The Influence of Religion/Spirituality on End of Life Outcomes Among Cancer Patients of Dharmic Religions (CO301B)

Outcomes 1. Identify the barriers to faith-concordant EOL care encountered by patients with a serious illness who identify with a Dharmic religion.2. Identify opportunities to deliver faith-concordant EOL care to patients with a serious illness who identify with a Dharmic religion. Key Message Compared to other faiths, cancer patients of Dharmic religions (DR) had higher EOL care utilization. Few patients who desired faith-based EOL care had discussed these preferences with clinicians. Future work should improve staff's understanding of DR-specific EOL practices and increase patients' access to faith-concordant resources. Importance Spiritual support of cancer patients has been associated with improved EOL outcomes; however, little is known about EOL experiences among cancer patients who identify with a Dharmic religion (DR; Hinduism, Buddhism, Sikhism, Jainism). Objectives The primary objective was to measure EOL care utilization [hospice enrollment in the last 3 days (H); chemotherapy use in the last 14 days (C); urgent care center (UCC) visits or ICU admissions within the last 30 days; inpatient deaths (ID)] among DR and non-DR (NDR) cancer patients. Scientific Methods Utilized 1) We conducted a secondary analysis of data from a separate retrospective study of utilization of chaplaincy services by patients hospitalized at a specialty cancer center in New York City (2015-2019). Bivariate analyses examined associations between religious affiliation and EOL care metrics. 2) We conducted semi-structured interviews with hospitalized patients and chaplains (2020) to explore EOL care preferences. Data were coded and analyzed independently and iteratively by two investigators, and themes were identified. Results Among 28711 patients (DR 2.3%), DR patients had significantly higher rates of EOL care utilization compared to NDR patients: H (5.2% vs 2.1%, p< 0.001), C (11% vs. 7.7%; p=0.021), UCC (48% vs. 23%, p< 0.001), ICU (12% vs. 5.1%; p< 0.001), ID (28% vs. 12%; p< 0.001). In interviews [22 patients (20 Hindu, 2 Sikh); 11 chaplains (7 Christian, 2 Muslim, 2 Jewish)], few patients felt religion influenced their preferences for resuscitative measures. Some desired faith-based EOL care though did not always expect staff to be aware. Several chaplains acknowledged lacking knowledge in EOL practices. Suggestions for improvement included improving chaplaincy training and developing relationships with community-based leaders and volunteers. Conclusion(s) While DR patients had higher EOL care utilization, most did not report religion influenced their EOL care preferences. Although patients desired faith-based EOL care, few had discussed these preferences and not all chaplains were familiar with DR-specific EOL practices. Impact Future work should improve healthcare staff's understanding of DR-specific EOL practices and increase access to faith-concordant support. Keywords Cultural diversity/Qualitative and mixed methods research