Treatment preferences and advance care planning at end of life: The role of ethnicity and spiritual coping in cancer patients

Background: Although studies have reported ethnic differences in approaches to end of life, the role of spiritual beliefs is less well understood. Purpose: This study investigated differences between African American and White patients with cancer in their use of spirituality to cope with their cancer and examined the role of spiritual coping in preferences at end-of-life. Methods: The authors analyzed data from interviews with 68 African American and White patients with an advanced stage of lung or colon cancer between December 1999 and June 2001. Results: Similar high percentages of African American and White patients reported being "moderately to very spiritual" and "moderately to very religious." African American patients were more likely to report using spirituality to cope with their cancer as compared to their White counterparts (p =.002). Patients who reported belief in divine intervention were less likely to have a living will (p =.007). Belief in divine intervention, turning to higher power for strength, support and guidance, and using spirituality to cope with cancer were associated with preference for cardiopulmonary resuscitation, mechanical ventilation, and hospitalization in a near-death scenario. Conclusions: It was found that patients with cancer who used spiritual coping to a greater extent were less likely to have a living will and more likely to desire life-sustaining measures. If efforts aimed at improving end-of-life care are to be successful, they must take into account the complex interplay of ethnicity and spirituality as they shape patients' views and preferences around end of life.