care professionals dealing
with cancer patients by stating that accurate and timely evaluation of religious
and spiritual issues [should be made] through regular assessment 5, 7. With these
considerations in place, positive patient outcomes and healthcare delivery can
be achieved.
Chronic illness can also have a debilitating effect on a patients life and
wellbeing. Mrs Xs chronic hip pain at times caused her to lose independence

which was understandably frustrating for her. However, her firm belief in God
and determination not to give up is what has kept her going. There has been
extensive research into the effects of religion on those experiencing chronic pain.
One study concluded that hope-inspiring strategies especially through religious
beliefs, can have positive effects on those experiencing chronic pain

5, 8

Additional psychological benefit due to religious activity and spiritual experiences

has been observed in geriatric chronic pain sufferers

5, 9

The death of Mrs Xs husband 5 years ago was something she adjusted to
despite the huge loss for her. I think of him often and cry sometimes, but I know
hes in a better place now. Her belief in life after death allowed Mrs X to come to
terms with the loss. A prospective cohort study that explored the relation
between religious beliefs and the resolution of bereavement concluded that
those who hold stronger beliefs resolve their grief more rapidly and completely
after the death of someone close, compared to people who had no religious
beliefs10.
It is clear that studies are increasingly providing more evidence of a positive
correlation between religious activity and the improvement of physical and
mental health. However, the exact mechanism underlying this improvement is
yet to be fully understood11. Several hypotheses include a possible mechanism
involving psychoneuroendocrinology whereby the stress-hormone secretion is
reduced11. With all that being said, studies of this type do carry with them some
limitations. For example, confounding bias may be present due to variables such
as age, physical mobility, perceived social support and stage of illness not taken
into consideration when conducting the studies 5, 12, 13.
Although religious beliefs have clearly shown to have positive effects on patient
outcomes, there are also cases where some religious beliefs can cause a
negative impact on the patients health. For instance, one study involving
psychiatric patients on medical inpatient units found some participants who had
fallen ill reported that they felt alienated and abandoned by God or had
attributed their illness to the devil14. These patients had an increased risk of
dying within the following 2 years compared to those who had no such religious
doubts14. This emphasises the need for accurate and timely evaluation of
religious and spiritual issues [of patients] in order to improve healthcare
delivery and patient outcomes7.

Conclusion
Religion can clearly play a pivotal role in the lives of patients. The numerous
studies showing the effect of religious beliefs on patient outcomes, regardless of
their limitations, reaffirms the need for doctors and healthcare professionals to
take a more holistic approach when assessing patient needs. Mrs X had been
through a number of difficult situations in the past 15 years of her life both
emotionally and physically. The one thing that has stuck with me is the
importance of appreciating the uniqueness of each patients story. Their
perception of what is important in their lives differs to another individual who
may suffer from the exact same illness. For someone else a diagnosis of bowel
cancer may have defeated them psychologically, but Mrs Xs worry had only ever
been losing her independence because of the hip problem. Her firm faith and
optimism have been the pillars of strength that have brought her through the
many struggles she has been faced with.