Negotiating the religious obstacle course in end-of-life care and cancer care

As an upfront disclaimer I’ll note that I am an atheist.

Now that’s out of the way I’d like to think/write out loud about the problem of religion and spirituality in the care of cancer patients.

The role of religion in the overall outcome of cancer patients has been the subject of a lot of research and overall I’d have to say that the results are conflicting or inconclusive. There is no real evidence of improved outcomes with respect to the gold-standard – survival and/or cure. Spirituality and religiosity has however been associated with improved quality of life. There is mixed evidence, and this reflects my own experience, that religious individuals might choose less aggressive or more aggressive treatment at the end-of-life.

This makes it challenging for the clinician wanting to exploit religiosity for therapeutic ends. In some cases the religious person is sometimes reliant on their God for a miracle and to that end won’t accept a palliative pathway whereas in other cases the individual uses their faith as a crutch to help them deal with their impending death. Personally I feel that the latter pathway is the correct pathway from a theological perspective. My personal view is that many religious people don’t understand their religion (but again I’ll invoke my disclaimer at this point).

So what should the clinician do when it comes to intercalating a spiritual discussion into end-of-life care? The existing evidence suggests that access to spiritual care and support from spiritual care is low and also not provided by conventional medical systems. Yet it may play a role in helping individuals clarify their wishes. Should I as a clinician try to exploit spirituality to steer a patient to a conservative path of care? Alternately should I ask for a ‘religion consult’ in the same way that I might ask for a ‘cardiology consult’?

At the end of the day, and until there is more evidence, I think the clinician needs to tailor these discussions based on their gut instinct but I tell you now, it takes a lot of practice.

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