Holly Prigerson, PhD
In a new study of terminally ill cancer patients, researchers at
Dana-Farber Cancer Institute found that those who draw on religion to
cope with their illness are more likely to receive intensive,
life-prolonging medical care as death approaches — treatment that often
entails a lower quality of life in patients' final days.
Previous research has shown that more religious patients often prefer
aggressive end-of-life (EOL) treatment. The new study — to be
published in the March 18 issue of the Journal of the American Medical Association
— examined whether these patients actually receive such care. The
study's findings suggest that physicians tend to comply with religious
patients' wishes for more aggressive care.
"Recent research has shown that religion and spirituality are major
sources of comfort and support for patients confronting advanced
disease," says the study's senior author, Holly Prigerson, PhD, of
Dana-Farber and Brigham and Women's Hospital (BWH). "We focused
specifically on positive religious coping, on people who rely on their
faith to handle the stresses of serious illness and approaching death.
Our findings indicate that patients who turn to religion to cope in
times of crisis, such as when facing death, are more likely to receive
aggressive care when they die."
The study involved 345 advanced cancer patients at seven hospital and
cancer centers around the country. Participants were interviewed about
their means of coping with the illness, their use of advance care
planning tools such as living wills and durable power of attorney, and
their preferences regarding end-of-life treatment. Investigators then
tracked each patient's course of care during the remainder of his or her
An analysis of the data showed that patients identified as positive
religious copers had nearly three times the odds of receiving
life-prolonging care, in the form of being on a ventilator or receiving
cardiopulmonary resuscitation, in the final week of life. Even after
researchers accounted for the influence of important factors such as
age, ethnicity, or other coping techniques, the connection between
religious coping and aggressive EOL care held up.
The researchers also found that religious copers in the study were
less likely to have completed advance medical directives, such as a
living will or do-not-resuscitate order, which can limit the extent of
such interventions in advance. The effects of religious coping on the
use of intensive medical care in the last week of life remained
significant even after adjusting for differences in advance care
In interpreting the results, study lead author Andrea Phelps, MD, of
Dana-Farber and Beth Israel Deaconess Medical Center (BIDMC), and a
clinical fellow in medicine at Harvard Medical School, says that "beyond
the significance of religious faith in coping with the emotional
challenge of incurable cancer, it is important to recognize how
religious coping factors into extremely difficult decisions confronting
patients as their cancer progresses and death appears imminent. Beyond
turning to doctors for advice, patients often look to God for guidance
in these times of crisis."
The study did not explore why religious copers often tend to prefer
and receive extensive end-of-life care, the authors note. The
researchers hope to examine such questions in future studies.
"Our results highlight how patients' ways of coping, particularly
their use of religious coping, factor prominently into the ultimate
medical care patients receive. This suggests that clinicians should be
attentive to terminally ill patients' religious views as they discuss
prognosis and treatment options with them," said Prigerson, who is also
an associate professor of psychiatry at Harvard Medical School. "A
greater understanding of the basis of patients' medical choices can go a
long way toward achieving shared goals of care.
Financial support for the study was provided by grants from the
National Cancer Institute, the National Institute of Mental Health, and
the Fetzer Institute.
The study's co-authors include Deborah Schrag, MD, MPH, Tracy
Balboni, MD, Alexi Wright, MD, Elizabeth Trice, MD, and Matthew Nilsson,
of Dana-Farber; Paul Maciejewski, PhD, John Peteet, MD, and Susan
Block, of Dana-Farber and BWH; and M. Elizabeth Paulk, MD, of the
University of Texas Southwestern Medical Center, Dallas.