Religiosity, Spirituality, and End-of-Life Planning: A Single-Site Survey of Medical Inpatients

Abstract

Context Prior studies suggest that terminally ill patients who use religious coping are less likely to have advance directives and more likely to opt for heroic end-of-life measures. Yet, no study to date has examined whether end-of-life practices are associated with measures of religiosity and spirituality. Objectives To assess the relationship between general measures of patient religiosity and spirituality and patients’ preferences for care at the end of life. Methods We examined data from the University of Chicago Hospitalist Study, which gathers sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center. Primary outcomes were whether the patient had an advance directive, a do-not-resuscitate (DNR) order, a durable power of attorney for health care, and an informally designated decision maker. Primary predictors were religious attendance, intrinsic religiosity, and self-rated spirituality. Results The sample population (n=8,308) was predominantly African American (73%) and female (60%). In this population, 1.5% had advance directives and 10.4% had DNR orders. Half (51%) of patients had specified a decision maker. White patients were more likely than African-American patients to have an advance directive (adjusted odds ratio [OR] 2.1; 95% confidence interval [CI] 1.1, 4.0) and a DNR order (OR 1.7; 95% CI 1.0, 2.9). Patients reporting high intrinsic religiosity were more likely to have specified a decision maker than those with low intrinsic religiosity (OR 1.3; CI 1.1, 1.6). The same was true for those with high compared to low spirituality (OR 1.3; CI 1.1, 1.5). Religious characteristics were not significantly associated with having an advance directive or DNR order. Conclusion Among general medicine inpatients at an urban academic medical center, those who were highly religious and/or spiritual were more likely to have a designated decision-maker to help with end-of-life decisions, but did not differ from other patients in their likelihood of having an advance directive or DNR order.

The Relationship of Faith-Related Characteristics to Attitudes and Behaviors Regarding End-of-Life Care

“…This is consistent with prior research (e.g., Balboni et al, 2007;Caralis, Davis, Wright, & Marcial, 1993;Fischer et al, 2012;Hopp & Duffy, 2000;Johnson et al, 2008;Karches et al, 2012;Kwak & Haley, 2005;Smith et al, 2008;True et al, 2005), and the current study found this effect of ethnicity to be robust even after controlling for other personal characteristics such education, marital status, satisfaction with finances, and perceived health. Although not the primary focus of the present study, this suggests that sociocultural, familial, or relational aspects that could foster these differential views and behaviors are important to consider, and sensitivity to these factors is warranted when discussing EOL issues, particularly for health care providers, ministerial professionals, and those in the legal profession.…”

“…A number of studies have observed that ethnicity is related to views and behaviors involving end-oflife issues (e.g., Balboni et al, 2007;Fischer, Sauaia, Min, & Kutner, 2012;Johnson, Kuchibhatla, & Tulsky, 2008;Karches, Chung, Arora, Meltzer, & Curlin, 2012;Smith et al, 2008;True et al, 2005). Kwak and Haley (2005), in their review of 33 empirical studies, observed that non-White individuals were less likely than White persons to support advance directives, and that African American individuals consistently favored the use of life support.…”

“…For example, several studies using clinical samples (Balboni et al, 2007;Jacobs, Burns, & Jacobs, 2008;Phelps et al, 2009;Smith et al, 2008;True et al, 2005) have shown that individuals who tend to use religion to cope with stress and adversity are more likely to prefer pursuing heroic measures to extend one's life than individuals who don't use such religious coping, and also are less likely to have prepared an AD. Karches et al (2012), using a relatively large clinical sample (N = 8,308) of predominantly African American and female internal medicine patients, found that those with high intrinsic religiosity or high spirituality were more likely to have a designated decision-maker than those with low intrinsic religiosity or high spirituality. However, they found that individuals' religious characteristics were not significantly related to having an AD or a "do-not-resuscitate" order.…”

Patients' characteristics associated with the decision of “do not attempt cardiopulmonary resuscitation” order in a Swiss hospital

“…The protestant patients were older than catholic patients, but still remain an independent factor in the multivariate analyses. A previous study showed no association between religious characteristics and DNACPR order [32]. However, other publications showed that religious individuals more frequently want aggressive measures to extend life [33,34], but these studies did not make any differences between religions.…”

The role of religious beliefs in ethics committee consultations for conflict over life-sustaining treatment

“…Some have suggested that religious doctrine, participation in a religious community, support from a higher power, a belief in miracles or the belief that do not resuscitate (DNR) is morally wrong may be reasons that religion is associated with choosing more aggressive treatment or wanting cardiopulmonary resuscitation (CPR) 9 11–13. Karches et al ,14 however, suggest that not all dimensions of religion may be associated with more aggressive treatment, and that prior studies used different measures of religion including religious affiliation, religiosity or religiousness and religious coping to assess these relationships. Geros-Willfond et al 15 also note the diversity in perspectives around religion and surrogate decision-making, suggesting that there are complexities around the ways in which religion and/or spirituality may shape preferences, decisions and assent around end-of-life treatment.…”