Patients with advanced cancer who used their religious faith to help cope were more likely to receive intensive life-prolonging medical care such as mechanical ventilation or cardiopulmonary resuscitation during their last week of life, according to a study in the March 18 issue of JAMA.
For patients facing a life-threatening illness, religious coping, such as through prayer, meditation and religious study can offer patients a sense of meaning, comfort, control and personal growth, according to background information in the article. "Positive religious coping has been widely associated with improved psychological adjustment to stressors including serious illness," the authors write. They add that religion may influence patients' medical decisions, but little is known about the associations between religious coping and the use of intensive life-prolonging care at the end of life.
Andrea C. Phelps, M.D., of Beth Israel Deaconess Medical Center, Boston, and colleagues examined the relationship between 345 patients with advanced cancer and their use of religious coping at the start of the study and their receipt of intensive medical care during their last week of life. Positive religious coping was assessed by a questionnaire. Interviews at the beginning of the study also assessed psychosocial and religious/spiritual measures, advance care planning and end-of-life treatment preferences. Patients were followed up until death, a median (midpoint) of 122 days after the assessment at the beginning of the study.
Patients were asked about how much they rely on religion to cope with illness. A total of 272 patients (78.8 percent) reported that religion helps them cope "to a moderate extent" or more and 109 (31.6 percent) endorsed the statement that "it is the most important thing that keeps you going." Most patients (55.9 percent) endorsed engaging in times of prayer, meditation, or religious study at least daily.
The researchers found that patients with a high level of positive religious coping at the start of the study had nearly three times the odds of receiving mechanical ventilation and intensive life-prolonging care in the last week of life compared with patients with a low level of religious coping.
A high level of positive religious coping was also significantly associated with preferring heroic measures (wanting physicians to do everything possible to keep the patient alive) compared with patients with a low level and was associated with less advance care planning in all forms: do-not-resuscitate order, living will and health care proxy/durable power of attorney.
"These results suggest that relying upon religion to cope with terminal cancer may contribute to receiving aggressive medical care near death," the authors write.
"Taken together, these results highlight the need for clinicians to recognize and be sensitive to the influence of religious coping on medical decisions and goals of care at the end of life. When appropriate, clinicians might include chaplains or other trained professionals (e.g., liaison psychiatrists) to inquire about religious coping during family meetings while the patient is in an intensive care unit and end-of-life discussions occurring earlier in the disease course. Because aggressive end-of-life cancer care has been associated with poor quality of death and caregiver bereavement adjustment, intensive end-of-life care might represent a negative outcome for religious copers. These findings merit further discussion within religious communities, and consideration from those providing pastoral counsel to terminally ill patients with cancer."
(JAMA. 2009;301:1140-1147. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.