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Religious Coping Associated With Aggressive End-of-Life Care


A study published in the March 18 issue of the Journal of the American Medical Association looked at how the religious faith of a patient with advanced cancer might affect the end-of-life care they receive.

It is well known that patients with strong religious faith use their beliefs to help them cope with their disease and struggles. The study found that their strong faith also made them more likely to more likely to receive intensive and aggressive treatment during their last week of life.

For the study, the authors defined intensive life-prolonging care as receiving mechanical ventilation or resuscitation in the last week of life. It was found that patients with a high level of religious coping were 3 times more likely to ask for and receive such aggressive medical care.

The authors made the distinction “religious coping refers to how a patient makes use of his or her religious beliefs to understand and adapt to stress.” Positive religious coping is characterized by a constructive reliance on faith to promote healthy adaptation (eg, through "seeking God's love and care"). Negative religious coping is uncommon and tends to view illness as a divine punishment.

The study was a multicenter study of 345 patients who lived a median of about 4 months after entering the study. When asked about how much they rely on religion to cope with illness, 272 patients (78.8%) reported that religion helps them cope "to a moderate extent" or more, and 109 (31.6%) agreed that "it is the most important thing that keeps you going." More than half of all patients (55.9%) reported engaging in prayer, meditation, or religious study at least daily.

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The researchers also noted that their religious patients were less likely to have made preparations for death, such as filling out "do not resuscitate" orders, writing living wills or giving someone power of attorney.

It was observed that positive religious coping was significantly higher in blacks and Hispanics. Patients with a high level of positive religious coping tended to be younger, less educated, less likely to be insured, less likely to be married, and more likely to have been recruited from sites in Texas than those with low levels of religious coping.

Religion remained the most important factor, even after researchers considered other factors that could have affected patients' treatment choices, such as race, income or psychological distress.

The study highlights the importance that both patients and clinicians recognize that religious coping is driving a desire for and the ultimate receipt of intensive, life-prolonging care.

It is also important to remember, as the authors state "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."

Religious Coping and Use of Intensive Life-Prolonging Care Near Death in Patients With Advanced Cancer; JAMA. 2009;301(11):1140-1147; Andrea C. Phelps, MD; Paul K. Maciejewski, PhD; Matthew Nilsson, BS; Tracy A. Balboni, MD; Alexi A. Wright, MD; M. Elizabeth Paulk, MD; Elizabeth Trice, MD, PhD; Deborah Schrag, MD, MPH; John R. Peteet, MD; Susan D. Block, MD; Holly G. Prigerson, PhD