title: Religious coping and behavioral disengagement: opposing influences on advance care planning and receipt of intensive care near death.
abstract: OBJECTIVE
  This study examines the relationships between methods of coping with advanced cancer, completion of advance care directives, and receipt of intensive, life-prolonging care near death.
  
  
  METHODS
  The analysis is based on a sample of 345 patients interviewed between January 1, 2003, and August 31, 2007, and followed until death as part of the Coping with Cancer Study, an NCI/NIMH-funded, multi-site, prospective, longitudinal, cohort study of patients with advanced cancer. The Brief COPE was used to assess active coping, use of emotional-support, and behavioral disengagement. The Brief RCOPE was used to assess positive and negative religious coping. The main outcome was intensive, life-prolonging care near death, defined as receipt of ventilation or resuscitation in the last week of life.
  
  
  RESULTS
  Positive religious coping was associated with lower rates of having a living will (AOR = 0.39, p = 0.003) and predicted higher rates of intensive, life-prolonging care near death (AOR, 5.43; p<0.001), adjusting for other coping methods and potential socio-demographic and health status confounds. Behavioral disengagement was associated with higher rates of DNR order completion (AOR, 2.78; p = 0.003) and predicted lower rates of intensive life-prolonging care near death (AOR, 0.20; p = 0.036). Not having a living will partially mediate the influence of positive religious coping on receipt of intensive, life-prolonging care near death.
  
  
  CONCLUSIONS
  Positive religious coping and behavioral disengagement are important determinants of completion of advance care directives and receipt of intensive, life-prolonging care near death.
authors: Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.
authors: Paul K
authors: PK
authors: Maciejewski
authors: Andrea C
authors: AC
authors: Phelps
authors: Elizabeth L
authors: EL
authors: Kacel
authors: Tracy A
authors: TA
authors: Balboni
authors: Michael
authors: M
authors: Balboni
authors: Alexi A
authors: AA
authors: Wright
authors: William
authors: W
authors: Pirl
authors: Holly G
authors: HG
authors: Prigerson
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D032722:Advance Care Planning; D016223:Advance Directives / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008020:Life Support Care; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D011446:Prospective Studies; D011788:Quality of Life; D016414:Resuscitation Orders; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D029181:Spirituality; D013727:Terminal Care / Q000523:psychology*