Using the FICA Spirituality Assessment

The FICA Spiritual History Tool was developed by Dr. Puchalski and a group of primary care physicians to equip physicians and other healthcare professionals with a tool to address spiritual issues with patients. Spiritual histories are taken as part of the regular history during an annual exam or new patient visit, but can also be taken as part of follow- up visits, as appropriate. The FICA tool serves as a guide for conversations in the clinical setting.

The acronym FICA can help structure questions in taking a spiritual history by healthcare professionals.


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F – Faith and Belief

Do you consider yourself spiritual or religious?” or “Do you have spiritual beliefs that help you cope with stress?” If the patient responds “No,” the health care provider might ask, “What gives your life meaning?” Sometimes patients respond with answers such as family, career, or nature.

I – Importance

“What importance does your faith or belief have in our life? Have your beliefs influenced how you take care of yourself in this illness? What role do your beliefs play in regaining your health?”

C – Community

“Are you part of a spiritual or religious community? Is this of support to you and how? Is there a group of people you really love or who are important to you?” Communities such as churches, temples, and mosques, or a group of like-minded friends can serve as strong support systems for some patients.

A – Address in Care

“How would you like me, your healthcare provider, to address these issues in your healthcare?” As with any other part of the patient interview, the spiritual histories should be patient-centered. Thus, the tool is meant to create an environment of trust by indicating to the patient that the physician or other healthcare professional is open to listening to the patient about his or her spiritual issues, if the patient wants to talk about those issues. There are ethical guidelines to which the physician or healthcare provider should adhere when taking a spiritual history. Healthcare professionals are encouraged not to use the FICA tool as a checklist, but rather to rely on it as a guide to aid and open the discussion to spiritual issues.

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