High spiritual support linked to more aggressive end-of-life care
EXECUTIVE SUMMARY
Patients with high spiritual support were more likely to receive aggressive end-of-life medical treatment, according to a recent study. However, palliative care experts have found the opposite to be true.
- The goal of palliative care is for people to exercise their own treatment preferences, whatever these are.
- Discussions about how patients' religious and spiritual beliefs affect their treatment choices are needed.
- Bioethicists can encourage institutions to develop systems to ensure discussions occur before a crisis.
Patients with high spiritual support were less likely to receive hospice care, and more likely to receive aggressive end-of-life medical treatment, according to a recent study.1
However, George Handzo, BCC, CSSBB, director of health services research and quality at the HealthCare Chaplaincy Network in New York, NY, says it's still unclear whether there is an actual link between less hospice care and spiritual support, and that more research is needed to determine this.
"We shouldn't be rushing to judgment about what is good or bad for individuals, because people have a right to decide for themselves," he adds. A certain percentage of people will choose aggressive care, and should have the opportunity to do so, he says.
"We assume that hospice use is good and aggressive care is bad; and so, we get in an uproar because here are people who apparently are not choosing hospice and are choosing aggressive care," he says.
The goal of palliative care is for people to exercise their own treatment preferences, whatever these are, says Handzo.
J. Vincent Guss, Jr., director of medical bioethics at Kaiser Permanente West Los Angeles (CA) Medical Center, says that based on his own experience as a hospital chaplain and clinical ethicist, he has found that individuals who are more spiritual are more likely to use hospice care, rather than less likely.
"Those who receive spiritual support from their communities are more likely to engage in end-of-life discussions; avoid non-beneficial, aggressive interventions; and welcome hospice care," he says.
Discussions needed earlier
The study's findings underscore that a better job needs to be done in having discussions with people about their religious and spiritual beliefs and how these affect their treatment choices, according to Handzo.
"We don't do that often enough or in-depth enough," he says. "It may be that lack of those discussions leads to more use of aggressive care and less use of hospice care."
Some patients choose aggressive care because they believe their religion requires them to do everything possible to preserve life, and may need to arrive at a deeper understanding, adds Handzo. "Until you talk it out, people may take a very simplistic view of it. This is something that is not addressed in their churches, synagogues, or mosques," he says.
Handzo says that bioethicists should "redouble our efforts to find out what each patient and family wants, and help them to have a full look at their belief systems. Right now, we have holes in the process."
Better systems are needed to ensure that those discussions are held with patients and families before a crisis occurs, however.
"Bioethicists can play a key role in reminding the institution that it has a duty to build these systems upfront, and to deliver care that respects patients' choices," emphasizes Handzo.
- Balboni TA, Balboni M, Enzinger AC, et al. Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life. JAMA Intern Med 2013;173(12):11091117.
- George Handzo, BCC, CSSBB, Director of Health Services Research and Quality, HealthCare Chaplaincy Network, New York, NY. Phone: (212) 644-1111 ext. 234. E-mail: [email protected].
- J. Vincent Guss, Jr., Director of Medical Bioethics, Kaiser Permanente West Los Angeles (CA) Medical Center. E-mail: [email protected].
