Spiritual support of patients with advanced illness and associations with end-of-life care and quality of death

Abstract

9514 Background: Little is known about whether spiritual support is associated with advanced cancer patients' medical care and quality of death (QoD) at the end of life (EoL). Methods: Coping with Cancer is an NCI/NIMH-funded, prospective, longitudinal, multi-institutional study of advanced, incurable cancer patients conducted from September 2002-August 2008. Analyses were based on 343 deceased patients who were interviewed at baseline and then followed until death a median of 117 days later. At baseline, spiritual support was assessed by (1) patient-rated support of spiritual needs by the medical system (eg, physicians, nurses, chaplains) scored from 0 (not at all) to 5 (completely supported) and (2) patient-reported receipt of hospital/clinic pastoral care services. Outcomes measured included medical care received in the last week of life (hospice; receipt of aggressive EoL care defined as ICU admission, resuscitation, ventilation or chemotherapy in the last week of life; and death in an acute care facility) and QoD. QoD assessments (possible 0–30, with increasing scores reflecting better QoD) were obtained by post-mortem interviews of a caregiver present in the patient's last week of life. Multivariable analyses examined (1) associations between spiritual support variables and EoL care outcomes, controlling for baseline confounds (eg, race, religiousness, patient EoL care preferences) and (2) associations between spiritual support variables and QoD with adjustment for confounds (eg, baseline quality of life, aggressive EoL care). Results: In adjusted analyses, greater medical system spiritual support was associated with increased receipt of hospice care [OR = 2.97 (1.24–7.11), p = .01], but not with receipt of aggressive EoL care or death in an acute care facility. Receipt of pastoral care services was not associated with any EoL care outcome. In adjusted analyses, spiritual support from the medical system and receipt of pastoral care services were significantly associated with better patient QoD (standardized β = 0.16, p = .009 and β = 0.20, p = .0005, respectively). Conclusions: Support of advanced cancer patients' spiritual needs by the medical care team is associated with increased receipt of hospice care and improved patient QoD. No significant financial relationships to disclose.