Terminally ill cancer patients who rely on their religion to cope with their illness are more likely to receive intensive, life-prolonging care during their final week of life, according to the results of a study published in the Journal of the American Medical Association.1
Religion often provides a source of comfort and guidance for patients with advanced cancer who are confronting their own mortality. Religion is a deeply personal experience and researchers have continued to investigate the impact it plays on medical treatment and outcomes.
The number of patients signing advanced directives and living wills has increased markedly in recent years. Many patients indicate that they do not want life-prolonging measures such as cardiopulmonary resuscitation or mechanical ventilation; however, the results of some studies indicate that individuals who believe in a higher power or divine intervention are more likely to want to utilize all measures to extend life.
Researchers at the Dana Farber Cancer Institute evaluated “religious coping”— the act of drawing on faith to cope with the emotional and physical impact of a terminal diagnosis—in order to determine how it impacts the use of intensive, life-prolonging end-of-life care among patients with advanced cancer.
The study included 345 terminally ill cancer patients at seven hospitals in the United States. Patients were enrolled between 2003 and 2007 and were interviewed regarding their religious and spiritual beliefs, their advance care planning, and their end-of-life treatment preferences. Patients were then followed until death, which occurred on average about four months from baseline assessment.
Intensive life-prolonging care was defined as the receipt of mechanical ventilation or resuscitation during the final week of life. The results of the study indicated that patients who were identified as “positive religious copers” were nearly three times as likely to receive intensive life-prolonging care when compared with their non-religious counterparts. Among patients with a high level of positive religious coping, 11.3% received mechanical ventilation and 13.6% received life-prolonging care compared with 3.6% of non-religious patients who received mechanical ventilation and 4.2% who received intensive life-prolonging care.
It is unclear why patients with a high level of positive religious coping opt to receive intensive life-prolonging care near death. The researchers concluded that more research is needed to evaluate this link. In the meantime, the results of this study underscore the importance of clear doctor–patient communication in order to meet the individual needs of each patient.
1 Phelps AC, Maciejewski PK, Nilsson M, et al. Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer. Journal of the American Medical Association. 2009; 301:1140-1147.
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