Provision of Spiritual Support to Patients With Advanced Cancer by Religious Communities and Associations With Medical Care at the End of Life

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.Objective: To determine whether spiritual support from religious communities influences terminally ill patients' medical care and quality of life (QoL) near death. Design, Setting, and Participants: 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. Main Outcomes and Measures: 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. Results: 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 [PϽ.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 wellsupported 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]). Conclusions and Relevance: 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.

Qualidade de vida de pacientes oncológicos em cuidados paliativos

“…Estudo apontou que o apoio espiritual fornecido pela equipe assistencial está associado a melhor QV, maior utilização dos CP e intervenções médicas menos agressivas no final de vida. Contudo, reconhece-se que esse tipo de apoio é pouco frequente entre os profissionais, devido a múltiplos fatores como a insuficiência de recursos humanos, falta de capacitação e escassez de tempo (17) . Em relação à caracterização do perfil clínico, observou-se que o sítio primário do câncer mais comum entre os participantes foi o de mama (n= 3; 33,3%), como pode ser observado na Tabela 2 que se segue.…”

Sexual minority experiences of cancer care: A systematic review

“…Many cancer patients draw strength from religious or support groups in addition to their partners [32]. A study in the USA explored the effects of spirituality and religion among lesbians diagnosed with cancer [33].…”

Spiritual care in Israel: the future is now

“…First, there is an increasing body of literature being produced regarding the effects of spiritual care on health care, which demonstrate that spiritual care improves patient quality of life near the end of life [13]. Additionally, when the spiritual care interventions are provided by a trained spiritual care provider and/ or team, there is an increased impact on quality of life and can help influence patient medical-decision making toward appropriate end of life care [13,14].…”