The Association of Surrogate Decision Makers' Religious and Spiritual Beliefs With End-of-Life Decisions

Abstract

Context: Although religion and spirituality are important to surrogate decision makers, little is known about the role of religion in decision making regarding life sustaining treatments.Objectives: To determine the relationships between dimensions of religion and spirituality and medical treatment decisions made by surrogates. Methods:This prospective, observational study enrolled patient/surrogate dyads from three hospitals in one metropolitan area. Eligible patients were 65 years or older and admitted to the medicine or medical intensive care services. Baseline surveys between hospital days 2-10 assessed seven dimensions of religion and spirituality. Chart reviews of the electronic medical record and regional health information exchange 6 months after enrollment identified the use of life sustaining treatments and hospice for patients who died.Results: There were 291 patient/surrogate dyads. When adjusting for other religious dimensions, demographic, and illness factors, only surrogates' belief in miracles was significantly associated with a lower surrogate preference for DNR status (Adjusted odds Ratio (aOR) 0.39, 95%

Psychological Attachment Orientations of Surrogate Decision-Makers and Goals-of-Care Decisions for Brain Injury Patients in ICUs

“…Existing literature on racial differences have generally found that African-Americans are more likely to prefer aggressive LST than Caucasians, in-line with our findings ( 45 – 52 ). Furthermore, our religiosity findings are supported by previous evidence with patient populations that suggest religiosity is associated with preferences for cardiopulmonary resuscitation, mechanical ventilation, and hospitalization near death ( 53 – 56 ). Future studies should further explore the role of race and religiosity when surrogates are making decisions, as opposed to when patients are making decisions themselves.…”

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“…Self-reported religiosity but not the religion itself also had a slight but signi cant in uence on the opinion on necessary survival of close relatives in the whole study population. While in our study, self-reported religiosity was associated with a lower necessary survival chance to start a risky or uncomfortable treatment, a higher surrogate intrinsic religiosity was associated with lower patient receipt of life-sustaining treatments in adults and children [25] In a study in cancer patients, family caregivers and oncologists, male gender and having no religion was associated with approval of withholding life-sustaining measures. [26] In our multivariate subgroup analysis, religiosity was a signi cant explanatory variable in female but not in male respondents, indicating gender-speci c differences in the importance of religiosity in such decisions.…”

Assisted life termination and truth telling to terminally ill patients – a cross-sectional study of public opinions in Israel

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