Association Between Self-reported Importance of Religious or Spiritual Beliefs and End-of-Life Care Preferences Among People Receiving Dialysis.

Autor:	Scherer JS; Division of Geriatrics and Palliative Care, Department of Internal Medicine, NYU Grossman School of Medicine, New York.; Division of Nephrology, Department of Internal Medicine, NYU Grossman School of Medicine, New York., Milazzo KC; Division of Geriatrics and Palliative Care, Department of Internal Medicine, NYU Grossman School of Medicine, New York.; Department of Spiritual Care, NYU Langone Health, New York., Hebert PL; Department of Health Services, University of Washington, Seattle.; US Department of Veterans Affairs (VA) Health Services Research and Development Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington., Engelberg RA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle.; Cambia Palliative Care Center of Excellence, University of Washington, Seattle., Lavallee DC; Department of Health Services, University of Washington, Seattle.; Department of Surgery, University of Washington, Seattle.; British Columbia Academic Health Science Network, Vancouver, British Columbia, Canada., Vig EK; Division of Geriatrics, Department of Medicine, University of Washington, Seattle.; Geriatrics and Extended Care, VA Puget Sound Health Care System, Seattle, Washington., Kurella Tamura M; Division of Nephrology, Stanford University Medical Center, Palo Alto, California.; Geriatric Research and Education Clinical Center and Division of Nephrology, VA Palo Alto Health Care System, Palo Alto, California., Roberts G; Kidney Research Institute, University of Washington, Seattle., Curtis JR; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle.; Cambia Palliative Care Center of Excellence, University of Washington, Seattle., O'Hare AM; US Department of Veterans Affairs (VA) Health Services Research and Development Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington.; Kidney Research Institute, University of Washington, Seattle.; Division of Nephrology, Department of Medicine, University of Washington, Seattle.; Hospital Specialty and Medicine Service, VA Puget Sound Health Care System, Seattle, Washington.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2021 Aug 02; Vol. 4 (8), pp. e2119355. Date of Electronic Publication: 2021 Aug 02.
DOI:	10.1001/jamanetworkopen.2021.19355
Abstrakt:	Importance: Although people receiving maintenance dialysis have limited life expectancy and a high burden of comorbidity, relatively few studies have examined spirituality and religious beliefs among members of this population. Objective: To examine whether there is an association between the importance of religious or spiritual beliefs and care preferences and palliative care needs in people who receive dialysis. Design, Setting, and Participants: A cross-sectional survey study was conducted among adults who were undergoing maintenance dialysis at 31 facilities in Seattle, Washington, and Nashville, Tennessee, between April 22, 2015, and October 2, 2018. The survey included a series of questions assessing patients' knowledge, preferences, values, and expectations related to end-of-life care. Data were analyzed from February 12, 2020, to April 21, 2021. Exposures: The importance of religious or spiritual beliefs was ascertained by asking participants to respond to this statement: "My religious or spiritual beliefs are what really lie behind my whole approach to life." Response options were definitely true, tends to be true, tends not to be true, or definitely not true. Main Outcomes and Measurements: Outcome measures were based on self-reported engagement in advance care planning, resuscitation preferences, values regarding life prolongation, preferred place of death, decision-making preference, thoughts or discussion about hospice or stopping dialysis, prognostic expectations, and palliative care needs. Results: A total of 937 participants were included in the cohort, of whom the mean (SD) age was 62.8 (13.8) years and 524 (55.9%) were men. Overall, 435 (46.4%) participants rated the statement about religious or spiritual beliefs as definitely true, 230 (24.6%) rated it as tends to be true, 137 (14.6%) rated it as tends not to be true, and 135 (14.4%) rated it as definitely not true. Participants for whom these beliefs were more important were more likely to prefer cardiopulmonary resuscitation (estimated probability for definitely true: 69.8% [95% CI, 66.5%-73.2%]; tends to be true: 60.8% [95% CI, 53.4%-68.3%]; tends not to be true: 61.6% [95% CI, 53.6%-69.6%]; and definitely not true: 60.6% [95% CI, 52.5%-68.6%]; P for trend = .003) and mechanical ventilation (estimated probability for definitely true: 42.6% [95% CI, 38.1%-47.0%]; tends to be true: 33.5% [95% CI, 25.9%-41.2%]; tends not to be true: 35.1% [95% CI, 27.2%-42.9%]; and definitely not true: 27.9% [95% CI, 19.6%-36.1%]; P for trend = .002) and to prefer a shared role in decision-making (estimated probability for definitely true: 41.6% [95% CI, 37.7%-45.5%]; tends to be true: 35.4% [95% CI, 29.0%-41.8%]; tends not to be true: 36.0% [95% CI, 26.7%-45.2%]; and definitely not true: 23.8% [95% CI, 17.3%-30.3%]; P for trend = .001) and were less likely to have thought or spoken about stopping dialysis. These participants were no less likely to have engaged in advance care planning, to value relief of pain and discomfort, to prefer to die at home, to have ever thought or spoken about hospice, and to have unmet palliative care needs and had similar prognostic expectations. Conclusions and Relevance: The finding that religious or spiritual beliefs were important to most study participants suggests the value of an integrative approach that addresses these beliefs in caring for people who receive dialysis.
Databáze:	MEDLINE
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