How can the nurse in her/his role as patient advocate be equipped to assist the patient and family in honoring their spiritual beliefs when considering end of life treatment?
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According to a study published this week in the journal of the American Medical Association, "cancer patients who rely on their faith to handle the stresses of serious illness and approaching death are more likely to receive aggressive care when they die".
In this study, nearly 80 percent of the 345 patients with advanced stages of various cancers said religion helped them cope, and about 32 percent reported that their faith was "the most important thing that keeps you going."
"Cancer patients who relied heavily on religious coping were less likely to understand a do-not-resuscitate order and felt that such an order was morally wrong. These patients were less likely to have advanced planning such as having a living will (29 percent, versus 68 percent who were less religious) or medical power of attorney, which is the ability to act on someone else's behalf (34 percent, versus 64 percent who relied less on religion)."
In interpreting the results, study lead author Andrea Phelps, MD says "beyond the significance of religious faith in coping with the emotional challenge of incurable cancer, it is important to recognize how religious coping factors into extremely difficult decisions confronting patients as their cancer progresses and death appears imminent. Beyond turning to doctors for advice, patients often look to god for guidance in these times of crisis."
Holly Prigerson, associate professor of psychiatry at Harvard Medical school says, "our results highlight how patients' ways of coping, particularly their use of religious coping, factor prominently into the ultimate medical care patients receive. This suggests that clinicians should be attentive to terminally ill patients' religious views as they discuss prognosis and treatment options with them. A greater understanding of the basis of patients' medical choices can go a long way toward achieving shared goals of care."
In the face of serious illness and/or impending death, a person's spiritual and religious beliefs will influence the choices and decisions regarding treatment.
During these times of health crisis, patients and families may not be sure what is ethical or appropriate. They may not have enough knowledge about their medical condition or understand the scope and meaning of the potential treatments. Nurses play a vital role in communicating with family, educating them and assisting them to make decisions that are congruent with their beliefs.
What are your experiences in dealing with spiritual issues during end of life care?
