Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life

Tracy A. Balboni, Michael Balboni, Andrea C. Enzinger, Kathleen Gallivan, M. Elizabeth Paulk, Alexi Wright, Karen Steinhauser, Tyler J. VanderWeele, Holly G. Prigerson

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

Importance: Previous studies report associations between medical utilization at the end-of-life (EoL) and religious coping and spiritual support from the medical team. However, the influence of clergy and religious communities on EoL outcomes is unclear. Objective: To determine whether spiritual support from religious communities influences terminally ill patients' medical care and quality of life (QoL) near death. Design, Setting, and Participants: A US-based, multisite cohort study of 343 patients with advanced cancer enrolled from September 2002 through August 2008 and followed up (median duration, 116 days) until death. Baseline interviews assessed support of patients' spiritual needs by religious communities. End-of-life medical care in the final week included the following: hospice, aggressive EoL measures (care in an intensive care unit [ICU], resuscitation, or ventilation), and ICU death. Main Outcomes and Measures: End-of-life QoL was assessed by caregiver ratings of patient QoL in the last week of life. Multivariable regression analyses were performed on EoL care outcomes in relation to religious community spiritual support, controlling for confounding variables, and were repeated among high religious coping and racial/ethnic minority patients. Results: Patients reporting high spiritual support from religious communities (43%) were less likely to receive hospice (adjusted odds ratio [AOR], 0.37; 95% CI, 0.20-0.70 [P=.002]), more likely to receive aggressive EoL measures (AOR, 2.62; 95% CI, 1.14-6.06 [P=.02]), and more likely to die in an ICU (AOR, 5.22; 95% CI, 1.71-15.60 [P=.004]). Risks of receiving aggressive EoL interventions and ICU deaths were greater among high religious coping (AOR, 11.02; 95% CI, 2.83-42.89 [P<.001]; and AOR, 22.02; 95% CI, 3.24-149.58 [P=.002]; respectively) and racial/ethnic minority patients (AOR, 8.03; 95% CI, 2.04-31.55 [P=.003]; and AOR, 11.21; 95% CI, 2.29-54.88 [P=.003]; respectively). Among patients well-supported by religious communities, receiving spiritual support from the medical team was associated with higher rates of hospice use (AOR, 2.37; 95% CI, 1.03-5.44 [P=.04]), fewer aggressive interventions (AOR, 0.23; 95% CI, 0.06-0.79 [P=.02]) and fewer ICU deaths (AOR, 0.19; 95% CI, 0.05-0.80 [P=.02]); and EoL discussions were associated with fewer aggressive interventions (AOR, 0.12; 95% CI, 0.02-0.63 [P=.01]). Conclusions and Relevance: Terminally ill patients who are well supported by religious communities access hospice care less and aggressive medical interventions more near death. Spiritual care and EoL discussions by the medical team may reduce aggressive treatment, highlighting spiritual care as a key component of EoL medical care guidelines.

Original languageEnglish (US)
Pages (from-to)1109-1117
Number of pages9
JournalJAMA Internal Medicine
Volume173
Issue number12
DOIs
StatePublished - Jun 24 2013

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Terminal Care
Odds Ratio
Neoplasms
Intensive Care Units
Hospices
Quality of Life
Terminally Ill
Clergy
Hospice Care
Confounding Factors (Epidemiology)
Resuscitation
Caregivers
Ventilation
Patient Care
Cohort Studies
Regression Analysis
Outcome Assessment (Health Care)
Guidelines
Interviews

ASJC Scopus subject areas

  • Internal Medicine

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Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life. / Balboni, Tracy A.; Balboni, Michael; Enzinger, Andrea C.; Gallivan, Kathleen; Paulk, M. Elizabeth; Wright, Alexi; Steinhauser, Karen; VanderWeele, Tyler J.; Prigerson, Holly G.

In: JAMA Internal Medicine, Vol. 173, No. 12, 24.06.2013, p. 1109-1117.

