Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life. Academic Article Article uri icon

Overview

MeSH

  • Adaptation, Psychological
  • Advance Care Planning
  • Aged
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Hospice Care
  • Humans
  • Male
  • Middle Aged
  • Sampling Studies
  • Severity of Illness Index
  • Spirituality
  • Surveys and Questionnaires
  • United States

MeSH Major

  • Neoplasms
  • Palliative Care
  • Quality of Life
  • Religion
  • Terminal Care

abstract

  • Previous studies report associations between medical utilization at the end-of-life (EoL) and religious coping and spiritual support from the medical team. However, the influence of clergy and religious communities on EoL outcomes is unclear. To determine whether spiritual support from religious communities influences terminally ill patients' medical care and quality of life (QoL) near death. A US-based, multisite cohort study of 343 patients with advanced cancer enrolled from September 2002 through August 2008 and followed up (median duration, 116 days) until death. Baseline interviews assessed support of patients' spiritual needs by religious communities. End-of-life medical care in the final week included the following: hospice, aggressive EoL measures (care in an intensive care unit [ICU], resuscitation, or ventilation), and ICU death. End-of-life QoL was assessed by caregiver ratings of patient QoL in the last week of life. Multivariable regression analyses were performed on EoL care outcomes in relation to religious community spiritual support, controlling for confounding variables, and were repeated among high religious coping and racial/ethnic minority patients. Patients reporting high spiritual support from religious communities (43%) were less likely to receive hospice (adjusted odds ratio [AOR], 0.37; 95% CI, 0.20-0.70 [P = .002]), more likely to receive aggressive EoL measures (AOR, 2.62; 95% CI, 1.14-6.06 [P = .02]), and more likely to die in an ICU (AOR, 5.22; 95% CI, 1.71-15.60 [P = .004]). Risks of receiving aggressive EoL interventions and ICU deaths were greater among high religious coping (AOR, 11.02; 95% CI, 2.83-42.89 [P < .001]; and AOR, 22.02; 95% CI, 3.24-149.58 [P = .002]; respectively) and racial/ethnic minority patients (AOR, 8.03; 95% CI, 2.04-31.55 [P = .003]; and AOR, 11.21; 95% CI, 2.29-54.88 [P = .003]; respectively). Among patients well-supported by religious communities, receiving spiritual support from the medical team was associated with higher rates of hospice use (AOR, 2.37; 95% CI, 1.03-5.44 [P = .04]), fewer aggressive interventions (AOR, 0.23; 95% CI, 0.06-0.79 [P = .02]) and fewer ICU deaths (AOR, 0.19; 95% CI, 0.05-0.80 [P = .02]); and EoL discussions were associated with fewer aggressive interventions (AOR, 0.12; 95% CI, 0.02-0.63 [P = .01]). Terminally ill patients who are well supported by religious communities access hospice care less and aggressive medical interventions more near death. Spiritual care and EoL discussions by the medical team may reduce aggressive treatment, highlighting spiritual care as a key component of EoL medical care guidelines.

publication date

  • June 24, 2013

has subject area

  • Adaptation, Psychological
  • Advance Care Planning
  • Aged
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Hospice Care
  • Humans
  • Male
  • Middle Aged
  • Neoplasms
  • Palliative Care
  • Quality of Life
  • Religion
  • Sampling Studies
  • Severity of Illness Index
  • Spirituality
  • Surveys and Questionnaires
  • Terminal Care
  • United States

Research

keywords

  • Comparative Study
  • Journal Article
  • Multicenter Study

Identity

Language

  • eng

PubMed Central ID

  • PMC3791610

Digital Object Identifier (DOI)

  • 10.1001/jamainternmed.2013.903

PubMed ID

  • 23649656

Additional Document Info

start page

  • 1109

end page

  • 1117

volume

  • 173

number

  • 12