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Religious support tied to intensive end-of-life care

By Genevra Pittman

NEW YORK (Reuters Health) - People with advanced cancer tend to get more aggressive care at the end of life and spend more time in the intensive care unit if they receive spiritual support from their religious communities, according to a new study.

The report's lead researcher said that finding was "quite the opposite" of what her team was expecting - in part because of evidence that spiritual support coming from within a patient's medical team leads to less aggressive care and more use of hospice.

In the new study, spiritual patients who reported high levels of support from their religious communities were two to three times more likely to receive aggressive end-of-life treatment than those who got less support. However, spiritual support from doctors, nurses and chaplains was tied to a 77-percent drop in aggressive interventions, consistent with past research.

"The spiritual supporters that are integrated into the medical team, knowing the diagnosis of the patient and where things are, are much more able to see the bigger picture of where someone's illness is heading," said Dr. Tracy Balboni, from the Dana-Farber Cancer Institute in Boston.

She told Reuters Health the new findings point to a need for more collaboration between religious communities and medical teams - so a patient's religious supporters understand the "medical realities" of terminal cancer.

"Where there is that better collaboration and communication, that increase in aggressive interventions at life's end is no longer seen," Balboni explained.

Her team surveyed 343 patients with terminal cancer at seven hospitals in New England and Texas, analyzed their medical records before and after their deaths and interviewed caregivers about patients' quality of life in their final days. Almost all patients reported a religious affiliation, most commonly Catholic, Protestant or Baptist.

Among patients who said they received little or no spiritual support from religious communities, about 11 percent underwent aggressive medical interventions at the end of life - such as cardiopulmonary resuscitation or being put on a ventilator.

That compared to more than 16 percent of those with high spiritual support who had aggressive measures taken to prolong their lives.

Likewise, less than 4 percent of people receiving little support from religious communities died in the ICU instead of at home, for example, compared to 12 percent with high religious-based spiritual support.

In contrast, aggressive care and ICU deaths were both significantly less common when cancer patients were spiritually supported by their medical team, the researchers reported this week in JAMA Internal Medicine.

Religious community support was not tied to a better quality of life near death.

"I really think (the study) speaks to the type of information that medical providers would be giving to patients and the type of information that the religious leaders don't have, certainly," said Allison Applebaum, a clinical psychologist at Memorial Sloan-Kettering Cancer Center in New York.

Still, she told Reuters Health that doctors have to acknowledge how important religious ties are for many patients, including in the way they see their disease.

"If that is the case, it makes absolute sense and it's important to involve their religious guides at end of life," said Applebaum, who wasn't involved in the new study.

What's most crucial, she said, is talking about what treatment - and how much - a patient wants at the end of life early on, when the patient is stable and able to make that decision. Both patients and their families can benefit from being on the same page about prognosis and options, she added.

Balboni said that if patients want all measures taken at the end of life, that's okay and doctors should care for them in accordance with their values. But being religious doesn't have to mean always pursuing the most aggressive treatment possible and hoping for a miracle, she added.

"I think there are also times when it is placing things in God's hands to let aggressive medical technologies go and pursue care that's focused on supporting patients' quality of life and symptoms and focus more on spiritually supporting them and their families," Balboni said.

SOURCE: http://bit.ly/17Iuyco JAMA Internal Medicine, online May 6, 2013.

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