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

JAMA. 2009;301(11):1140-1147.

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}, 1.03-7.69]; 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 Affiliations: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Phelps); Center for Psycho-Oncology and Palliative Care Research (Drs Phelps, Maciejewski, Balboni, Wright, Trice, and Prigerson and Mr Nilsson) and Departments of Radiation Oncology (Dr Balboni), Medical Oncology (Drs Wright, Trice, and Schrag), and Psycho-oncology and Palliative Care (Drs Peteet, Block, and Prigerson), Dana-Farber Cancer Institute, Boston, Massachusetts; Parkland Hospital and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (Dr Paulk); Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts (Drs Maciejewski, Peteet, Block, and Prigerson); and Harvard Medical School Center for Palliative Care, Boston, Massachusetts (Drs Block and Prigerson).

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