Influence of Religion and Spirituality in Cancer Care

In the United States, there are nearly 2 million new cancer diagnoses each year. After these patients are diagnosed, most patients will have to make significant, life-altering decisions regarding their treatment and care. While some decisions may seem straight forward, many patients face uncertainties surrounding diagnosis and prognosis, challenging treatment‐related decisions, as well as consideration of prolonged therapies that do not come with any guarantees of cure. To make these incredibly difficult decisions, many patients will reflect on their own values and belief systems. For many patients, this will include their religious and spiritual beliefs. The influence of religion and spirituality in cancer care is not limited to just patients; these belief systems may also influence the provider in the treatment decision making process. Consequently, our study team undertook a systematic review to best understand the influence of patient and provider spiritual beliefs on the cancer treatment decision making process.

As a result of our systematic search, we found 32 articles that focused on the religion and/or spirituality of cancer patients and/or providers during the treatment decision-making process. The articles focused on a variety of cancers included lung, colon, gynecologic, prostate and breast while other studies focused more on cancer stage including advanced/late stage, nonmetastatic, and newly diagnosed cancers. The overwhelming majority of articles focused on the patient perspective, while 2 focused on the provider perspective and 1 article included both perspectives.

When analyzing the content of the included articles, we classified articles based on the context that treatment decisions were being made including general decision making, end-of-life/advance care planning and other, specific contexts (e.x., whether to participate in a clinical trial for cancer treatment). Within the general decision-making context, articles discussed patients wanting direct and indirect integration of their religious and spiritual belief systems into treatment decision making. For patients wanting more direct integration, they wanted the ability to consult a spiritual leader or prayed to God to help make treatment related decisions. Those patients that preferred more indirect integration utilized spiritual belief systems to cope with the stress and uncertainty with the treatment decision-making process. Interestingly, there were some conflicting results in the end-of-life/advance care planning context. Specifically, there was a discrepancy on if patient religious and spiritual preferences encouraged or discouraged the use of life-extending, aggressive measures at the end of life including CPR, mechanical ventilation, and presence/absence of do-not-resuscitate orders. Lastly, data collected from our review suggest that religion and spirituality may have a more pronounced influence on the treatment decision-making process of Black cancer patients.

Based on the results of our review, we suggest that cancer providers expand their treatment decision-making conversations and not solely focus on disease-related factors. Instead, provers can have explicit conversations with their patients on how they may want (or don’t want) religion and spirituality addressed and integrated in their care. While these conversations are important at the end-of-life, are study also showed that patient beliefs can have an influence across the cancer care continuum. Finally, these conversations may be especially important for historically marginalized patient groups, such as Black cancer patients. Conversations about religion and spirituality may help providers in their efforts to provide culturally informed patient-centered care.

Article details

The Influence of Patient and Provider Religious and Spiritual Beliefs on Treatment Decision Making in the Cancer Care Context
Elizabeth Palmer Kelly, Brian Myers, Brent Henderson, Petra Sprik, Kelsey B. White. Timothy M. Pawlik.
First Published: July 1, 2021
DOI: 10.1177/0272989X211022246

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Timothy M. Pawlik, MD, MPH, MTS, MBA, PhD

Dr. Pawlik received his undergraduate degree from Georgetown University and his medical degree from Tufts University School of Medicine. Dr. Pawlik completed surgical training at the University of Michigan Hospital and spent two years at the Massachusetts General Hospital as a surgical oncology research fellow. He then went on for advanced training in surgical oncology at The University of Texas M. D. Anderson Cancer Center in Houston. Dr. Pawlik’s main clinical interests include alimentary tract surgery, with a special interest in hepatic, pancreatic and biliary diseases. Dr. Pawlik also has an interest in medical ethics and completed a fellowship in medical ethics at the Harvard School of Public Health as well as a Masters in Theology from Harvard Divinity School in Boston. In addition, Dr. Pawlik was the recipient of a Clinical and Translational Science Award (CTSA) KL2 Research Scholar Award and received a PhD from the Johns Hopkins Bloomberg School of Public Health in Clinical Investigations. Dr. Pawlik completed the Executive MBA Program at The Ohio State University Fisher Business School.

Elizabeth Palmer Kelly graduated from Elon University in 2011 with a B.A. in Psychology and Women’s and Gender Studies. After her undergraduate work, she completed a Master's degree in Marriage and Family Therapy from Thomas Jefferson University and a Ph.D. of Human Development and Family Science from Ohio State. Currently, Liz is a Research Scientist at The Ohio State University Comprehensive Cancer Center-James Cancer Hospital & Solove Research Institute where she collaborates on multiple projects with Dr. Tim Pawlik around the patient cancer care experience including the patient-physician relationship and the role of patient and provider religious and spiritual beliefs during cancer treatment.