title: Seeking and Accepting: U.S. Clergy Theological and Moral Perspectives Informing Decision Making at the End of Life.
abstract: People with serious illness frequently rely on religion/spirituality to cope with their diagnosis, with potentially positive and negative consequences. Clergy are uniquely positioned to help patients consider medical decisions at or near the end of life within a religious/spiritual framework.
  
  
  
  We aimed to examine clergy knowledge of end-of-life (EOL) care and beliefs about the role of faith in EOL decision making for patients with serious illness.
  
  
  
  Key informant interviews, focus groups, and survey.
  
  
  
  A purposive sample of 35 active clergy in five U.S. states as part of the National Clergy End-of-Life Project.
  
  
  
  We assessed participant knowledge of and desire for further education about EOL care. We transcribed interviews and focus groups for the purpose of qualitative analysis.
  
  
  
  Clergy had poor knowledge of EOL care; 75% desired more EOL training. Qualitative analysis revealed a theological framework for decision making in serious illness that balances seeking life and accepting death. Clergy viewed comfort-focused treatments as consistent with their faith traditions' views of a good death. They employed a moral framework to determine the appropriateness of EOL decisions, which weighs the impact of multiple factors and upholds the importance of God-given free will. They viewed EOL care choices to be the primary prerogative of patients and families. Clergy described ambivalence about and a passive approach to counseling congregants about decision making despite having defined beliefs regarding EOL care.
  
  
  
  Poor knowledge of EOL care may lead clergy to passively enable congregants with serious illness to pursue potentially nonbeneficial treatments that are associated with increased suffering.
authors.affiliation: 1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.|11 Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Sanders
authors.affiliation: 2 Department of Anesthesia, Duke University , Durham, North Carolina.
authors.forename: Vinca
authors.initials: V
authors.lastname: Chow
authors.affiliation: 3 Departments of Medical Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Enzinger
authors.affiliation: 4 Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, University of Hong Kong , Hong Kong, China .
authors.forename: Tai-Chung
authors.initials: TC
authors.lastname: Lam
authors.affiliation: 5 Harvard Medical School Center for Bioethics , Boston, Massachusetts.|6 Gordon-Conwell Theological Seminary , South Hamilton, Massachusetts.
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Smith
authors.affiliation: 1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Quiñones
authors.affiliation: 7 Harvard Divinity School , Boston, Massachusetts.
authors.forename: Andrew
authors.initials: A
authors.lastname: Baccari
authors.affiliation: 8 Kirksville College of Osteopathic Medicine, A.T. Still University , Kirksville, Missouri.
authors.forename: Sarah
authors.initials: S
authors.lastname: Philbrick
authors.affiliation: 9 Harvard Divinity School , Cambridge, Massachusetts.
authors.forename: Gloria
authors.initials: G
authors.lastname: White-Hammond
authors.affiliation: 1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.
authors.forename: John
authors.initials: J
authors.lastname: Peteet
authors.affiliation: 10 Department of Radiation Oncology, Dana-Farber Cancer Institute , Boston, Massachusetts.|11 Brigham and Women's Hospital , Boston, Massachusetts.|12 Initiative on Health, Religion, and Spirituality within Harvard, Boston, Massachusetts.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Balboni
authors.affiliation: 1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.|12 Initiative on Health, Religion, and Spirituality within Harvard, Boston, Massachusetts.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Balboni
mesh_terms: D000328:Adult; D002977:Clergy / Q000523:psychology*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009014:Morals; D029181:Spirituality; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*; D014481:United States
keywords: clergy; clinical decision making; palliative care; pastoral care; religion; serious illness; spirituality