Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer

Andrea C. Phelps, Paul K. Maciejewski, Matthew Nilsson, Tracy A. Balboni, Alexi A. Wright, M. Elizabeth Paulk, Elizabeth Trice, Deborah Schrag, John R. Peteet, Susan D. Block, Holly G. Prigerson

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Abstract

Context Patients frequently rely on religious faith to cope with cancer, but little is known about the associations between religious coping and the use of intensive life- prolonging care at the end of life. Objective To determine the way religious coping relates to the use of intensive life-prolonging end-of-life care among patients with advanced cancer. Design, Setting, and Participants A US multisite, prospective, longitudinal cohort of 345 patients with advanced cancer, who were enrolled between January 1, 2003, and August 31, 2007. The Brief RCOPE assessed positive religious coping. Baseline interviews assessed psychosocial and religious/spiritual measures, advance care planning, and end-of-life treatment preferences. Patients were followed up until death, a median of 122 days after baseline assessment. Main Outcome Measures Intensive life-prolonging care, defined as receipt of mechanical ventilation or resuscitation in the last week of life. Analyses were adjusted for demographic factors significantly associated with positive religious coping and any end-of-life outcome at P<.05 (ie, age and race/ethnicity). The main outcome was further, adjusted for potential psychosocial confounders (eg, other coping styles, terminal illness acknowledgment, spiritual support, preference for heroics, and advance care planning). Results A high level of positive religious coping at baseline was significantly associated with receipt of mechanical ventilation compared with patients with a low level (11.3% vs 3.6%; adjusted odds ratio [AOR], 2.81 [95% confidence interval {CI}, 1.037.69]; P =.04) and intensive life-prolonging care during the last week of life (13.6% [ vs 4.2%; AOR, 2.90 [95% CI, 1.14-7.35]; P =.03) after adjusting for age and race. In the model that further adjusted for other coping styles, terminal illness acknowledgment, support of spiritual needs, preference for heroics, and advance care planning (do-not-resuscitate order, living will, and health care proxy/durable power of attorney), positive religious coping remained a significant predictor of receiving intensive life-prolonging care near death (AOR, 2.90 [95% CI, 1.07-7.89]; P =.04). Conclusions Positive religious coping in patients with advanced cancer is associated with receipt of intensive life-prolonging medical care near death. Further research is needed to determine the mechanisms for this association.

Original languageEnglish (US)
Pages (from-to)1140-1147
Number of pages8
JournalJAMA - Journal of the American Medical Association
Volume301
Issue number11
DOIs
StatePublished - Mar 18 2009

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Advance Care Planning
Neoplasms
Terminal Care
Odds Ratio
Confidence Intervals
Artificial Respiration
Living Wills
Resuscitation Orders
Lawyers
Proxy
Resuscitation
Demography
Outcome Assessment (Health Care)
Interviews
Delivery of Health Care
Research
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

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Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer. / Phelps, Andrea C.; Maciejewski, Paul K.; Nilsson, Matthew; Balboni, Tracy A.; Wright, Alexi A.; Paulk, M. Elizabeth; Trice, Elizabeth; Schrag, Deborah; Peteet, John R.; Block, Susan D.; Prigerson, Holly G.

In: JAMA - Journal of the American Medical Association, Vol. 301, No. 11, 18.03.2009, p. 1140-1147.

Research output: Contribution to journalArticle

Phelps, AC, Maciejewski, PK, Nilsson, M, Balboni, TA, Wright, AA, Paulk, ME, Trice, E, Schrag, D, Peteet, JR, Block, SD & Prigerson, HG 2009, 'Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer', JAMA - Journal of the American Medical Association, vol. 301, no. 11, pp. 1140-1147. https://doi.org/10.1001/jama.2009.341
Phelps, Andrea C. ; Maciejewski, Paul K. ; Nilsson, Matthew ; Balboni, Tracy A. ; Wright, Alexi A. ; Paulk, M. Elizabeth ; Trice, Elizabeth ; Schrag, Deborah ; Peteet, John R. ; Block, Susan D. ; Prigerson, Holly G. / Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer. In: JAMA - Journal of the American Medical Association. 2009 ; Vol. 301, No. 11. pp. 1140-1147.
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title = "Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer",
abstract = "Context Patients frequently rely on religious faith to cope with cancer, but little is known about the associations between religious coping and the use of intensive life- prolonging care at the end of life. Objective To determine the way religious coping relates to the use of intensive life-prolonging end-of-life care among patients with advanced cancer. Design, Setting, and Participants A US multisite, prospective, longitudinal cohort of 345 patients with advanced cancer, who were enrolled between January 1, 2003, and August 31, 2007. The Brief RCOPE assessed positive religious coping. Baseline interviews assessed psychosocial and religious/spiritual measures, advance care planning, and end-of-life treatment preferences. Patients were followed up until death, a median of 122 days after baseline assessment. Main Outcome Measures Intensive life-prolonging care, defined as receipt of mechanical ventilation or resuscitation in the last week of life. Analyses were adjusted for demographic factors significantly associated with positive religious coping and any end-of-life outcome at P<.05 (ie, age and race/ethnicity). The main outcome was further, adjusted for potential psychosocial confounders (eg, other coping styles, terminal illness acknowledgment, spiritual support, preference for heroics, and advance care planning). Results A high level of positive religious coping at baseline was significantly associated with receipt of mechanical ventilation compared with patients with a low level (11.3{\%} vs 3.6{\%}; adjusted odds ratio [AOR], 2.81 [95{\%} confidence interval {CI}, 1.037.69]; P =.04) and intensive life-prolonging care during the last week of life (13.6{\%} [ vs 4.2{\%}; AOR, 2.90 [95{\%} CI, 1.14-7.35]; P =.03) after adjusting for age and race. In the model that further adjusted for other coping styles, terminal illness acknowledgment, support of spiritual needs, preference for heroics, and advance care planning (do-not-resuscitate order, living will, and health care proxy/durable power of attorney), positive religious coping remained a significant predictor of receiving intensive life-prolonging care near death (AOR, 2.90 [95{\%} CI, 1.07-7.89]; P =.04). Conclusions Positive religious coping in patients with advanced cancer is associated with receipt of intensive life-prolonging medical care near death. Further research is needed to determine the mechanisms for this association.",
author = "Phelps, {Andrea C.} and Maciejewski, {Paul K.} and Matthew Nilsson and Balboni, {Tracy A.} and Wright, {Alexi A.} and Paulk, {M. Elizabeth} and Elizabeth Trice and Deborah Schrag and Peteet, {John R.} and Block, {Susan D.} and Prigerson, {Holly G.}",
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T1 - Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer

