• Justin J Sanders, Vinca Chow, Andrea C Enzinger, Tai-Chung Lam, Patrick T Smith, Rebecca Quiñones, Andrew Baccari, Sarah Philbrick, Gloria White-Hammond, John Peteet, Tracy A Balboni, and Michael J Balboni.
• 1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.
• J Palliat Med. 2017 Oct 1; 20 (10): 1059-1067.

BackgroundPeople with serious illness frequently rely on religion/spirituality to cope with their diagnosis, with potentially positive and negative consequences. Clergy are uniquely positioned to help patients consider medical decisions at or near the end of life within a religious/spiritual framework.ObjectiveWe aimed to examine clergy knowledge of end-of-life (EOL) care and beliefs about the role of faith in EOL decision making for patients with serious illness.DesignKey informant interviews, focus groups, and survey.Setting/SubjectsA purposive sample of 35 active clergy in five U.S. states as part of the National Clergy End-of-Life Project.MeasurementWe assessed participant knowledge of and desire for further education about EOL care. We transcribed interviews and focus groups for the purpose of qualitative analysis.ResultsClergy had poor knowledge of EOL care; 75% desired more EOL training. Qualitative analysis revealed a theological framework for decision making in serious illness that balances seeking life and accepting death. Clergy viewed comfort-focused treatments as consistent with their faith traditions' views of a good death. They employed a moral framework to determine the appropriateness of EOL decisions, which weighs the impact of multiple factors and upholds the importance of God-given free will. They viewed EOL care choices to be the primary prerogative of patients and families. Clergy described ambivalence about and a passive approach to counseling congregants about decision making despite having defined beliefs regarding EOL care.ConclusionsPoor knowledge of EOL care may lead clergy to passively enable congregants with serious illness to pursue potentially nonbeneficial treatments that are associated with increased suffering.

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