U.S. Clergy Religious Values and Relationships to
End-of-Life Discussions and Care
Michael J. Balboni, PhD, ThM, MDiv, Adam Sullivan, PhD, Andrea C. Enzinger, MD, Patrick T. Smith, MDiv, PhD, Christine Mitchell, MDiv, John R. Peteet, MD, James A. Tulsky, MD, Tyler VanderWeele, PhD, and Tracy A. Balboni, MD, MPH
Context. Although clergy interact with approximately half of U.S. patients facing end-of-life medical decisions, little is known about clergy-congregant interactions or clergy influence on end-of-life decisions.
Objective. The objective was to conduct a nationally representative survey of clergy beliefs and practices.
Methods. A mailed survey to a nationally representative sample of clergy completed in March 2015 with 1005 of 1665 responding (60% response rate). The primary predictor variable was clergy religious values about end-of-life medical decisions, which measured belief in miracles, the sanctity of life, trust in divine control, and redemptive suffering. Outcome variables included clergy-congregant end-of-life medical conversations and congregant receipt of hospice and intensive care unit (ICU) care in the final week of life.
Results. Most U.S. clergy are Christian (98%) and affirm religious values despite a congregant’s terminal diagnosis. Endorsement included God performing a miracle (86%), pursuing treatment because of the sanctity of life (54%), postponement of medical decisions because God is in control (28%), and enduring painful treatment because of redemptive suffering (27%). Life-prolonging religious values in end-of-life medical decisions were associated with fewer clergy-congregant conversations about considering hospice (adjusted odds ratio [AOR], 0.58; 95% CI 0.42e0.80), P < 0.0001), stopping treatment (AOR 0.58, 95% CI 0.41e0.84, P 1⁄4 0.003), and forgoing future treatment (AOR 0.50, 95% CI 0.36e0.71, P < 0.001) but not associated with congregant receipt of hospice or ICU care. Clergy with lower medical knowledge were less likely to have certain end-of-life conversations. The absence of a clergy-congregant hospice discussion was associated with less hospice (AOR 0.45; 95% CI 0.29e0.66, P < 0.001) and more ICU care (AOR 1.67; 95% CI 1.14e2.50, P < 0.01) in the final week of life.
Conclusion. American clergy hold religious values concerning end-of-life medical decisions, which appear to decrease end- of-life discussions. Clergy end-of-life education may enable better quality end-of-life care for religious patients. J Pain Symptom Manage 2017;-:-e-. ! 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.