Treatment preferences and advance care planning at end of life: The role of ethnicity and spiritual coping in cancer patients |
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Authors: | Gala True Etienne J Phipps Leonard E Braitman Tina Harralson Diana Harris William Tester |
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Institution: | (1) Albert Einstein Healthcare Network, Center for Urban Health Policy and Research, 1 Penn Boulevard, 19144 Philadelphia, PA |
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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.
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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