By the time Stacie Davis’ mother was diagnosed with stomach cancer in the fall of 2005, the disease had advanced past the point of saving her.
As Davis tells her mother’s story, her voice slightly quavers. She knows what cancer can do, both as a daughter and as the nurse manager of oncology at Johnson City Medical Center.
Her mother and family had decided against heroic measures, but sometimes her mother seemed to forget.
“It was like she would say, ‘I’ve got to do something’ – almost like a panic,” Davis said. “I’d remind her that chemotherapy would only make her sicker and end her life sooner.”
Her mother was “a very strong woman, a great believer, very active in the church,” Davis recalled. “She always studied the Scriptures. But as with most people, fear stepped in for a while.”
Eventually, her mother accepted her approaching death and focused on final preparations, right down to what her grandson would wear to her funeral.
“It gave her a lot of peace to know that she had worked out the arrangements,” Davis said.
Both personally and professionally, Davis was intrigued by a study in the March 18 issue of the Journal of the American Medical Association. A team of researchers found that patients who were near death with advanced cancer and who drew on their religious faith to help cope with stress were three times more likely to receive intensive life-prolonging medical care than those who weren’t “religious copers.” Most of the patients in the study, which was conducted in New England and Texas, were Christians.
“Many people … assume that more religious patients would be less likely to pursue aggressive end-of-life care (such as mechanical ventilation and cardiopulmonary resuscitation) because they have peace with the idea of death because of faith in God and belief in an afterlife,” wrote the study’s lead author, Dr. Andrea Phelps of Beth Israel Deaconess Medical Center in Boston, in an e-mail this week. “Our results show that the influence of religious factors on care at the end-of-life is much more complicated.”
Religious copers were also less likely to have less advance-care planning, such as living wills or do-not-resuscitate orders. (Phelps pointed out that most religious copers did not receive aggressive end-of-life care; they just received it at greater rates than other patients.)
The researchers suggest several reasons for this connection: trust that God could heal them through the treatment or that they are working with God to overcome illness or bring about transformation through suffering.
“Alternatively, religious copers might feel they are abandoning a spiritual calling as they transition from fighting cancer to accepting the limitations of medicine and preparing for death,” they wrote. Other patients pursue life-sustaining treatments because of their belief that only God knows when it’s a patient’s time to die or, out of moral or religious conviction, place high value on prolonging life.
Davis hasn’t noticed a strong connection between a patient’s religion and decisions about life-prolonging therapy.
“What I have seen is that it is really more individualistic, as far as their life experience goes,” she said. “Some people feel like they’re done, and it’s OK. But I’ve had people who thought much more about the separation from a loved one, especially if they were caregivers. It’s feeling like their job is not done.”
Davis sees many deeply religious people decline life-extending treatment.
“They see it almost as a grace thing, like ‘Thy will be done,'” she said. “On the other hand, it’s a struggle for a lot of patients. At times they’re sure they know what God wants them to do, but like anyone they have doubts.”
A more common factor in treatment decisions, she said, is whether or not patients had indicated their wishes in advance.
“With advance directives you see a much calmer environment with the family,” she said. “It gives you a sort of control. People have thought about it and talked about it and have in a way rehearsed their roles.”
Davis’ mother lived until June 2006, long enough to see Davis’ son graduate from high school and celebrate three family birthdays, including her own.
“We wanted to go through the milestones with her,” Davis said. “But terminal patients can detach from this world and start looking forward to the next. We were glad she was there, but she was ready to move on.”
Johnson City (Tenn.) Press, 28 March 2009. Image: NIH Consensus Development Program.