Religious Coping and Use of Intensive Life-Prolonging Care Near Death in Patients With Advanced Cancer
Religious Coping and Use of Intensive Life-Prolonging Care Near Death in Patients With Advanced Cancer
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DOI：
10.1001/jama.2009.341
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发表时间：
2009-03-18
影响因子：
120.7
通讯作者：
Prigerson, Holly G.
中科院分区：
文献类型：
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作者：
Phelps, Andrea C.;Maciejewski, Paul K.;Prigerson, Holly G.
背景患者经常依靠宗教信仰来科普癌症，但对宗教应对和生命末期强化生命延长护理的使用之间的关联知之甚少。目的确定晚期癌症患者宗教应对与生命末期强化生命延长护理的使用之间的关系。2003年1月1日至2007年8月31日期间入组的345例晚期癌症患者的纵向队列。RCOPE评估了积极的宗教应对。基线访谈评估了社会心理和宗教/精神措施，提前护理计划和临终治疗偏好。患者随访至死亡，平均122天后基线assessment.Main结果指标强化生命延长护理，定义为接受机械通气或复苏的最后一周的生活。对与积极的宗教应对和任何临终结局显著相关的人口统计学因素（即年龄和种族/民族）进行了调整，P < .05。主要结果进一步调整了潜在的心理社会混杂因素结果基线时高水平的积极宗教应对与接受机械通气的患者相比，低水平的积极宗教应对与接受机械通气的患者相比，（11.3% vs 3.6%;校正比值比[AOR]，2.81 [95%置信区间{CI}，1.03-7.69]; P = .04）和生命最后一周内的强化生命延长护理（13.6% vs 4.2%; AOR，2.90 [ 95% CI，1.14-7.35]; P = .03）。在进一步调整其他应对方式的模型中，晚期疾病的承认，精神需求的支持，英雄主义的偏好，以及预先护理计划（不复苏令、生前遗嘱和医疗代理/持久授权书），积极的宗教应对仍然是临近死亡时接受强化生命延长护理的重要预测因素结论晚期癌症患者积极的宗教应对方式与临终前接受强化的延长生命的医疗护理有关。需要进一步的研究来确定这种关联的机制。
Context Patients frequently rely on religious faith to cope with cancer, but little is known about the associations between religious coping and the use of intensive life-prolonging care at the end of life.Objective To determine the way religious coping relates to the use of intensive life-prolonging end-of-life care among patients with advanced cancer.Design, Setting, and Participants A US multisite, prospective, longitudinal cohort of 345 patients with advanced cancer, who were enrolled between January 1, 2003, and August 31, 2007. The Brief RCOPE assessed positive religious coping. Baseline interviews assessed psychosocial and religious/spiritual measures, advance care planning, and end-of-life treatment preferences. Patients were followed up until death, a median of 122 days after baseline assessment.Main Outcome Measures Intensive life-prolonging care, defined as receipt of mechanical ventilation or resuscitation in the last week of life. Analyses were adjusted for demographic factors significantly associated with positive religious coping and any end-of-life outcome at P < .05 (ie, age and race/ethnicity). The main outcome was further adjusted for potential psychosocial confounders (eg, other coping styles, terminal illness acknowledgment, spiritual support, preference for heroics, and advance care planning).Results A high level of positive religious coping at baseline was significantly associated with receipt of mechanical ventilation compared with patients with a low level (11.3% vs 3.6%; adjusted odds ratio [AOR], 2.81 [95% confidence interval {CI}, 1.03-7.69]; P = .04) and intensive life-prolonging care during the last week of life (13.6% vs 4.2%; AOR, 2.90 [ 95% CI, 1.14-7.35]; P = .03) after adjusting for age and race. In the model that further adjusted for other coping styles, terminal illness acknowledgment, support of spiritual needs, preference for heroics, and advance care planning (do-not-resuscitate order, living will, and health care proxy/durable power of attorney), positive religious coping remained a significant predictor of receiving intensive life-prolonging care near death (AOR, 2.90 [95% CI, 1.07-7.89]; P = .04).Conclusions Positive religious coping in patients with advanced cancer is associated with receipt of intensive life-prolonging medical care near death. Further research is needed to determine the mechanisms for this association.