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Religion's Impact on End-of-Life Care

Patients Who Rely on Religion to Cope Are More Likely to Have Aggressive Medical Care
By
WebMD Health News
Reviewed by Louise Chang, MD

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March 17, 2009 -- Terminally ill cancer patients who relied on their religious faith to help them cope with their disease were more likely to receive aggressive medical care during their last week of life, a study shows.

Patients who engaged in what the researchers called positive religious coping, which included prayer, meditation, and religious study, ended up having more intensive life-prolonging interventions such as mechanical ventilation or cardiopulmonary resuscitation.

The study is published in the latest edition of The Journal of the American Medical Association.

The patients who reported a high level of positive religious coping at the start of the study were almost three times as likely to receive mechanical ventilation and other life-prolonging medical care in the last week of life as patients who said they relied less on their religious beliefs to help them deal with their illness.

A high level of religious coping was also associated with less use of end-of-life planning strategies, including do-not-resuscitate orders, living wills, and appointment of a health care power of attorney.

It is not entirely clear why terminally ill patients who report relying more on their religion would choose more life-prolonging medical interventions.

But researchers say these patients may be less likely to believe their doctors when they are told there is no hope.

"There may be a sense that it is really not in the hands of the doctors to decide when to give up," study researcher Holly G. Prigerson, PhD, of Boston's Dana-Farber Cancer Institute tells WebMD. "Refusing some of these very aggressive medical interventions may be seen as giving up on the possibility that God might intervene."

Religion and Coping With Illness

The study included 345 advanced cancer patients treated between January 2003 and August 2007 at medical facilities across the country.

Use of religion to cope with illness was assessed through questionnaires and patient interviews.

Patients were followed until death, which occurred an average of four months after enrollment.

The study revealed that:

  • Roughly four out of five patients reported that religion helped them cope "to a moderate extent" or more and close to one in three agreed with the statement "it is the most important thing that keeps me going."
  • More than half of the patients (55.9%) reported praying, meditating, or studying their religion daily.
  • Patients who reported a high level of positive religious coping were more likely to be black or Hispanic. They also tended to be less educated, were less likely to have medical insurance, or be married than patients who reported a low reliance on religion.
  • Of the patients who reported a high level of religious coping, 11% had mechanical ventilation during their last week of life and 7.4% underwent cardiopulmonary resuscitation (CPR), compared to 3.6% and 1.8%, respectively, of patients who reported a low level of religious coping.

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