Religious more likely to seek 'heroic measures,' Harvard study says

Patients who used religious faith to cope with their advanced cancer were three times more likely to receive intensive life-prolonging treatment than those not relying on spiritual beliefs, according to a Harvard University study.

The faith-oriented patients were more likely to use ventilation to breathe or have CPR administered in the week before they died, according to the study, published Tuesday in the Journal of the American Medical Association. They wanted physicians to take "heroic measures" to keep them alive, and were less likely to have do-not-resuscitate orders, living wills or someone designated as their health-care proxy.

It isn't clear why these patients pursue more aggressive treatment, said Andrea Phelps, a senior medical resident at Beth Israel Deaconess Medical Center in Boston and the study's lead author. It may be that people with a strong sense of faith are more optimistic or are more satisfied with their quality of life, Phelps said. Doctors should be sensitive to religious beliefs and help plan care accordingly, Phelps said.

"Advanced care planning is an important way we can, as physicians, understand a patient's wishes ahead of time, and try to achieve shared goals at the end of life," Phelps said in a telephone interview Tuesday. "And if you don't understand why a patient is making these decisions, you should ask. Physicians can't relegate all spiritual concerns to the chaplains."

About a third of the study's 345 patients said religion was the most important thing that kept them going, according to the report. These patients were more likely than the others to be younger, less educated, uninsured, and unmarried. About 79 percent of patients reported that religion helped them cope to some extent.

Only a third of highly religious patients had a do-not- resuscitate order, compared with half of patients who weren't as spiritual, the study found. Less than 30 percent of those who used religion to cope had a living will, compared with 68 percent of those who didn't rely on faith, and 34 percent of religious patients had named a health-care proxy compared with two-thirds of those who weren't using religion as strongly to carry on, the authors found.

"There's a presumption among religious people that God will provide," said David Paskinski, the executive director of Huntington Family Centers in Syracuse, New York, who worked as a hospice chaplain for 15 years. "Whether they say 'It's my time,' or 'It's in God's hands,' there's a way of looking at life's planning that makes them less likely to plan than others."

Religious authority figures should help patients consider their end-of-life choices, Paskinski said in a telephone interview Tuesday. He wasn't an author.

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