Religiously affiliated intensive care unit patients receive more aggressive end-of-life care ("...does not translate into any significant difference in survival.")

J Surg Res. 2014 Jun 2. pii: S0022-4804(14)00540-X. doi: 10.1016/j.jss.2014.05.074. [Epub ahead of print]

Religiously affiliated intensive care unit patients receive more aggressive end-of-life care.

Shinall MC Jr1, Ehrenfeld JM2, Guillamondegui OD3.

Author information

• 1Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: Ricky.shinall@vanderbilt.edu.
• 2Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.
• 3Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.

Abstract

BACKGROUND:

Previous studies among cancer patients have demonstrated that religious patients receive more aggressive end-of-life (EOL) care. We sought to examine the effect of religious affiliation on EOL care in the intensive care unit (ICU) setting.

MATERIALS AND METHODS:

We conducted a retrospective review of all patients admitted to any adult ICU at a tertiary academic center in 2010 requiring at least 2 d of mechanical ventilation. EOL patients were those who died within 30 d of admission. Hospital charges, ventilator days, hospital days, and days until death were used as proxies for intensity of care among the EOL patients. Multivariate analysis using multiple linear regression, zero-truncated negative binomial regression, and Cox proportional hazard model were used.

RESULTS:

A total of 2013 patients met inclusion criteria; of which, 1355 (67%) affirmed a religious affiliation. The EOL group had 334 patients, with 235 (70%) affirming a religious affiliation. The affiliated and nonaffiliated patients had similar levels of acuity. Controlling for demographic and medical confounders, religiously affiliated patients in the EOL group incurred 23% (P = 0.030) more hospital charges, 25% (P = 0.035) more ventilator days, 23% (P = 0.045) more hospital days, and 30% (P = 0.036) longer time until death than their nonaffiliated counterparts. Among all included patients, survival did not differ significantly among affiliated and nonaffiliated patients (log-rank test P = 0.317), neither was religious affiliation associated with a difference in survival on multivariate analysis (hazard ratio of death for religious versus nonreligious patients 0.95, P = 0.542).

CONCLUSIONS:

Compared with nonaffiliated patients, religiously affiliated patients receive more aggressive EOL care in the ICU. However, this high-intensity care does not translate into any significant difference in survival.