• Alexia M Torke, George Fitchett, Saneta Maiko, Emily S Burke, James E Slaven, Beth Newton Watson, Steven Ivy, and Patrick O Monahan.
• Indiana University (IU) Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA; IU Division of General Internal Medicine and Geriatrics, Indianapolis, Indiana, USA; Daniel F. Evans Center for Spiritual and Religious Values in Healthcare, IU Health, Indianapolis, Indiana, USA. Electronic address: atorke@iupui.edu.
• J Pain Symptom Manage. 2020 Feb 1; 59 (2): 261-269.

ContextAlthough religion and spirituality are important to surrogate decision makers, little is known about the role of religion in decision making regarding life-sustaining treatments.ObjectivesTo determine the relationships between dimensions of religion and spirituality and medical treatment decisions made by surrogates.MethodsThis prospective observational study enrolled patient/surrogate dyads from three hospitals in one metropolitan area. Eligible patients were 65 years or older and admitted to the medicine or medical intensive care services. Baseline surveys between hospital days 2 and 10 assessed seven dimensions of religion and spirituality. Chart reviews of the electronic medical record and regional health information exchange six months after enrollment identified the use of life-sustaining treatments and hospice for patients who died.ResultsThere were 291 patient/surrogate dyads. When adjusting for other religious dimensions, demographic, and illness factors, only surrogates' belief in miracles was significantly associated with a lower surrogate preference for do-not-resuscitate status (adjusted odds ratio [aOR] 0.39; 95% CI 0.19, 0.78). Among patients who died, higher surrogate intrinsic religiosity was associated with lower patient receipt of life-sustaining treatments within the last 30 days (aOR 0.66; 95% CI 0.45, 0.97). Belief in miracles (aOR 0.30; 95% CI 0.10, 0.96) and higher intrinsic religiosity (aOR 0.70; 95% CI 0.53, 0.93) were associated with lower hospice utilization.ConclusionFew religious variables are associated with end-of-life preferences or treatment. Belief in miracles and intrinsic religiosity may affect treatment and should be identified and explored with surrogates by trained chaplains or other clinicians with appropriate training.Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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