Palliative Care for Hospitalized Patients with Cancer of Dharmic Religions: A Mixed Methods Study

Outcomes 1. Participants will be able to identify the religious/spiritual considerations of patients with serious illness who identify with a Dharmic religion.2. Participants will be able to identify opportunities to improve the faith-concordant care for patients with serious illness who identify with a Dharmic religion. Key Message Patients with cancer belonging to Dharmic religions had higher inpatient palliative care utilization. Beliefs (e.g., karma, trust in God, inevitability of death, or afterlife) allowed patients to accept their diagnosis. Further work is needed to explore how these beliefs influence palliative care needs. Introduction Palliative care (PC) is an integral component of cancer care in the US, but utilization among patients who identify with a Dharmic religion (DR; Hinduism, Buddhism, Sikhism, Jainism) is unknown. Objective This study measures PC utilization (PCU) and explores the religious/spiritual (R/S) considerations of hospitalized DR patients with cancer. Methods We conducted a secondary analysis of data from a separate retrospective study of chaplaincy utilization by patients hospitalized at a specialty cancer center in New York City between 2015 and 2019. Multivariable logistic regression modeling examined associations between religion, age, race/ethnicity, language, LOS, and severe illness (ICU admission, inpatient death, hospice discharge) with ≥1 PC visit; p< 0.05 was considered statistically significant. In 2020, we prospectively conducted semi-structured qualitative interviews to explore the R/S considerations among DR patients at this hospital. Data were coded and analyzed independently and iteratively by two investigators; themes were identified. Results Among 54828 patients (59% Christian; 14% Jewish; 2% DR), 6498 patients had ≥1 PC visit (15% DR vs. 12% non-DR, p< 0.01). Age, race/ethnicity, language, and severe illness were independently associated with PCU (p < 0.01); faith group (p=0.28) and LOS (p=0.23) were not associated with PCU. Twenty-two patients (91% Hindu, 9% Sikh) and 11 non-DR chaplains were interviewed. Belief in karma, trust in God, the inevitability of death, and the afterlife allowed for acceptance of diagnosis. Many chaplains reported lacking knowledge about at least one DR. Patient attribution of cancer to past karma was uncommon in chaplains’ experience. Conclusion R/S influences how DR patients with cancer cope and find meaning in their illness. Patients didn't blame their cancer diagnosis on The belief in karma was not associated with self-blame for the diagnosis . Further work exploring how DR beliefs inform PC needs is needed to develop training to improve patient care. Keywords Diversity, Equity, Inclusion, Belonging, Justice Existential / Humanities / Spirituality / Religion