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In Reply: Dr van Laarhoven and colleagues note that the association we reported between positive religious coping and receipt of intensive life-prolonging care may not be generalizable to non-Christian populations. It is true that many items in the RCOPE¹ and Brief RCOPE² questionnaires presuppose faith in a relational God (eg, "I tried to see how God might be trying to strengthen me in this situation."). It is also correct that these surveys were validated among predominantly Christian patient samples. Because only 11.6% of participants in the Coping with Cancer study did not endorse a Christian religious affiliation, the Brief RCOPE was a well-suited measurement of religious coping in this sample. We agree that patients who adhere to nonpersonal views of God may have differing attitudes toward death and end-of-life care.

The letter from van Laarhoven et al also highlights the need for a fuller understanding of how religion or spirituality . . . [Full Text of this Article]

Andrea C. Phelps, MD
Department of Medicine
Beth Israel Deaconess Medical Center
Boston, Massachusetts

Paul K. Maciejewski, PhD; Holly G. Prigerson, PhD
holly_prigerson@dfci.harvard.edu
Center for Psycho-oncology and Palliative Care Research
Dana-Farber Cancer Institute
Boston

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