Positive religious coping methods led to intense, life-prolonging care at end of life

Data from a multisite, prospective, longitudinal study suggested that people with advanced cancer who used religion as a positive way to cope received intensive, life-prolonging medical care near death.

Study participants included 345 people with advanced cancer who were enrolled in the Coping With Cancer Study between Jan. 1, 2003 and Aug. 31, 2007. Participants were followed until death — a median of 122 days after baseline assessment.

Both positive and negative religious coping methods were assessed by the Brief RCOPE questionnaire — a 14-item questionnaire to assess religious coping methods. Psychosocial and religious measures, the planning for advance care and end-of-life treatment preferences were assessed during interviews at baseline.

When compared with people with a low level of positive religious coping at baseline, people with high levels of religious coping had a significant association with receipt of mechanical ventilation (3.6% vs. 11.3%; adjusted OR=2.81; 95% CI, 1.03-7.69) and intensive life-prolonging care (4.2% vs. 13.6%; adjusted OR=2.90; 95% CI, 1.14-7.35) during the last week of life.

Results further indicated that a high level of positive religious coping was significantly associated with preferring heroic measures when compared with people with a low level of positive religious coping (38.3% vs. 8.6%; OR=6.60; 95% CI, 3.53-12.36) and was also associated with less advance care planning, such as a do-not-resuscitate order, a living will and a health care proxy or durable power of attorney.

“Taken together, these results highlight the need for clinicians to recognize and be sensitive to the influence of religious coping on medical decisions and goals of care at the end of life,” the researchers wrote.

Phelps AC. JAMA. 2009;301:1140-1147.

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