title: U.S. Clergy Religious Values and Relationships to End-of-Life Discussions and Care.
abstract: Although clergy interact with approximately half of U.S. patients facing end-of-life medical decisions, little is known about clergy-congregant interactions or clergy influence on end-of-life decisions.
  
  
  
  The objective was to conduct a nationally representative survey of clergy beliefs and practices.
  
  
  
  A mailed survey to a nationally representative sample of clergy completed in March 2015 with 1005 of 1665 responding (60% response rate). The primary predictor variable was clergy religious values about end-of-life medical decisions, which measured belief in miracles, the sanctity of life, trust in divine control, and redemptive suffering. Outcome variables included clergy-congregant end-of-life medical conversations and congregant receipt of hospice and intensive care unit (ICU) care in the final week of life.
  
  
  
  Most U.S. clergy are Christian (98%) and affirm religious values despite a congregant's terminal diagnosis. Endorsement included God performing a miracle (86%), pursuing treatment because of the sanctity of life (54%), postponement of medical decisions because God is in control (28%), and enduring painful treatment because of redemptive suffering (27%). Life-prolonging religious values in end-of-life medical decisions were associated with fewer clergy-congregant conversations about considering hospice (adjusted odds ratio [AOR], 0.58; 95% CI 0.42-0.80), P < 0.0001), stopping treatment (AOR 0.58, 95% CI 0.41-0.84, P = 0.003), and forgoing future treatment (AOR 0.50, 95% CI 0.36-0.71, P < 0.001) but not associated with congregant receipt of hospice or ICU care. Clergy with lower medical knowledge were less likely to have certain end-of-life conversations. The absence of a clergy-congregant hospice discussion was associated with less hospice (AOR 0.45; 95% CI 0.29-0.66, P < 0.001) and more ICU care (AOR 1.67; 95% CI 1.14-2.50, P < 0.01) in the final week of life.
  
  
  
  American clergy hold religious values concerning end-of-life medical decisions, which appear to decrease end-of-life discussions. Clergy end-of-life education may enable better quality end-of-life care for religious patients.
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Initiative on Health, Religion, and Spirituality within Harvard, Boston, Massachusetts, USA. Electronic address: michael_balboni@dfci.harvard.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Balboni
authors.affiliation: Department of Biostatistics, Brown University, Providence, Rhode Island.
authors.forename: Adam
authors.initials: A
authors.lastname: Sullivan
authors.affiliation: Departments of Medical Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Enzinger
authors.affiliation: Harvard Medical School Center for Bioethics, Boston, Massachusetts, USA; Gordon-Conwell Theological Seminary, S. Hamilton, Massachusetts, USA.
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Smith
authors.affiliation: Department of Social and Behavioral Health, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Mitchell
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Peteet
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
authors.affiliation: Initiative on Health, Religion, and Spirituality within Harvard, Boston, Massachusetts, USA; Department of Epidemiology and Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: VanderWeele
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Initiative on Health, Religion, and Spirituality within Harvard, Boston, Massachusetts, USA; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Balboni
mesh_terms: D002835:Christianity; D002977:Clergy / Q000523:psychology*; D003142:Communication; D003422:Critical Care / Q000523:psychology; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006738:Hospices; D006801:Humans; D008020:Life Support Care / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D012068:Religion and Medicine; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*; D035502:Trust; D014481:United States
keywords: End of life; clergy; hospice; palliative care; religion; religious communities; spirituality