Research output: Contribution to journalArticle

Balboni, TA, Balboni, M, Enzinger, AC, Gallivan, K, Paulk, ME, Wright, A, Steinhauser, K, VanderWeele, TJ & Prigerson, HG 2013, 'Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life', JAMA Internal Medicine, vol. 173, no. 12, pp. 1109-1117. https://doi.org/10.1001/jamainternmed.2013.903
Balboni, Tracy A. ; Balboni, Michael ; Enzinger, Andrea C. ; Gallivan, Kathleen ; Paulk, M. Elizabeth ; Wright, Alexi ; Steinhauser, Karen ; VanderWeele, Tyler J. ; Prigerson, Holly G. / Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life. In: JAMA Internal Medicine. 2013 ; Vol. 173, No. 12. pp. 1109-1117.
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title = "Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life",
abstract = "Importance: Previous studies report associations between medical utilization at the end-of-life (EoL) and religious coping and spiritual support from the medical team. However, the influence of clergy and religious communities on EoL outcomes is unclear. Objective: To determine whether spiritual support from religious communities influences terminally ill patients' medical care and quality of life (QoL) near death. Design, Setting, and Participants: A US-based, multisite cohort study of 343 patients with advanced cancer enrolled from September 2002 through August 2008 and followed up (median duration, 116 days) until death. Baseline interviews assessed support of patients' spiritual needs by religious communities. End-of-life medical care in the final week included the following: hospice, aggressive EoL measures (care in an intensive care unit [ICU], resuscitation, or ventilation), and ICU death. Main Outcomes and Measures: End-of-life QoL was assessed by caregiver ratings of patient QoL in the last week of life. Multivariable regression analyses were performed on EoL care outcomes in relation to religious community spiritual support, controlling for confounding variables, and were repeated among high religious coping and racial/ethnic minority patients. Results: Patients reporting high spiritual support from religious communities (43{\%}) were less likely to receive hospice (adjusted odds ratio [AOR], 0.37; 95{\%} CI, 0.20-0.70 [P=.002]), more likely to receive aggressive EoL measures (AOR, 2.62; 95{\%} CI, 1.14-6.06 [P=.02]), and more likely to die in an ICU (AOR, 5.22; 95{\%} CI, 1.71-15.60 [P=.004]). Risks of receiving aggressive EoL interventions and ICU deaths were greater among high religious coping (AOR, 11.02; 95{\%} CI, 2.83-42.89 [P<.001]; and AOR, 22.02; 95{\%} CI, 3.24-149.58 [P=.002]; respectively) and racial/ethnic minority patients (AOR, 8.03; 95{\%} CI, 2.04-31.55 [P=.003]; and AOR, 11.21; 95{\%} CI, 2.29-54.88 [P=.003]; respectively). Among patients well-supported by religious communities, receiving spiritual support from the medical team was associated with higher rates of hospice use (AOR, 2.37; 95{\%} CI, 1.03-5.44 [P=.04]), fewer aggressive interventions (AOR, 0.23; 95{\%} CI, 0.06-0.79 [P=.02]) and fewer ICU deaths (AOR, 0.19; 95{\%} CI, 0.05-0.80 [P=.02]); and EoL discussions were associated with fewer aggressive interventions (AOR, 0.12; 95{\%} CI, 0.02-0.63 [P=.01]). Conclusions and Relevance: Terminally ill patients who are well supported by religious communities access hospice care less and aggressive medical interventions more near death. Spiritual care and EoL discussions by the medical team may reduce aggressive treatment, highlighting spiritual care as a key component of EoL medical care guidelines.",
author = "Balboni, {Tracy A.} and Michael Balboni and Enzinger, {Andrea C.} and Kathleen Gallivan and Paulk, {M. Elizabeth} and Alexi Wright and Karen Steinhauser and VanderWeele, {Tyler J.} and Prigerson, {Holly G.}",
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T1 - Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life

AU - Balboni, Tracy A.

AU - Balboni, Michael

AU - Enzinger, Andrea C.

AU - Gallivan, Kathleen

AU - Paulk, M. Elizabeth

AU - Wright, Alexi

AU - Steinhauser, Karen

AU - VanderWeele, Tyler J.

AU - Prigerson, Holly G.

