People with advanced cancer tend to get more aggressive care
at the end of life and spend more time in the intensive care unit if they
receive spiritual support from their religious communities, according to a new
The report's lead researcher said that finding was
"quite the opposite" of what her team was expecting - in part because
of evidence that spiritual support coming from within a patient's medical team
leads to less aggressive care and more use of hospice.
In the new study, spiritual patients who reported high
levels of support from their religious communities were two to three times more
likely to receive aggressive end-of-life treatment than those who got less
support. However, spiritual support from doctors, nurses and chaplains was tied
to a 77% drop in aggressive interventions, consistent with past research.
"The spiritual supporters that are integrated into the
medical team, knowing the diagnosis of the patient and where things are, are
much more able to see the bigger picture of where someone's illness is
heading," said Dr Tracy Balboni, from the Dana-Farber Cancer Institute in
Understanding the "medical
She said the new findings point to a need for
more collaboration between religious communities and medical teams - so a
patient's religious supporters understand the "medical realities" of
"Where there is that better collaboration and
communication, that increase in aggressive interventions at life's end is no
longer seen," Balboni explained. Her team surveyed 343 patients with
terminal cancer at seven hospitals in New England and Texas, analyzed their
medical records before and after their deaths and interviewed caregivers about
patients' quality of life in their final days.
Almost all patients reported a religious affiliation, most
commonly Catholic, Protestant or Baptist. Among patients who said they received
little or no spiritual support from religious communities, about 11% underwent
aggressive medical interventions at the end of life - such as cardiopulmonary
resuscitation or being put on a ventilator.
Spiritual support to
prolong their lives
That compared to more
than 16% of those with high spiritual support who had aggressive measures taken
to prolong their lives. Likewise, less than 4% of people receiving little
support from religious communities died in the ICU instead of at home, for
example, compared to 12% with high religious-based spiritual support.
In contrast, aggressive care and ICU deaths were both
significantly less common when cancer patients were spiritually supported by
their medical team, the researchers reported this week in JAMA Internal
Medicine. Religious community support was not tied to a better quality of life
"I really think (the study) speaks to the type of
information that medical providers would be giving to patients and the type of
information that the religious leaders don't have, certainly," said
Allison Applebaum, a clinical psychologist at Memorial Sloan-Kettering Cancer
Center in New York. Still, she told Reuters Health that doctors have to acknowledge
how important religious ties are for many patients, including in the way they
see their disease.
Families can benefit from understanding
"If that is the case, it makes absolute sense and it's
important to involve their religious guides at end of life," said
Applebaum, who wasn't involved in the new study. What's most crucial, she said,
is talking about what treatment - and how much - a patient wants at the end of
life early on, when the patient is stable and able to make that decision. Both
patients and their families can benefit from being on the same page about
prognosis and options, she added.
Balboni said that if patients want all measures taken at the
end of life, that's okay and doctors should care for them in accordance with
their values. But being religious doesn't have to mean always pursuing the most
aggressive treatment possible and hoping for a miracle, she added.
"I think there are also times when it is placing things
in God's hands to let aggressive medical technologies go and pursue care that's
focused on supporting patients' quality of life and symptoms and focus more on
spiritually supporting them and their families," Balboni said.