Religion, Spirituality and End of Life Care

Cancer patients who have greater religious support more likely to pursue aggressive treatment

(RxWiki News) Do you believe in miracles? Do you believe that God is in charge of your fate? If you were nearing the end of your life, would your beliefs affect which treatment you received?

A new study suggests that people who rely on a high level of spiritual support from religious communities were more likely to choose aggressive treatment at the end of life.

They were also more likely to die in an Intensive Care Unit (ICU) than people who did not have this spiritual support or those who had discussed end-of-life care with their medical teams.

When medical teams discussed end-of-life care with people nearing death, these individuals were more likely to choose hospice care.

"Tell your loved ones what you want at the end of life."

Tracy A. Balboni, MD, MPH, of the Dana-Farber Cancer Institute in Boston, and colleagues recently conducted this study.

The goal of the research was to determine if spiritual support from religious communities affects how terminally ill patients are treated and the quality of their lives in the last week of life.

The study involved 343 patients who were treated for advanced cancer between September 2002 and August 2008. The individuals were followed for about 116 days until the time of their death.

Interviews were conducted to assess support of patients’ spiritual needs.

Of the patients involved in the study, 43 percent said they received high support from religious communities. These individuals were less likely to choose hospice care, which focuses on providing comfort care, rather than curative care, in the last days of a person’s life.

People with high support were also nearly three times more likely to receive aggressive treatment in the last week of their lives and five times more likely to die in an ICU compared to individuals who did not report high support from religious groups.

Hospice care was defined as receiving either inpatient or outpatient hospice care versus no hospice in the last week of life. Aggressive end-of-life care included medical care given in an ICU, ventilation or resuscitation in the last week of life.

Individuals who had religious support and who also received spiritual support from the medical team were nearly two and a half times more likely to have hospice care and less likely to receive aggressive treatments or die in an ICU.

“Terminally ill patients who are well supported by religious communities access hospice care less and aggressive medical interventions more near death,” the authors wrote. “Spiritual care and end-of-life discussions by the medical team may reduce aggressive treatment, highlighting spiritual care as a key component of end-of-life medical care guidelines.”

Christina Puchalski, MD, MS, FACP, founder and director of the George Washington Institute for Spirituality and Health (GWish), told dailyRx News, “Spiritual care is care focused on understanding patients’ values and beliefs; honoring those values and beliefs; assessing for spiritual distress as well as resources of strength and integrating spirituality into the treatment plan. It also underlies compassionate whole person care.” 

She continued, “In the discussion about patient values, it’s more likely to open up the door to talk honestly about death and dying and what is most meaningful to a patient. Spirituality in all of this is broadly defined to meaning purpose and connection. Not just religion.”

Dr. Puchalski said, “When patients and families are in ICUs, the focus is usually very technical and does not leave room for the non-technical conversation, i.e., meaning, purpose, etc. I think that is why people may choose aggressive care because they have not been given the opportunity to think about other options such as hospice. End of life education also addresses this. In my opinion, though, all end of life discussions should include the spiritual, as that is so central to living and dying," Dr. Puchalski said.

This study was published May 6 in JAMA Internal Medicine. The research was funded by a grant from the National Institute of Mental Health, the National Cancer Institute and other sources.

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Review Date: 
May 6, 2013