PY - 2013/6/24

Y1 - 2013/6/24

N2 - Importance: Previous studies report associations between medical utilization at the end-of-life (EoL) and religious coping and spiritual support from the medical team. However, the influence of clergy and religious communities on EoL outcomes is unclear. Objective: To determine whether spiritual support from religious communities influences terminally ill patients' medical care and quality of life (QoL) near death. Design, Setting, and Participants: A US-based, multisite cohort study of 343 patients with advanced cancer enrolled from September 2002 through August 2008 and followed up (median duration, 116 days) until death. Baseline interviews assessed support of patients' spiritual needs by religious communities. End-of-life medical care in the final week included the following: hospice, aggressive EoL measures (care in an intensive care unit [ICU], resuscitation, or ventilation), and ICU death. Main Outcomes and Measures: End-of-life QoL was assessed by caregiver ratings of patient QoL in the last week of life. Multivariable regression analyses were performed on EoL care outcomes in relation to religious community spiritual support, controlling for confounding variables, and were repeated among high religious coping and racial/ethnic minority patients. Results: Patients reporting high spiritual support from religious communities (43%) were less likely to receive hospice (adjusted odds ratio [AOR], 0.37; 95% CI, 0.20-0.70 [P=.002]), more likely to receive aggressive EoL measures (AOR, 2.62; 95% CI, 1.14-6.06 [P=.02]), and more likely to die in an ICU (AOR, 5.22; 95% CI, 1.71-15.60 [P=.004]). Risks of receiving aggressive EoL interventions and ICU deaths were greater among high religious coping (AOR, 11.02; 95% CI, 2.83-42.89 [P<.001]; and AOR, 22.02; 95% CI, 3.24-149.58 [P=.002]; respectively) and racial/ethnic minority patients (AOR, 8.03; 95% CI, 2.04-31.55 [P=.003]; and AOR, 11.21; 95% CI, 2.29-54.88 [P=.003]; respectively). Among patients well-supported by religious communities, receiving spiritual support from the medical team was associated with higher rates of hospice use (AOR, 2.37; 95% CI, 1.03-5.44 [P=.04]), fewer aggressive interventions (AOR, 0.23; 95% CI, 0.06-0.79 [P=.02]) and fewer ICU deaths (AOR, 0.19; 95% CI, 0.05-0.80 [P=.02]); and EoL discussions were associated with fewer aggressive interventions (AOR, 0.12; 95% CI, 0.02-0.63 [P=.01]). Conclusions and Relevance: Terminally ill patients who are well supported by religious communities access hospice care less and aggressive medical interventions more near death. Spiritual care and EoL discussions by the medical team may reduce aggressive treatment, highlighting spiritual care as a key component of EoL medical care guidelines.

AB - Importance: Previous studies report associations between medical utilization at the end-of-life (EoL) and religious coping and spiritual support from the medical team. However, the influence of clergy and religious communities on EoL outcomes is unclear. Objective: To determine whether spiritual support from religious communities influences terminally ill patients' medical care and quality of life (QoL) near death. Design, Setting, and Participants: A US-based, multisite cohort study of 343 patients with advanced cancer enrolled from September 2002 through August 2008 and followed up (median duration, 116 days) until death. Baseline interviews assessed support of patients' spiritual needs by religious communities. End-of-life medical care in the final week included the following: hospice, aggressive EoL measures (care in an intensive care unit [ICU], resuscitation, or ventilation), and ICU death. Main Outcomes and Measures: End-of-life QoL was assessed by caregiver ratings of patient QoL in the last week of life. Multivariable regression analyses were performed on EoL care outcomes in relation to religious community spiritual support, controlling for confounding variables, and were repeated among high religious coping and racial/ethnic minority patients. Results: Patients reporting high spiritual support from religious communities (43%) were less likely to receive hospice (adjusted odds ratio [AOR], 0.37; 95% CI, 0.20-0.70 [P=.002]), more likely to receive aggressive EoL measures (AOR, 2.62; 95% CI, 1.14-6.06 [P=.02]), and more likely to die in an ICU (AOR, 5.22; 95% CI, 1.71-15.60 [P=.004]). Risks of receiving aggressive EoL interventions and ICU deaths were greater among high religious coping (AOR, 11.02; 95% CI, 2.83-42.89 [P<.001]; and AOR, 22.02; 95% CI, 3.24-149.58 [P=.002]; respectively) and racial/ethnic minority patients (AOR, 8.03; 95% CI, 2.04-31.55 [P=.003]; and AOR, 11.21; 95% CI, 2.29-54.88 [P=.003]; respectively). Among patients well-supported by religious communities, receiving spiritual support from the medical team was associated with higher rates of hospice use (AOR, 2.37; 95% CI, 1.03-5.44 [P=.04]), fewer aggressive interventions (AOR, 0.23; 95% CI, 0.06-0.79 [P=.02]) and fewer ICU deaths (AOR, 0.19; 95% CI, 0.05-0.80 [P=.02]); and EoL discussions were associated with fewer aggressive interventions (AOR, 0.12; 95% CI, 0.02-0.63 [P=.01]). Conclusions and Relevance: Terminally ill patients who are well supported by religious communities access hospice care less and aggressive medical interventions more near death. Spiritual care and EoL discussions by the medical team may reduce aggressive treatment, highlighting spiritual care as a key component of EoL medical care guidelines.

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