Symptoms, End-of-Life Preferences, and Religiosity in Adults With End-Stage Cancer

In 2018, an estimated 1,735,350 new cases of cancer will be diagnosed in the United States, according to the American Cancer Association. Colon and rectal cancer will account for approximately 140,250 cases, and lung cancers will account for another 234,030 cases. Persons diagnosed with end-stage colon and lung cancer average a 5-year survival rate of 11-18%, and persons with end stage pancreatic cancer have a 5% 5-year survival rate (Lung Cancer Survival, 2018; Colon Cancer Survival, 2018; Jump, 2018; Pancreatic Cancer Survival, 2018).

A cancer diagnosis, no matter the type or location, is devastating, particularly if it carries the potential for shortened life expectancy or debility. Patients can be overwhelmed with symptoms and emotions, inundated with information, and face the need to examine their values and treatment preferences. Simultaneously occurring symptoms and necessary decisions regarding treatment can create negative feelings that require multiple coping strategies (Bakitas, 2007; Cleeland, 2000). While some persons turn to healthcare providers for support, others turn to family or religion to help make choices regarding symptom control and treatment preferences (Winter, Dennis, and Parker, 2008; Delgado-Guay et al., 2015).

The purpose of this study was to examine the relationships between symptoms, end-of-life preferences and religiosity. Two theoretical underpinnings framed the study. First was the Model of Quality of Life (Ferrell et al., 1995) as it has continued to demonstrate construct reliability and validity in the cancer population (Ferrell, Koczywas, Grannis, and Harrington, 2011). The second was the Conceptual Framework for Individual and Family End-of-life Decision Making, developed from a meta-analysis of decision-making (Kim et al., 2017).

Throughout the symptom experience and decision making process, nurses are the bridge between patients and physicians, as educators and advocates for the patient’s care. Therefore, it is important that nurses be educated on symptom control and intervention, care resources, and care coordination to provide the physical and emotional support needed (Schenker et al., 2015). It is also imperative that patient’s values, preferences and religious desires are assessed and integrated in care (Mack et al., 2010; Detering et al., 2010; Steinhauser, 2000).