September 10, 2015 5:50 AM EDT

Many people who are legally bound to make medical decisions for a critically ill friend or loved one turn to faith for guidance. But when researchers from the University of Pittsburgh and Duke University analyzed recorded chats between such surrogates and health care workers in ICUs across America, they found that spirituality rarely came up. When it did, doctors often changed the subject, possibly leaving the surrogates unsatisfied. Specifically:

78% of surrogates said faith is important to them.

16% of ICU conversations about medical care included mentions of spirituality or religion.

5.6% of those conversations were initiated by health care professionals. The vast majority started with surrogates saying things like “I’m very, very optimistic [about a recovery] because I know our faith is strong.”

3 doctors co-signed an op-ed that ran with the study, arguing that health care workers might want to learn how to engage with surrogates who start spiritual conversations.

–Alexandra Sifferlin

This appears in the September 21, 2015 issue of TIME.

Contact us at editors@time.com.

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