Support of Cancer Patients’ Spiritual Needs and Associations with Medical Care Costs at the End of Life (419-C)

Abstract

1.Recognize spiritual care as a key domain of palliative care with known implications for patient well-being and medical care intensity at the end of life.2.Recognize the association of spiritual care with medical care costs at the end of life.3.Discuss the study design and limitations, and future study directions implicated by the study findings. Background. Spiritual care is associated with better patient well-being and less intensive end-of-life (EOL) medical care. It remains unclear if spiritual care is associated with lower EOL costs, particularly among groups predisposed to receive aggressive care. Research objectives. Determine the relationship of spiritual care to EOL costs. Methods. Prospective, multi-site study of 339 terminal cancer patients accrued September 2002–August 2008 and followed until death. Spiritual care was measured by patients’ reports that the healthcare team supported their religious/spiritual needs. EOL care and costs in the last week were compared among patients whose spiritual needs were well-supported versus those not. Analyses were adjusted for confounders and repeated among racial/ethnic minority and high religious coping patients. Results. In comparison to patients receiving less spiritual care, patients whose religious/spiritual needs were well-supported by clinic staff were more likely to receive a week or more of hospice (54% versus 72.8%; p = 0.01) and less likely to die in an ICU (5.1% versus 1.0%, p = 0.03). Among racial/ethnic minorities and high religious coping patients, those with well-supported R/S needs received less ICU care (11.3% versus 1.2%, p = 0.03 and 13.1% versus 1.6%, p = 0.02), more hospice care (43% versus 75.3%, p = 0.01 and 45.3% versus 73.1%, p = 0.007) and had fewer ICU deaths (11.2% versus 1.2%, p = .03 and 7.7% versus 0.6%, p = .009). EOL costs were lower when clinicians supported patients’ spiritual needs ($4,947 versus $2,833, p = 0.03), particularly among racial/ethnic minorities ($6,533 versus $2,276, p = 0.02) and high religious coping patients ($6,344 versus $,2431, p = 0.005). Conclusion. Cancer patients whose spiritual needs are well-supported by the healthcare team have lower EOL costs, particularly among racial/ethnic minorities and high religious coping patients. Implications for research, policy, or practice. Further research to define spiritual care and spiritual care education are required. Structure and Processes of Care; Spiritual, Religious, and Existential Aspects of Care