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Treatment preferences and advance care planning at end of life: The role of ethnicity and spiritual coping in cancer patients

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Annals of Behavioral Medicine

Abstract

Background:Although studies have reported ethnic differences in approaches to end of life, the role of spiritual beliefs is less well understood.Purpose: This study investigated differences between African American and White patients with cancer in their use of spirituality to cope with their cancer and examined the role of spiritual coping in preferences at end-of-life.Methods: The authors analyzed data from interviews with 68 African American and White patients with an advanced stage of lung or colon cancer between December 1999 and June 2001.Results: Similar high percentages of African American and White patients reported being “moderately to very spiritual” and “moderately to very religious.” African American patients were more likely to report using spirituality to cope with their cancer as compared to their White counterparts (p = .002). Patients who reported belief in divine intervention were less likely to have a living will (p = .007). Belief in divine intervention, turning to higher power for strength, support and guidance, and using spirituality to cope with cancer were associated with preference for cardiopulmonary resuscitation, mechanical ventilation, and hospitalization in a near-death scenario.Conclusions: It was found that patients with cancer who used spiritual coping to a greater extent were less likely to have a living will and more likely to desire life-sustaining measures. If efforts aimed at improving end-of-life care are to be successful, they must take into account the complex interplay of ethnicity and spirituality as they shape patients’ views and preferences around end of life.

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References

  1. SUPPORT Principal Investigators: A controlled trial to improve care for seriously ill hospitalized patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).Journal of the American Medical Association. 1995,274:1591–1598.

    Article  Google Scholar 

  2. Teno J, Lynn J, Connors Jr. AF, et al.: The illusion of end-of-life resource savings with advance directives. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment.Journal of the American Geriatrics Society. 1997,45:513–518.

    PubMed  CAS  Google Scholar 

  3. Teno JM, Stevens M, Spernak S, Lynn J: Role of written advance directives in decision making: Insights from qualitative and quantitative data.Journal of General Internal Medicine. 1998,13:439–446.

    Article  PubMed  CAS  Google Scholar 

  4. Baker ME: Economic, political, and ethnic influences on endof-life decision making: A decade in review.Journal of Health and Social Policy. 2002,14:27–39.

    Article  PubMed  Google Scholar 

  5. Koenig BA: Cultural diversity in decisionmaking about care at the end-of-life. In Field MJ, Cassel CK (eds),Approaching Death: Improving Care at the End of Life.Washington, DC: National Academy Press, 1997.

    Google Scholar 

  6. Blackhall LJ, Frank G, Murphy ST, et al.: Ethnicity and attitudes towards life sustaining technology.Social Science & Medicine. 1999,48:1779–1789.

    Article  CAS  Google Scholar 

  7. Blackhall LJ, Murphy ST, Frank G, Michel V, Azen S: Ethnicity and attitudes toward patient autonomy.Journal of the American Medical Association. 1995,274:820–825.

    Article  PubMed  CAS  Google Scholar 

  8. Caralis PV, Davis B, Wright K, Marcial E: The influence of ethnicity and race on attitudes toward advance directives, life-prolonging treatments, and euthanasia.The Journal of Clinical Ethics. 1993,4:155–165.

    PubMed  CAS  Google Scholar 

  9. Garrett JM, Harris RP, Norburn JK, Patrick DL, Danis M: Life-sustaining treatments during terminal illness: Who wants what?Journal of General Internal Medicine. 1993,8:361–368.

    Article  PubMed  CAS  Google Scholar 

  10. Hopp FP, Duffy SA: Racial variations in end-of-life care.Journal of the American Geriatrics Society. 2000,48:658–663.

    PubMed  CAS  Google Scholar 

  11. McKinley ED, Garrett JM, Evans AT, Danis M: Differences in end-of-life decision making among Black and White ambulatory cancer patients.Journal of General Internal Medicine. 1996,11:651–656.

    Article  PubMed  CAS  Google Scholar 

  12. Phipps E, True G, Harris D, et al.: Approaching the end of life: Attitudes, preferences, and behaviors of African American and White patients and their family caregivers.Journal of Clinical Oncology. 2003,21:549–554.

    Article  PubMed  Google Scholar 

  13. Waters CM: End-of-life care directives among African Americans: Lessons learned—A need for community-centered discussion and education.Journal of Community Health Nursing. 2000,17:25–37.

    Article  PubMed  CAS  Google Scholar 

  14. Waters CM: Understanding and supporting African Americans’ perspectives of end-of-life care planning and decision making.Qualitative Health Research. 2001,11:385–398.

