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Use of
Religious Coping associated with receiving
intensive medical care near death
Newswise — 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.”
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