Comfort and Anguish The Complex Role of Religion in Coping with Illness

1. Comfort and AnguishThe Complex Role of Religion in Coping with Illness George Fitchett, DMin, PhD Department of Religion, Health and Human Values george_fitchett@rush.edu

2. Objectives Become aware of evidence about the beneficial effects of religious/spiritual coping with serious illness (eg. cancer). Become aware of evidence about the harmful physical and emotional effects of religious/ spiritual struggle. Learn how clinicians can utilize findings from this research to improve referrals to chaplains.

3. Comfort & Anguish

4. Definitions: Spirituality, Religion Spirituality “a search for the sacred” Religion “the larger social and institutional context in which the search for the sacred takes place” Pargament, Desai & McConnell, 2006, p. 122

5. Risk of Mortality for More Frequent Worship Attenders No association

6. “You know, I have a lot of faith. And that keeps me going. I know that God is there walking with me. Even during the bad times I still feel blessed because it could be worse.” Comfort

7. Importance of Religion to Cancer Patients N=230 patients with advanced cancer. From Balboni et al, J of Clinical Oncology, 2007

8. 10 Most Commonly Used CAM Therapies in Past 12 Months N=31,004 adults, 2002 NHIS. From: Barnes et al. 2004.

9. Spiritual Well-Being and Quality of Life in Cancer Patients From Brady, Peterman, Fitchett, Mo, Cella. Psycho-Oncology, 1999

10. R/S and Quality of Life in Cancer Patients

12. Comfort • Religious/spiritual coping is very common. • Religious/spiritual coping takes different forms. • Positive religious/spiritual coping enhances emotional well being and quality of life.

13. ANGUISH A woman in her fifties with advanced cancer told a chaplain, “Why? Why me? I just can’t figure it out. And I get so depressed that I just want to give up on life altogether, you know? And I’m so very angry at God. So angry. I refuse to speak to Him. You know what I mean?” (Fitchett & Roberts, 2003)

14. Anger With God and Rehab Recovery From: Fitchett, et al., Rehabilitation Psychology, 1999.

15. Negative Religious Coping (Brief RCOPE) Pargament et al, 1998

16. Religious Struggle and Emotional Distress From Fitchett et al, 2004

18. ANGUISH Two Year Change in Religious Struggle and Its Effects on Outcomes Among Elderly Medically Ill Patients *Models adjusted for demographic factors and baseline values. Source: Pargament et al, Journal of Health Psychology, 2004

19. ANGUISH Religious Struggle as a Predictor of Mortality (30%, 176/596) Adjusted RR = 1.06 95% CI = 1.01 - 1.11 model adjusted for: positive religious coping, demographic factors, physical health, mental health Pargament et al. 2001, Arch Intern Med

20. Religious Struggle and Depression Religious Struggle recoded into 3 groups None (56%) 1-2 points (11%) 3+ points (33%) N=100 oncology in-patients

21. Prevalence of Religious Struggle 238 patients with diabetes, cancer or congestive heart failure Fitchett et al., 2004

22. Prevalence of Religious Struggle

23. Differences in RS by Patient Dx

24. Differences in RS by Age

25. Trajectories of Religious Coping *Differences in pre and post transplant mean scores were not significant. Average time between pre and post-transplant was 3.4 months (SD 2.9). N=94 myeloma patients who received autologous stem cell transplant Sherman et al, J Behav Med, 2009

26. ANGUISH Isn’t religious struggle really just about Fundamentalist beliefs about God? Jews Among 234 Jews (60% Orthodox), negative religious coping (JCOPE) was associated with more worry, anxiety and depression (Rosmarin et al 2009)

27. ANGUISH Isn’t religious struggle really just about Fundamentalist beliefs about God? Secular Europeans & Aussies • 53% of 202 UK women w breast cancer (Thune-Boyle et al., 2011) • 100 women w recent dx of gyne cancer religious struggle significantly associated with higher depressive symptoms (p<.001) and anxiety (p=.03) (models adjusted for demographic, disease and other religion variables; Boscaglia et al, 2005) ‘Atheists’ Among 15 pts w adv cancer who report R/S not important to cancer experience, 6 (40%) reported 4 or more ‘religious concerns’ (Alcorn et al., 2012)

28. ANGUISH Isn’t religious struggle really just depression? The size of the correlations between religious struggle and depression in our study (r from 0.22 to 0.42) suggest religious struggle is associated with but cannot be reduced to depression. Religious struggle predicts both poor recovery and mortality in models which adjust for depression.

29. “I am told that God lives in me – and yet the reality of darkness and coldness and emptiness is so great that nothing touches my soul.” Newsweek 9/3/07 ANGUISH

30. ANGUISH Religious/spiritual struggle • compromises emotional adjustment to illness and quality of life • may compromise recovery • may increase risk of mortality

31. Further Research on R/S Struggle Descriptive • Conceptualization and measurement • Screening • Prevalence in specific populations • Correlates • Trajectory Spiritual Care • Intervention What, if anything, helps people resolve R/S struggle?

32. 3 Actions: • Refer for spiritual assessment re: possible RS struggle. • Spiritual care requested, make referral. • No action: no indication of RS struggle, no interest in spiritual care. Fitchett & Risk, 2009

33. Results from Spiritual Struggle Screening Protocol Fitchett and Risk, Journal of Pastoral Care and Counseling, 2009 33

34. Prevalence of Religious Struggle Cancer patients at SCCA and Dana Farber ESRA-C (Electronic Self-Report Assessment-Cancer) 171/700 (24%) cases were positive for religious struggle Maine Medical Center

35. Other Screening Tools Are you at peace? N=248 patients with cancer, COPD, CHF, ESRD (Steinhauser et al., 2006) Are you experiencing spiritual pain right now? “A pain deep in your being that is not physical” Yes = 61% N=57 patients with advanced cancer, prognosis < 6 months (Mako et al., 2006)

36. Three Implications for Chaplains

37. Comfort & Anguish