A study published in the October issue of JAMA Internal Medicine sought to determine how frequently surrogate decision-makers and healthcare professionals discuss religious or spiritual considerations during goals-of-care discussions in the intensive care unit.
Between Oct. 8, 2009, and Oct. 24, 2012, researchers examined roughly 250 goals-of-care conversations between surrogate decision-makers and healthcare professionals in 13 ICUs across the United States.
Analyses of the conversations revealed:
1. More than three quarters (77.6 percent) of the surrogate decision-makers said religion or spirituality is fairly or very important in their life.
2. Despite the important of religion or spirituality, this subject was discussed in only 40 (16.1 percent) of the conversations. More often than not, surrogates were the first to raise religious or spiritual considerations (26 of 40), not the healthcare professionals.
3. Regarding their religious or spiritual beliefs, surrogates were most likely to reference miracles (34 conversations), religious practices (19 conversations) and their religious community (eight conversations). The notion that the physician is God's instrument to promote healing and the interpretation that the end of life is a new beginning for their loved one also came up in four conversations.
4. In response to surrogates' religious or spiritual statements, the healthcare professionals studied were most likely to redirect the conversation to medical considerations (15 conversations), offer to involve hospital spiritual care providers or the patient's own religious or spiritual community (14 conversations), express empathy (13 conversations), acknowledge the surrogates' statements (11 conversations) or explain their own religious or spiritual beliefs (3 conversations).
5. In only eight conversations did healthcare professionals attempt to further understand surrogates' beliefs, for example, by asking questions about the patient's religion.
Ultimately, the researchers concluded that despite a relatively high degree of religiosity among the surrogate decision-makers, discussions of this considerations rarely took place and healthcare professionals rarely explored the patient's or family's religious or spiritual ideas.