    Article  PubMed  CAS  Google Scholar 

  15. Spears R, Drinka P, Voeks S: Obtaining a durable power of attorney for health care from nursing home residents.Journal of Family Practice 1993,36:409–413.

    PubMed  CAS  Google Scholar 

  16. Yellen S, Elpern E, Burton L: A preliminary investigation of opinions and behaviors regarding advance directives for medical care.Journal of Critical Care. 1993,2:161–167.

    Google Scholar 

  17. Mebane EW, Oman RF, Kroonen LT, Goldstein MK: The influence of physician race, age, and gender on physician attitudes toward advance care directives and preferences for end-of-life decision-making.Journal of the American Geriatrics Society. 1999,47:579–591.

    PubMed  CAS  Google Scholar 

  18. Heeren O, Mennon A, Raskin A, Ruskin P: Religion and end of life treatment preferences among geriatric patients.International Journal of Geriatric Psychiatry. 2001,16:203–208.

    Article  PubMed  CAS  Google Scholar 

  19. Koenig H: Use of religion by patients with severe medical illness.Mind/Body Medicine. 1997,2:31–43.

    Google Scholar 

  20. Koenig H, McCullough M, Larson DB:Handbook of Religion and Health. New York: Oxford University Press, 2001.

    Google Scholar 

  21. Pargament K:The Psychology of Religion and Coping: Theory, Resarch, and Practice. New York: Guilford, 1997.

    Google Scholar 

  22. Pargament KI, Koenig HG, Perez LM: The many methods of religious coping: Development and initial validation of the RCOPE.Journal of Clinical Psychology. 2000,56:519–543.

    Article  PubMed  CAS  Google Scholar 

  23. Koenig H, Larson D, George L, et al.: Does religious attendance prolong survival? A six year follow-up study of 3,968 older adults.Journals of Gerontology Series A—Biological Sciences and Medical Sciences. 1999,54:M370-M376.

    CAS  Google Scholar 

  24. Strawbridge W, Shema SJ, Cohen R: Religiosity buffers effects of some stressors on depression, but exacerbates others.Journal of Gerontological Social Sciences. 1998,53B:S118-S126.

    Google Scholar 

  25. Ott BB, Ehman JW, Short TH, Ciampa RC, Hansen-Flaschen J: Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill?Archives of Internal Medicine. 1999,159:1803–1806.

    Article  PubMed  Google Scholar 

  26. Koenig H, Pargament K, Kielsen J: Religious coping and health status in medically ill hospitalized older adults.The Journal of Nervous and Mental Disease. 1998,160:513–521.

    Article  Google Scholar 

  27. Bourjolly JN: Differences in religiousness among Black and White women with breast cancer.Social Work in Health Care. 1998,28:21–39.

    PubMed  CAS  Google Scholar 

  28. Ang DC, Ibrahim SA, Burant CJ, Siminoff LA, Kwoh CK: Ethnic differences in the perception of prayer and consideration of joint arthroplasty.Medical Care. 2002,40:471–476.

    Article  PubMed  Google Scholar 

  29. Picot SJ, Debanne SM, Namazi KH, Wykle ML: Religiosity and perceived rewards of Black and White caregivers.Gerontologist. 1997,37:89–101.

    PubMed  CAS  Google Scholar 

  30. Weeks M, Moore R: Ethnicity of interviewer effects on ethnic respondents.Public Opinion Quarterly. 1981,45:245–249.

    Article  Google Scholar 

  31. Evans ME, Mejia-Maya LJ, Zayas LH, Boothroyd RA, Rodriguez O: Conducting research in culturally diverse inner-city neighborhoods: Some lessons learned.Journal of Transcultural Nursing. 2001,12:6–14.

    Article  PubMed  CAS  Google Scholar 

  32. Oken MM, Creech RH, Tormey DC, et al.: Toxicity and response criteria of the Eastern Oncology Cooperative Group.American Journal of Clinical Oncology. 1982,6:649–655.

    Article  Google Scholar 

  33. Fetzer Institute/National Institute on Aging Working Group:Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research: A Report of the Fetzer Institute/ National Institute on Aging Working Group. Kalamazoo, MI: Fetzer Institute, 1999.

    Google Scholar 

  34. Underwood LG, Teresi JA: The daily spiritual experience scale: Development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health-related data.Annals of Behavioral Medicine. 2002,24:22–33.

    Article  PubMed  Google Scholar 

  35. Zinnbauer BI, Pargament KI, Cowell B, Rye M, Scott AB:Religion and Spirituality: Unfuzzying the Fuzzy. Annual meeting of the American Psychological Association. Toronto, Ontario, Canada: 1996.

