Access to the PPM Journal and newsletters is FREE for clinicians.
10 Articles in Volume 17, Issue #7
Abuse-Deterrent Opioids: Why Rush to Judgment?
Alcohol Screen Recommended to Reduce Opioid-Induced Respiratory Depression Overdose
Ehlers-Danlos Syndrome: An Emerging Challenge for Pain Management
Guide to Laboratory Testing in Patients With Suspected Rheumatic Disease
Letters to the Editor: Arachnoiditis, Hormone Testing, Ehlers-Danlos Syndrome
Neurocognitive Disorders: Pain Expression in the Face of Mental Deficits
Preemptive and Preventive Analgesia for Chronic Postsurgical Pain
The Effects of Religion and Spirituality on Coping Efficacy for Death and Dying
Topical Nonsteroidal Anti-inflammatory Drugs and Nephrotoxicity: Is There a Safer Option?
Transformative Care for Chronic Pain and Addiction

The Effects of Religion and Spirituality on Coping Efficacy for Death and Dying

Clear practitioner-patient communication offers patients who are dying the best chance of achieving a “good death.”

Western culture has altered the concept of dying and death into a medical condition that should be delay

A high amount of uncertainty will produce anxiety and fear.10,16-18 In addition to causing anxiety, not accepting death as a natural part of life can lead to unpleasant situations, such as unnecessary suffering at the end of life, unwanted treatments, and regret.21

To prevent the loneliness and fear that dying cancer patients and their informal caregivers may face when they’ve avoided the impending end of life in the final days, experts are advocating for a movement toward a “good death.”7,8,19

A good death is highly variable and specific to each individual and may involve the following elements:7,19

  • Awareness and acceptance
  • Open communication
  • Well-managed pain
  • A sense of completion with one’s life
  • Participation in end-of-life decisions
  • Care that encompasses the whole person, not just the disease

However, because of the diversity in the way patients describe their expectations, communication is the most critical element and is essential to ensure that the patient’s views are understood in order to establish the chance for clinicians to foster a “good death.”

Pain patients who turn to faith cope better when dying or facing death.

Being open to discussion is a good first step because it can decrease the amount of uncertainty and fear that surround the topic of death and dying.8,9,20 Being open is a step toward information seeking, which is related to many positive outcomes, including increased perceptions of control,21 better coping ability,22 and decreased anxiety and fear.19,23,24 However, just being open to having a discussion can be a difficult first step. Past research has suggested that to carry out information-seeking behaviors, individuals need to believe they can cope with the knowledge that arises as a result.9

Spirituality Can Enhance the Ability to Cope

One factor that enables patients and their caregivers to cope better is having a religion, faith, or some form of spirituality,25 which encourages a more positive outlook on how cancer affects their lives.26 Religion can also be a means of resolving the existential uncertainty of what comes after life on earth.27

It also may provide extended social support from within the faith-based community. Elisabeth Kübler-Ross, MD, wrote on death and dying, “The most important communication, perhaps, is the fact that we let him know that we are ready and willing to share some of his concerns.”28 This type of support can help other individuals open up about discussing the patient’s death; otherwise, avoidance, anxiety, and fear will likely increase. With information seeking through open discussion and communication, the patient and the family have the best chance of attaining peace.18

Some religions, such as Christianity, Buddhism, and Judaism, have a belief in the afterlife that lowers the level of uncertainty, and by extension, the level of anxiety about dying.29 The afterlife, which can be defined as any state of mind or state of being that occurs after one has left this earth, has many different forms in different religions but serves the same purpose. Christians believe in heaven and hell and that all humans will eventually go to one or the other after death. Muslims believe in paradise, which is similar but not equivalent to Christianity’s heaven. Buddhists and Hindus believe people are reincarnated, or come back to this world as new beings, until enlightenment (ie, nirvana) is reached.

Overall, believing in the concept of an afterlife may direct the way people behave while living.2 Having faith in some form of existence after death may decrease the uncertainty discrepancy because believers anticipate and have a concept of life in the hereafter. Knowing that the patient with cancer is going to “a better place” may also help caregivers cope with the death or dying of the patient.

However, it is important to note that whereas positive religious practices can have these positive effects, negative religious practices (eg, blaming God and cursing bad karma) can have harmful costs for the patients in chronic pain.30,31 Presumably, the same applies to caregivers of patients, as patient symptom distress is tied to caregiver burden.32

Much research has been done on caregivers and how they help patients, which stresses they may experience, and how they cope with those stresses. According to the National Family Caregivers Association, there are over 65 million caregivers in the United States, and 59% to 75% are women.33,34 In addition, the number of informal caregivers is predicted to rise as the average lifespan grows, and advances in medicine may be able to extend the lives of terminally ill patients.35 However, death eventually does come to terminally ill patients.

During the last months of a terminal illness, open and clear communication is important to ensure adequate social support for all concerned.8,36 Caregivers will be better able to make effective healthcare decisions knowing the patient’s values, such as the notion of quality versus quantity of life.37

Open communication affects caregivers directly in a role that is already stressful and demanding, both emotionally and physically. When caregivers are reluctant to share their needs and worries with others, it is likely to have a negative effect on their care-providing abilities.38-40 To help family members cope with the burdens of caring for a loved one, many turn to religion or spirituality.

Spirituality is a belief in a transcendent power that controls at least some forces in individuals’ lives.41 Religion is a group or organization of people who have a shared system of beliefs, rituals, practices, and symbols, which strengthen or facilitate their relationship with a sacred being.41 Even though religion and spirituality are different concepts, they do overlap in many ways in the caregiver context.42,43

Taylor found that caregivers, like the cancer patients they care for, had spiritual needs, such as the need to have meaning, to consider beliefs, and to rely on their religion in preparing for death.25 Chang et al and Koenig et al found that religion and spirituality strengthened the relationship between patient and informal caregiver, and improve their ability to cope with distress.44,45

The researchers did not measure differences in the level of communication, which act as a moderator or mediator of relationship strength and coping ability. Hebert and colleagues reviewed published literature on religion/ spirituality and informal caregiver well-being but found no clear association.46 This lack of clinical evidence was attributed to the multidimensionality of religion and well-being outcomes. However, other studies have clearly found that religious/spiritual exercises (eg, prayer and prayer circles, trusting in God, meditation, etc.) to be effective coping strategies for caregivers of patients with Alzheimer’s disease.47,48

Caregiving is an emotionally, financially, and physically challenging and depleting experience, especially when the patient is facing imminent death. One factor that may help caregivers cope with death is religion or spirituality, which has been suggested to help caregivers understand and deal with a diagnosis and death of a loved one.49    

The Theory of Motivated Information Management is an uncertainty management theory that explains both why and how individuals manage their uncertainties, but also introduces efficacy into the equation and recognizes the information provider’s role. This will be explored in the next article in this series.

Last updated on: November 9, 2017
Continue Reading:
Pain, Sleep & Suicide: The Core Role of Interventional Care

Join The Conversation

Register or Log-in to Join the Conversation
close X