Relationships Between Advance Care Planning Engagement, Patients’ Religious Practices, and Spirituality

Background Research has shown that people who consider themselves religious have a lower advance directive (AD) completion rate. However, advance care planning (ACP) includes a broader range of activities that are important in determining medical treatments. Little has been published on the relationship between spirituality, religion, and engagement in ACP activities. Objective We examined whether religiosity and spirituality are associated with ACP engagement. Methods This is a secondary analysis of interview data collected at baseline during a randomized controlled trial of a nurse-led ACP intervention. Measures included the 5-item Duke University Religious Index (DUREL), a measure of spirituality, and the 15-question ACP Engagement Survey, which examines engagement in multiple aspects of ACP. Results We found a significant association between higher scores on each domain of the DUREL and higher ACP Engagement scores. In separate multivariable models adjusting for demographic factors, the relationship between greater religiosity (higher total DUREL scores) and greater ACP Engagement scores was significant ( P < .0001 for each model). Identifying as spiritual was significantly associated with greater ACP Engagement scores ( P = .0038) in adjusted multivariate models. Conclusions In contrast to prior findings of lower AD completion in more religious individuals, this study found that higher religiosity and spirituality are associated with higher ACP engagement. These results suggest ACP opportunities offered for religious congregations or spirituality focused communities may be especially successful.