title: Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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 [P < .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 well-supported 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
  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.
authors: Center for Psychosocial Epidemiology and Outcomes Research, and Department of Radiation Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA. tbalboni@lroc.harvard.edu
authors: Tracy A
authors: TA
authors: Balboni
authors: Michael
authors: M
authors: Balboni
authors: Andrea C
authors: AC
authors: Enzinger
authors: Kathleen
authors: K
authors: Gallivan
authors: M Elizabeth
authors: ME
authors: Paulk
authors: Alexi
authors: A
authors: Wright
authors: Karen
authors: K
authors: Steinhauser
authors: Tyler J
authors: TJ
authors: VanderWeele
authors: Holly G
authors: HG
authors: Prigerson
mesh_terms: D000223:Adaptation, Psychological; D032722:Advance Care Planning / Q000706:statistics & numerical data; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017051:Hospice Care / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000523:psychology* / Q000628:therapy*; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data*; D011788:Quality of Life / Q000523:psychology; D012067:Religion; D012494:Sampling Studies; D012720:Severity of Illness Index; D029181:Spirituality; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
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