Clergy Religious Beliefs Are Associated With Greater ICU Care in Congregants’ Final Days


Key Points

  • A majority of survey respondents affirmed miracles and sanctity of life in congregants’ theological statements in end-of-life medical decisions. A minority affirmed God is in control and redemptive suffering.
  • Clergy endorsement of theological beliefs was strongly correlated with not having end-of-life discussions with congregants.
  • A lack of clergy-congregant discussion of hospice predicted less hospice utilization and increased ICU care. Clergy endorsement that God is in control was the only theological belief predicting ICU use in the final week of life.

A survey exploring the relationship between spiritual support and end-of-life care by evaluating clergy members’ opinions and experiences related to care provided to congregants at the end of their life has found that a majority of clergy endorse religious beliefs regarding their congregants’ medical care. Eighty-six percent of respondents affirmed belief in a miraculous cure, and 54% agreed that the congregant should accept every medical treatment out of religious obligations.

These beliefs, according to the study findings, are associated with greater intensive care unit (ICU) care in their congregants’ final days. The study (Abstract 223) by Balboni et al was presented during the 2015 Palliative Care in Oncology Symposium in Boston.

Study Methodology

The researchers used data supplied from a survey they conducted as part of the National Clergy Project on End-of-Life Care, a National Cancer Institute–funded study. The study included responses from 1,665 U.S. clergy randomly selected from a database of 368,408 congregations. The survey was conducted via direct mail, telephone, and e-mail. Data collection occurred between August 2014 and March 2015.

The survey recipients were asked to rate their level of affirmation of six statements that assessed theological beliefs influencing medical decisions by patients who were “extremely likely to die in the next 6 months.”

The respondents reported endorsement of religious beliefs about the congregant’s end-of-life care, including miracles, sanctity of life, divine sovereignty, and redemptive suffering. The clergy members reported on their last experience in spiritual caregiving to a dying congregant, including the congregant’s care location in the final week of life. The primary outcome was any ICU care in the final week of life.

Study Results

The survey findings showed that most (86%) respondents affirmed belief in a miraculous cure; 54% agreed that the congregant should accept every medical treatment out of religious obligations. A minority of clergy affirmed that belief in divine sovereignty relieved congregants of future medical decisions (28%) and that they should endure medical procedures because suffering is God’s test (27%).

In multivariable analyses, higher religious beliefs about congregants’ end-of-life care (RBEC) scores were associated with a greater likelihood of any ICU utilization in the last week (adjusted odds ratio [AOR] = 1.28, P =.02), with belief in divine sovereignty being the strongest predictor (AOR = 2.1, P = .005). Predictors of having greater RBEC scores included being Hispanic (AOR = 3.35, P < .001) or black (AOR = 3.0, P < .001) as compared to white, and being Pentecostal (AOR = 3.54, P < .001) or Evangelical (AOR = 2.12, P < .001) as compared to clergy self-identified as liberal.

“A majority of clergy endorse religious beliefs regarding their dying congregants’ [end-of-life] medical care; these beliefs are associated with greater ICU care in the final days of life for congregants. Future research is needed to determine religiously consistent approaches to clergy [end-of-life] education to mitigate aggressive interventions at the [end of life],” concluded the researchers.

The study authors reported no conflicts of interest. This study was funded by the National Cancer Institute.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.