Patient Surrogate’s Spiritual Beliefs Impact Hospice Election

The spiritual beliefs of not only patients but their surrogate decision makers play a significant role in whether a terminally ill individual will enter hospice. 

Specifically, a surrogate’s belief in the existence of miracles has a significant influence on end-of-life care decisions. Surrogates who believe in miracles are less likely to elect hospice on behalf of the patient according to new research in the Journal of Pain and Symptom Management.

“The most important implication is about how family members of incapacitated patients might go about the process of thinking about hospice and choosing it for a family member or loved one. Anyone who talks to people about the process of making a decision about hospice will see that religion and spirituality often enter into it, as they do with any of these big life and death decisions,” said Alexia Torke, M.D., associate professor at Indiana University, investigator at the Regenstrief Institute, and co-author of the study. “Enrolling in hospice involves kind of a process of coming to terms with the fact that the prognosis is limited, and may in fact, be limited to six months or less, in order to accept that [hospice] might be the best course of care. Questions of religion, spirituality, are often important in that context.” 


For this study, researchers asked surrogates of nonresponsive patients from three hospitals in one metropolitan area to complete surveys designed to assess seven aspects of religious and spiritual belief. The patients were 65 or older and admitted to either the medicine or medical intensive care services. The surrogates were predominantly next of kin such as a spouse or child.

The researchers conducted chart reviews and regional health information exchange data six months after the patient/surrogate pairs were enrolled in the study to determine which continued to pursue life-sustaining treatment and which opted to enter hospice.

Religious belief in general had little impact on hospice election, but belief in miracles in particular did play a significant role in end-of-life decisions. The study concluded that chaplains and other trained clinicians should explore belief in miracles with patients and families while discussing goals of care.


“There has been a kind of misconception that certain types of religious people don’t accept hospice, and one of the goals of this paper was to show that it’s a little more complicated,” Torke told Hospice News. “There are specific beliefs that are associated with reluctance to enroll in hospice, but it’s not just religion in a general sense. Many religious and spiritual variables were actually not associated with hospice enrollment, such as whether people engage in prayer and other practices.” 

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