As much as instinct might suggest otherwise, a new study reveals that, in fact, religious and spiritual discussions aren’t a big part of a person’s end-of-life experience. And this is the case particularly where ICU physicians are concerned.
The discussion of religious or spiritual considerations occurs in fewer than 20 percent of goals-of-care conferences in intensive care units according to a study just published in JAMA Internal Medicine, and healthcare professionals rarely explored the patient’s or family’s religious or spiritual ideas.
And this is the case in spite of the fact that many patients and their families regard religion and spirituality as important near end of life.
Dr. Douglas B. White and colleagues from the University of Pittsburgh School of Medicine recorded conversations from 2009 to 2012, in 13 ICUs at six medical centres across the States. The final sample yielded 249 goals-of-care conversations between 457 surrogate decision makers, and 145 healthcare professionals concerning the care of 249 ICU patients.
Out of 249 recorded meetings, only 40 touched on religious or spiritual conversations.
Just the same, of the 457 surrogate decision-makers, a full 77.6 percent of them said religion or spirituality was fairly or very important in their life.
In an accompanying opinion piece regarding the study’s findings, Dr. Tracy A. Balboni of the Dana-Farber Cancer Institute in Boston addressed this apparent irony thus: “The findings … regarding the silence surrounding religion and/or spirituality in IC conversations are loud and clear.”
But the definitions the authors assigned to denote religious and spiritual themes are not well explained, she feels. “Their concept of religion and/or spirituality appears largely to be framed by what colloquially might be termed ‘religious,’” she wrote.
“Understanding the definition is critical to interpreting these frequencies and placing them in proper context, particularly because the de-facto definition may leave spiritual concepts unidentified.
Given the stated importance of religion to most surrogates, she says, it’s unclear how many didn’t raise the subject because they preferred that these values not be discussed, didn’t find them relevant to the conversation, or didn’t feel the freedom to raise this topic, particularly given the medical team’s “lack of attention to these matters.”
Among the healthcare professionals surveyed for this research, the three largest affiliations were agnostic or atheist (51), Catholic (30) and protestant (29). And among surrogates, the top three were protestant (216), Catholic (119), and agnostic or atheist (62).
In all, five themes were identified in the religious conversations. The most common one — present in 15 of the talks — was a statement made by the surrogate that they believed that God is ultimately responsible for physical and spiritual health. This category included statements about miracles.
At the end of the day, the researchers concede that certain critical questions in this area remained unanswered, such as whether healthcare professionals are capable of integrating religion and/or spirituality into healthcare discussions, or if they can meet the larger goal of “providing value-sensitive holistic care in the ICU.”
This research arrives on the heels of a trio of recent studies that indicate that there is a significant link between religion, spirituality and outcomes for cancer patients’ mental, social and physical well-being.