Ai Amy L, Park Crystal L, Shearer Marshall
University of Washington Health Sciences, Seattle 98105-6299, USA.
Int J Psychiatry Med. 2008;38(1):113-32. doi: 10.2190/PM.38.1.k.
Settling one's end-of-life affairs in the face of coronary artery bypass graft surgery (CABG) can be both distressing and beneficial for individuals who are facing imminent threat of death. Religious thoughts, common in this context, may offer some comfort and support for facing this process. However, few empirical studies have addressed the role of religious or spiritual involvement in the settling of one's end-of-life affairs in cardiac patients. This prospective study investigated the effect of religious and spiritual factors on whether decisions regarding end-of-life had been made in a sample of middle-aged and older patients undergoing CABG. In particular, we expected faith factors of an intrinsic nature would promote this decision. Two weeks pre-operatively, patients (mean age = 65 years) were recruited for interviews. One hundred seventy-seven CABG patients completed the pre-operative and post-operative follow-up one month after surgery, while 96 offered information regarding their engagement in settling end-of-life affairs. Cardiac indicators were obtained from the computerized Society of Thoracic Surgeons' Adult Cardiac Database (STS). Multiple regression analyses revealed that private religiousness increased the likelihood of having engaged in end-of-life decision planning by nearly half again (OR = .1.47, 95% CI = 1.10, 1.96, p < .05) and that experiencing reverence in secular contexts nearly doubled the likelihood (OR = .1.99, 95% CI = 1.16, 3.44, p < .05). The reduced likelihood of having made plans was observed among those who scored higher on experiencing reverence in religious contexts (OR = .44, 95% CI = .23, .87, p < .05) and among patients using petitionary prayer (OR = .21, 95% CI = .04, .98,p < .05). These effects manifested after controlling for age, impacted functioning, and number of diseased arteries. Therefore, faith factors appear to have independent but complex effects on end-of-life decision making in middle-aged and older cardiac patients.
对于面临冠状动脉旁路移植术（CABG）且生命垂危的个体而言，处理其临终事务既令人痛苦又有益处。在这种情况下常见的宗教思想，可能为面对这一过程提供一些慰藉和支持。然而，很少有实证研究探讨宗教或精神参与在心脏病患者处理临终事务中所起的作用。这项前瞻性研究调查了宗教和精神因素对接受CABG的中老年患者是否做出临终决定的影响。特别是，我们预期内在性质的信仰因素会促进这一决定。术前两周，招募患者（平均年龄 = 65岁）进行访谈。177名CABG患者完成了术前访谈以及术后1个月的随访，其中96人提供了他们处理临终事务的相关信息。心脏指标从胸外科医师协会的成人心脏数据库（STS）电脑记录中获取。多元回归分析显示，个人宗教信仰使参与临终决策规划的可能性增加了近一半（比值比 = 1.47，95%置信区间 = 1.10，1.96，p < .05），并且在世俗情境中体验到敬畏感使这种可能性几乎翻倍（比值比 = 1.99，95%置信区间 = 1.16，3.44，p < .05）。在宗教情境中体验到敬畏感得分较高的患者（比值比 = 0.44，95%置信区间 = 0.23，0.87，p < .05）以及使用祈求祷告的患者（比值比 = 0.21，95%置信区间 = 0.04，0.98，p < .05）制定计划的可能性降低。在控制了年龄、功能影响和病变动脉数量后，这些影响依然存在。因此，信仰因素似乎对中老年心脏病患者的临终决策具有独立但复杂的影响。
