Contrasting effects of religious/spiritual support from religious communities versus medical teams on advanced cancer patient end-of-life care.

Abstract

9012 Background: It is unclear how religious/spiritual (R/S) support from religious communities and medical teams compare in their relationship to advance cancer patients' medical care at the end of life (EoL). Methods: Coping with Cancer is an NCI/NIMH-funded, multi-site study of advanced cancer patients conducted from 9/2002-8/2008. Analyses were of 343 patients who were interviewed at baseline and followed until death a median of 117 days later. At baseline, patients rated support of their R/S needs by religious communities and by their medical team, with ratings dichotomized (a median split) to “largely” or “completely” supported versus supported “not at all,” “to a small extent,” or “to a moderate extent.” EoL care outcomes included (in the last week of life): hospice, number of aggressive EoL measures [care in an intensive care unit (ICU), resuscitation, and ventilation], and death in an ICU. Multivariable analyses simultaneously examined associations of religious community and medical team R/S support to the EoL care outcomes, controlling for confounding variables. Results: Patients reporting their R/S needs were largely or completely supported by their medical team were more likely to receive hospice care [OR = 2.99 (95% CI = 1.45-6.17), p = .003], received fewer aggressive EoL care measures [β = −0.19 (SE = 0.09), p = 0.04], and were less likely to die in an ICU [OR = 0.26 (95% CI = 0.07-0.92), p = 0.04]. In contrast, patients reporting their R/S needs were largely or completely supported by religious communities were less likely to receive hospice [OR = 0.38 (95% CI = 0.20-0.72), p = 0.003], received more aggressive EoL care measures [β = 0.21 (SE = 0.08), p = 0.01], and were more likely to die in an ICU [OR = 4.69 (95% CI = 1.51-14.56), p = 0.008]. Conclusions: In contrast to the association of R/S support from medical teams with less aggressive EoL care, R/S support from religious communities predicts greater aggressive care at the EoL. These findings suggest that EoL decision-making may be influenced by the content or source of R/S care provided to patients. Improved collaboration with and education of religious communities may be strategies to reduce aggressive care at the EoL. No significant financial relationships to disclose.