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Wednesday, 18 March 2009 21:23

Positive religious people 3 times more likely to postpone death

A study based out of Boston, Massachusetts in the United States found that terminally ill patients were three times more likely to receive life-prolonging medical procedures during the last week of their lives if they were “positively” religious and spiritual as opposed to being “negatively” religious/spiritual.

The life-prolonging procedures--which were called "intensive" and "invasive" procedures--that the patients used, or didn't use, include being hooked up to a ventilator and getting cardiopulmonary resuscitation after their hearts had stopped.

According to the March 17, 2009 USA Today article Study: Cancer patients of faith more likely to get intensive treatments, “The new study shows that those who used "positive" religious coping — such as those "seeking God's love and care," as opposed to people tormented by the belief that God was punishing or abandoning them — were more likely to want doctors to do everything possible to keep them alive.

Also, “They also made fewer preparations for death, such as filling out "do not resuscitate" orders, writing living wills or giving someone power of attorney.... The patients lived a median of about four months after entering the study.”

Their article (JAMA. 2009;301(11):1140-1147) “Religious Coping and Use of Intensive Life-Prolonging Care Near Death in Patients With Advanced Cancer” appears in the Journal of the American Medical Association (JAMA).

The authors, all from medical facilities in Boston, Massachuseets, U.S.A., are Andrea C. Phelps, Paul K. Maciejewski, Matthew Nilsson, Tracy A. Balboni, Alexi A. Wright, M. Elizabeth PaulkElizabeth Trice, Deborah Schrag, John R. Peteet, Susan D. Block, and Holly G. Prigerson.

They state in the abstract to their paper, “Patients frequently rely on religious faith to cope with cancer, but little is known about the associations between religious coping and the use of intensive life-prolonging care at the end of life.”

Consequently, the researchers wanted to find out how patients with advanced (terminal) cancer cope religiously with their pending death by the use of “intensive life-prolonging end-of-life care.”

Page two talks more about the study.

The Boston researchers studied 345 patients with advanced cancer between January 1, 2003 and August 31, 2007.

The patients were accessed with the Brief RCOPE (Religious/spiritual coping short form), which consists of 14 points that determine the amount of positive or negative religious coping patterns within those people studied.

Positive religious coping was defined in the Boston study with such positive terms as people "seeking God's love and care."

On the other hand, negative religious coping was defined with such negative terms as people “tormented by the belief that God was punishing or abandoning them.”

Interviews were initially held, along with later assessments of psychosocial and religious/spiritual measures. They were also asked questions pertaining to advance care planning and end-of-life treatment preferences. Intensive life-prolonging care was defined as “receipt of mechanical ventilation or resuscitation in the last week of life.”

Further questions and interviews were held up to the point of death. In all, from the time of the first interview to the last, was, on average, 122 days.

External factors were excluded from the analysis, such as age, ethnicity/race, and psychosocial factors (such as coping styles, spiritual support, etc.).

Page three concludes with the conclusion of the study.

Two-hundred seventy two (272) patients (78.8%) stated that their religion helps them cope "to a moderate extent" or more. Another 31.6% (109 patients) said that religion "… is the most important thing that keeps you going."

In addition, 55.9% of the patients regularly prayed, meditated, or had religious study on a daily basis.

The researchers found, according to their abstract, that “A high level of positive religious coping at baseline was significantly associated with receipt of mechanical ventilation compared with patients with a low level.”

In fact, if a patient was found to have positive religious coping, they were 11.3% likely to use intensive life-prolonging care during the last week of life.

If they were found to have negative religious coping, they were only 3.6% likely to use intensive life-prolonging care during this time--which is actually 3.14 times less likely than the positive religious people.

They concluded, “Positive religious coping in patients with advanced cancer is associated with receipt of intensive life-prolonging medical care near death. Further research is needed to determine the mechanisms for this association.”

For further information on the study, please go to the e! Science News website “Use of religious coping associated with receiving intensive medical care near death.”

The article concluded by saying, "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.”

And, “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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