Justin J. Sanders, MD, MS, Vinca Chow, MD, Andrea C. Enzinger, MD, Tai-Chung Lam, MBBS, Patrick T. Smith, MDiv, PhD, Rebecca Quin ̃ones, MTS, Andrew Baccari, MDiv, Sarah Philbrick, BS, Gloria White-Hammond, MD, MDiv, John Peteet, MD, Tracy A. Balboni, MD, MPH, and Michael J. Balboni, PhD, ThM, MDiv


Background: People with serious illness frequently rely on religion/spirituality to cope with their diagnosis, with potentially positive and negative consequences. Clergy are uniquely positioned to help patients consider medical decisions at or near the end of life within a religious/spiritual framework.

Objective: We aimed to examine clergy knowledge of end-of-life (EOL) care and beliefs about the role of faith in EOL decision making for patients with serious illness.

Design: Key informant interviews, focus groups, and survey.

Setting/Subjects: A purposive sample of 35 active clergy in five U.S. states as part of the National Clergy End- of-Life Project.

Measurement: We assessed participant knowledge of and desire for further education about EOL care. We transcribed interviews and focus groups for the purpose of qualitative analysis.

Results: Clergy had poor knowledge of EOL care; 75% desired more EOL training. Qualitative analysis revealed a theological framework for decision making in serious illness that balances seeking life and accepting death. Clergy viewed comfort-focused treatments as consistent with their faith traditions’ views of a good death. They employed a moral framework to determine the appropriateness of EOL decisions, which weighs the impact of multiple factors and upholds the importance of God-given free will. They viewed EOL care choices to be the primary prerogative of patients and families. Clergy described ambivalence about and a passive approach to counseling congregants about decision making despite having defined beliefs regarding EOL care.Conclusions: Poor knowledge of EOL care may lead clergy to passively enable congregants with serious illness to pursue potentially nonbeneficial treatments that are associated with increased suffering.

Keywords: clergy; clinical decision making; palliative care; pastoral care; religion; serious illness; spirituality

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