Ironically, the most devout are the most likely to utilize death-to-the-end treatment

The New York Times reports, “Terminally ill cancer patients who drew comfort from religion were far more likely to seek aggressive, life-prolonging care in the week before they died than were less religious patients.” What does this story mean?

More Information:

According to research team member Holly G. Prigerson, MS, PhD, of Harvard University and the Dana-Farber Cancer Institute, the finding seems to contradict what some people tend to generally accept as true: “Spiritual patients are more likely to say their lives are in God’s hands.” But, “to religious people, life is sacred and sanctified,” Prigerson maintains.

In fact, she says, “there’s a sense that by not going for life-prolonging care, they’re letting God down,” the Los Angeles Times adds. A number of “other recent studies have made similar connections.” 

For example, “religious cancer patients who had unsuccessful chemotherapy treatments were twice as likely to want heroic end-of-life measures, according to a report last year in the Journal of Clinical Oncology.”  

And, a “2005 study in Annals of Behavioral Medicine found that patients with advanced-stage lung or colon cancer were more likely to want life-preserving CPR, mechanical ventilation, and hospitalization if they believed in divine intervention.” 

The current study, published in the Journal of the American Medical Association, adds to the assertion that “faith in a higher power can often lead to more aggressive treatment than is medically warranted.”

In fact, the study reveals that the highly devout patients they interviewed “were three times more likely than others to receive intensive, invasive medical procedures,” USA Today reports

They “also made fewer preparations for death, such as filling out ‘do not resuscitate’ orders, writing living wills, or giving someone power of attorney, according to the study of 345 patients” recruited from medical facilities throughout the country between 2003 and 2007. The participants were predominantly Christian.

Although some “79 percent of patients reported that religion helped them cope to some extent,” just one-third “of highly religious patients had a do-not-resuscitate order, compared with half of patients who weren’t as spiritual,” Bloomberg News points out. Instead, “they wanted physicians to take ‘heroic measures’ to keep them alive.”

Meanwhile, “the researchers also observed that positive religious coping was significantly associated with being black or Hispanic, and that those with a high level of positive religious coping tended to be younger, less educated, less likely to be insured, less likely to be married, and more likely to have been recruited from sites in Texas than those with low levels of religious coping,” according to Medscape.

The “mechanism underlying the association between religious coping and aggressive life-saving measures is unclear,” MedPage Today reported

The investigators hypothesized, however, that “highly religious patients ‘may choose aggressive therapies, because they believe that God could use the therapy to provide divine healing, or they hope for a miraculous cure while intensive medical care prolongs life.'”

 My friend and Duke University Medical Center psychiatrist Harold Koenig, MD, told WebMD that “the study underscores the importance of discussing religious beliefs within the medical setting.” 

Even though another “recent study” showed “that only about seven percent of physicians actually talked to their dying patients about religious or spiritual issues,” Dr. Koenig says that “there is also research finding that when doctors engage in discussions about spirituality with cancer patients, the patients trust them more.” 

In addition, “incorporating spiritual counseling into end-stage medical care results in better quality of life and less aggressive medical intervention prior to death.” 

Prigerson agreed, noting that “aggressive end-of-life medical interventions have costs that go far beyond patient quality of life.” Not only do aggressive treatments “have huge costs for society,” she contended that “many of these interventions” also “result…in more patient suffering.”

These studies and comments illuminate why I travel around the country teaching healthcare professionals how to take a spiritual assessment and how to incorporate spiritual interventions in their clinical practices.

It is, in my opinion, healthcare professionals, working alongside pastoral professionals, who can meet ailing men and women in the midst of their spiritual pain and be a source of comfort and healing.