Does Religion Belong in the ICU?

Close relatives or friends often serve as surrogate decision-makers for patients in intensive care units. Physicians are usually comfortable answering their medical questions. But what happens when spiritual or religious issues arise in the context of end-of-life decisions?

Researchers at The University of Pittsburgh and colleagues at other institutions designed a multicenter prospective cohort study in which —after obtaining appropriate consent from participants--they taped conversations between these surrogates and physicians.

The conversations were all in the ICU setting.

Among their findings: discussion of religious or spiritual considerations occurred in fewer than 20% of conversations when physicians were speaking to surrogates who had “a relatively high degree of religiosity.”

That might not matter to most physicians, who, the team found, were more likely than surrogates to be agnostic, atheistic, or at least non-practicing when it came to following an organized religion.

But to the surrogates—most of whom were religious—the physicians’ avoidance of any expression of religious or spiritual sentiments was seen as a lapse.

That goes against recommendations that “health care professionals attend to the spiritual concerns of patients and their family members,” the authors note.

Physicians and nurses do not necessarily have to use religious language, or pray with patients. But they should express concern by “using open-ended questions, asking patients to say more, providing empathy, and involving spiritual care appropriately,” wrote Natalie Ernecoff, MPH and colleagues in an article in JAMA Internal Medicine.

The team also found that in their participant group, about 75% of the surrogates said they were Christian, compared to 44.1% of the physicians and other caregivers. More than a third (35.2% of the physicians said they were atheist, agnostic, or had no religious affiliation.

The authors said their study shows that in this era of patient-centered care, “developing strategies to ensure adequate exploration and integration of religious and spiritual consideration may be important” to ICU patients and their families.