  36. Lo B, Ruston D, Kates L, Arnold R, Cohen C: Discussing religious and spiritual issues at the end of life: A practical guide for physicians.Journal of the American Medical Association. 2002,287:749–754.

    Article  PubMed  Google Scholar 

  37. Glaser B, Strauss A:The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine, 1967.

    Google Scholar 

  38. Glaser B:Basics of Grounded Theory Analysis. Mill Valley, CA: Sociology Press 1992.

    Google Scholar 

  39. Muhr T:ATLAS.(qualitative analysis software). Berlin, Germany: Scientific Software Development: Sage, 1993–2001.

  40. Steinhauser KE, Christakis NA, Clipp EC, et al.: Factors considered important at the end of life by patients, family, physicians, and other care providers.Journal of the American Medical Association. 2000,284:2476–2482.

    Article  PubMed  CAS  Google Scholar 

  41. Astrow AB, Puchalski CM, Sulmasy D: Religion, spirituality, and health care: Social, ethical, and practical considerations.American Journal of Medicine. 2001,110:283–287.

    Article  PubMed  CAS  Google Scholar 

  42. Steinhauser KE, Christakis NA, Clipp EC, et al.: Preparing for the end of life: Preferences of patients, families, physicians, and other care providers.Journal of Pain and Symptom Management. 2001,22:727–737.

    Article  PubMed  CAS  Google Scholar 

  43. Steinhauser KE, Clipp EC, McNeilly M, et al.: In search of a good death: Observations of patients, families, and providers.Annals of Internal Medicine. 2000,132:825–832.

    PubMed  CAS  Google Scholar 

  44. Byock I:Dying Well: The Prospect for Growth at the End of Life. New York: Riverhead Books, 1997.

    Google Scholar 

  45. Sulmasy D: A biopsychosocial-spiritual model for the care of patients at the end of life.The Gerontologist. 2002,42:24–33.

    PubMed  Google Scholar 

  46. Koenig H: A commentary: The role of religion and spirituality at the end of life.The Gerontologist. 2002,42:20–23.

    PubMed  Google Scholar 

  47. Exline J, Yali A, Lobel M: When God disappoints: Difficulty forgiving God and its role in negative emotion.Journal of Health Psychology. 1999,4:365–379.

    Article  Google Scholar 

  48. Sulmasy DP, Terry PB, Weisman CS, et al.: The accuracy of substituted judgments in patients with terminal diagnoses.Annals of Internal Medicine. 1998,128:621–629.

    PubMed  CAS  Google Scholar 

  49. Terry PB, Vettese M, Song J, et al.: End-of-life decision making: When patients and surrogates disagree.Journal of Clinical Ethics. 1999,10:286–293.

    PubMed  CAS  Google Scholar 

  50. McKinley ED, Garrett JM, Evans AT, Danis M: Differences in end-of-life decision making among Black and White ambulatory cancer patients.Journal of General Internal Medicine. 1996,11:651–656.

    Article  PubMed  CAS  Google Scholar 

  51. Mills PJ: Spirituality, religiousness, and health: From research to clinical practice.Annals of Behavioral Medicine. 2002,24:1–2.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Albert Einstein Healthcare Network, Center for Urban Health Policy and Research, 1 Penn Boulevard, 19144, Philadelphia, PA

    Gala True Ph.D., Etienne J. Phipps Ph.D., Leonard E. Braitman Ph.D., Tina Harralson Ph.D., Diana Harris M.A. & William Tester M.D., F.A.C.P.

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  1. Gala True Ph.D.
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  2. Etienne J. Phipps Ph.D.
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  3. Leonard E. Braitman Ph.D.
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  4. Tina Harralson Ph.D.
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  5. Diana Harris M.A.
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  6. William Tester M.D., F.A.C.P.
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Additional information

Preparation of this article was supported by grant R21 NR05112-02 (Phipps) from the National Institute of Nursing Research. Portions of this article were presented as a poster at the conference, “Integrating Research on Spirituality and Health and Well-Being Into Service Delivery,” sponsored by the International Center for the Integration of Health and Spirituality, Bethesda, Maryland, on April 3, 2003.

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True, G., Phipps, E.J., Braitman, L.E. et al. Treatment preferences and advance care planning at end of life: The role of ethnicity and spiritual coping in cancer patients. ann. behav. med. 30, 174–179 (2005). https://doi.org/10.1207/s15324796abm3002_10

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  • DOI: https://doi.org/10.1207/s15324796abm3002_10

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