AU - Phelps, Andrea C.

AU - Maciejewski, Paul K.

AU - Nilsson, Matthew

AU - Balboni, Tracy A.

AU - Wright, Alexi A.

AU - Paulk, M. Elizabeth

AU - Trice, Elizabeth

AU - Schrag, Deborah

AU - Peteet, John R.

AU - Block, Susan D.

AU - Prigerson, Holly G.

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N2 - Context Patients frequently rely on religious faith to cope with cancer, but little is known about the associations between religious coping and the use of intensive life- prolonging care at the end of life. Objective To determine the way religious coping relates to the use of intensive life-prolonging end-of-life care among patients with advanced cancer. Design, Setting, and Participants A US multisite, prospective, longitudinal cohort of 345 patients with advanced cancer, who were enrolled between January 1, 2003, and August 31, 2007. The Brief RCOPE assessed positive religious coping. Baseline interviews assessed psychosocial and religious/spiritual measures, advance care planning, and end-of-life treatment preferences. Patients were followed up until death, a median of 122 days after baseline assessment. Main Outcome Measures Intensive life-prolonging care, defined as receipt of mechanical ventilation or resuscitation in the last week of life. Analyses were adjusted for demographic factors significantly associated with positive religious coping and any end-of-life outcome at P<.05 (ie, age and race/ethnicity). The main outcome was further, adjusted for potential psychosocial confounders (eg, other coping styles, terminal illness acknowledgment, spiritual support, preference for heroics, and advance care planning). Results A high level of positive religious coping at baseline was significantly associated with receipt of mechanical ventilation compared with patients with a low level (11.3% vs 3.6%; adjusted odds ratio [AOR], 2.81 [95% confidence interval {CI}, 1.037.69]; P =.04) and intensive life-prolonging care during the last week of life (13.6% [ vs 4.2%; AOR, 2.90 [95% CI, 1.14-7.35]; P =.03) after adjusting for age and race. In the model that further adjusted for other coping styles, terminal illness acknowledgment, support of spiritual needs, preference for heroics, and advance care planning (do-not-resuscitate order, living will, and health care proxy/durable power of attorney), positive religious coping remained a significant predictor of receiving intensive life-prolonging care near death (AOR, 2.90 [95% CI, 1.07-7.89]; P =.04). Conclusions Positive religious coping in patients with advanced cancer is associated with receipt of intensive life-prolonging medical care near death. Further research is needed to determine the mechanisms for this association.

AB - Context Patients frequently rely on religious faith to cope with cancer, but little is known about the associations between religious coping and the use of intensive life- prolonging care at the end of life. Objective To determine the way religious coping relates to the use of intensive life-prolonging end-of-life care among patients with advanced cancer. Design, Setting, and Participants A US multisite, prospective, longitudinal cohort of 345 patients with advanced cancer, who were enrolled between January 1, 2003, and August 31, 2007. The Brief RCOPE assessed positive religious coping. Baseline interviews assessed psychosocial and religious/spiritual measures, advance care planning, and end-of-life treatment preferences. Patients were followed up until death, a median of 122 days after baseline assessment. Main Outcome Measures Intensive life-prolonging care, defined as receipt of mechanical ventilation or resuscitation in the last week of life. Analyses were adjusted for demographic factors significantly associated with positive religious coping and any end-of-life outcome at P<.05 (ie, age and race/ethnicity). The main outcome was further, adjusted for potential psychosocial confounders (eg, other coping styles, terminal illness acknowledgment, spiritual support, preference for heroics, and advance care planning). Results A high level of positive religious coping at baseline was significantly associated with receipt of mechanical ventilation compared with patients with a low level (11.3% vs 3.6%; adjusted odds ratio [AOR], 2.81 [95% confidence interval {CI}, 1.037.69]; P =.04) and intensive life-prolonging care during the last week of life (13.6% [ vs 4.2%; AOR, 2.90 [95% CI, 1.14-7.35]; P =.03) after adjusting for age and race. In the model that further adjusted for other coping styles, terminal illness acknowledgment, support of spiritual needs, preference for heroics, and advance care planning (do-not-resuscitate order, living will, and health care proxy/durable power of attorney), positive religious coping remained a significant predictor of receiving intensive life-prolonging care near death (AOR, 2.90 [95% CI, 1.07-7.89]; P =.04). Conclusions Positive religious coping in patients with advanced cancer is associated with receipt of intensive life-prolonging medical care near death. Further research is needed to determine the mechanisms for this association.

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