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.
Prigerson and colleagues reported that the association between religious reliance and use of aggressive medical intervention near the time of death persisted after other factors such as race, coping styles of patients, and advance medical care planning were considered.
But Duke University Medical Center psychiatrist Harold Koenig, MD, is not convinced that race did not influence the findings. He says that earlier studies have shown that blacks and Hispanics are more likely to have aggressive medical interventions at the end of life than whites.
In the newly reported study, blacks and Hispanics were much less likely to report a low level of reliance on religious coping than whites. Of the patients who said they did not rely on religion much, 6% were black, 9% were Hispanic, and 83% were white.
Patient-Doctor Discussions on Spiritual Issues
Koenig, who co-directs the Center for Spirituality, Theology and Health at Duke University, says the study underscores the importance of discussing religious beliefs within the medical setting.
"A recent study found that only about 7% of physicians actually talked to their dying patients about religious or spiritual issues," he tells WebMD. "There is also research finding that when doctors engage in discussions about spirituality with cancer patients, the patients trust them more."
There is also some evidence that incorporating spiritual counseling into end-stage medical care results in better quality of life and less aggressive medical intervention prior to death.
Prigerson, who directs the Dana-Farber Center for Research on Psycho-Oncology and Palliative Care, says aggressive end-of-life medical interventions have costs that go far beyond patient quality of life.
She points out that fully a third of the Medicare budget each year is spent treating patients in their last year of life, and a third of that expense occurs in the month before patients die.
"In the long run, many of these interventions result not only in more patient suffering, but they have huge costs for society," she says.