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Religion's Impact on End-of-Life Care

Terminally ill cancer patients who relied on their
religious faith to help them cope with their disease were more likely to
receive aggressive medical care during their last week of life, a study
shows.

Patients who engaged in what the researchers called positive religious
coping, which included prayer, meditation , and religious study, ended up having
more intensive life-prolonging interventions such as mechanical ventilation or
cardiopulmonary resuscitation.

The study is published in the latest edition of The Journal of the
American Medical Association.

The patients who reported a high level of positive religious coping at the
start of the study were almost three times as likely to receive mechanical
ventilation and other life-prolonging medical care in the last week of life as
patients who said they relied less on their religious beliefs to help them deal
with their illness.

A high level of religious coping was also associated with less use of
end-of-life planning strategies, including do-not-resuscitate orders, living
wills, and appointment of a health care power of attorney.

It is not entirely clear why terminally ill patients who report relying more
on their religion would choose more life-prolonging medical interventions.

But researchers say these patients may be less likely to believe their
doctors when they are told there is no hope.

"There may be a sense that it is really not in the hands of the doctors
to decide when to give up," study researcher Holly G. Prigerson, PhD, of
Boston's Dana-Farber Cancer Institute tells WebMD. "Refusing some of these
very aggressive medical interventions may be seen as giving up on the
possibility that God might intervene."

Religion and Coping With Illness

The study included 345 advanced cancer patients treated between January 2003
and August 2007 at medical facilities across the country.

Use of religion to cope with illness was assessed through questionnaires and
patient interviews.

Patients were followed until death, which occurred an average of four months
after enrollment.

The study revealed that:


  • Roughly four out of five patients reported that religion helped them cope
    "to a moderate extent" or more and close to one in three agreed with
    the statement "it is the most important thing that keeps me
    going."

  • More than half of the patients (55.9%) reported praying, meditating, or
    studying their religion daily.

  • Patients who reported a high level of positive religious coping were more
    likely to be black or Hispanic. They also tended to be less educated, were less
    likely to have medical insurance, or be married than patients who reported a
    low reliance on religion.

  • Of the patients who reported a high level of religious coping, 11% had
    mechanical ventilation during their last week of life and 7.4% underwent
    cardiopulmonary resuscitation (CPR), compared to 3.6% and 1.8%, respectively,
    of patients who reported a low level of religious coping.


Prigerson and colleagues reported that the association between religious
reliance and use of aggressive medical intervention near the time of death
persisted after other factors such as race, coping styles of patients, and
advance medical care planning were considered.

But Duke University Medical Center psychiatrist Harold Koenig, MD, is not
convinced that race did not influence the findings. He says that earlier
studies have shown that blacks and Hispanics are more likely to have aggressive
medical interventions at the end of life than whites.

In the newly reported study, blacks and Hispanics were much less likely to
report a low level of reliance on religious coping than whites. Of the patients
who said they did not rely on religion much, 6% were black, 9% were Hispanic,
and 83% were white.

Patient-Doctor Discussions on Spiitual Issues

Koenig, who co-directs the Center for Spirituality, Theology and Health at
Duke University, says the study underscores the importance of discussing
religious beliefs within the medical setting.

"A recent study found that only about 7% of physicians actually talked
to their dying patients about religious or spiritual issues," he tells
WebMD. "There is also research finding that when doctors engage in
discussions about spirituality with cancer patients, the patients trust them
more."

There is also some evidence that incorporating spiritual counseling into
end-stage medical care results in better quality of life and less aggressive
medical intervention prior to death.

Prigerson, who directs the Dana-Farber Center for Research on
Psycho-Oncology and Palliative Care, says aggressive end-of-life medical
interventions have costs that go far beyond patient quality of life.

She points out that fully a third of the Medicare budget each year is spent
treating patients in their last year of life, and a third of that expense
occurs in the month before patients die.

"In the long run, many of these interventions result not only in more
patient suffering, but they have huge costs for society," she says.

By Salynn Boyles
Reviewed by Louise Chang
©2005-2008 WebMD, LLC. All rights reserved

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