End of Life Decisions by Adults with Cancer : Role of Religious Practices and Spiritual Beliefs Rudolph M. Navari, M.D., Ph.D. Assistant Dean and Director Indiana University School of Medicine Director, Notre Dame Cancer Institute
End of Life Decisions • Do cancer patients receiving treatment have an advance directive? • What are the influencing factors on end of life decisions? • What is role of religious practices or spiritual beliefs?
End of Life Decisions • Two community oncology practices • Patient interview during an office visit • Interviewer unknown to patient • Family member or significant other may be present • Interview instrument: 30 questions, 20 -30 minutes
End of Life Decisions • Interview Specific and open ended questions Advance directive? Influences on end of life decisions? Religious/Spiritual affiliations/practices? Family discussions? Physician discussions?
End of Life Decisions • Patient Characteristics - 353 consecutive patients - 339 completed interview - Advanced cancer receiving active treatment (chemotherapy, radiation, hormonal therapy) - Common cancers (lung, breast, prostate, colon)
End of Life Decisions • Patient characteristics - Age (mean): 66.2 yrs - Gender: 52.7% female - Marital Status: Married: 57% Single: 18% Separated, Divorced, Widowed: 25%
End of Life Decisions • Patient characteristics (No. Patients, %) - Race: Caucasian: 197 (58%) African-American: 104 (30%) Hispanic: 38 (11%) - Education: High School: 206 (61%) College: 61 (18%)
End of Life Decisions • Religious / Spiritual Affiliation - Christian: 210 (61.9%) - Muslin: 23 ( 6.7%) - Jewish: 20 ( 5.9%) - Other: 24 ( 7.1%) - None: 62 (18.3%)
End of Life Decisions • Religious / Spiritual Practices - Group Activity Weekly: 203 (59.8%) - Individual Activity Weekly:156 (46.0%) - Prayed Daily: 51 (15.1%)
End of Life Decisions • Advance Directive - Total: 173 (51.0%) Living Will: 156 (46.0%) DPA: 17 ( 5.0%)
End of Life Decisions • Major Influences - Family Discussions: 214 (63%) - Quality of Life: 190 (56%) - Personal Experiences: 170 (50%) - Religious/Spiritual Beliefs: 163 (48%) - Financial Burdens: 140 (41%) - Physician Discussions: 135 (39%) - Individuals: 33 (10%)
End of Life Decisions Factors Associated with Advance Directives - Specific Religious Affiliation - Participated in daily or weekly religious / spiritual practices - Family discussions - Physician discussions
End of Life Decisions • Conclusions In a patient population with potentially life threatening disease, religious and spiritual affiliations and practices, as well as discussions with family and physicians, appear to significantly influence end of life decisions.