"We found that patients whose spiritual needs were well-supported seemed to transition to hospice more frequently and had a marked reduction in the use of aggressive care," Balboni said.
Yet despite the findings, said Dr. Harold G. Koenig, co-director of the Center for Spirituality, Theology and Health at Duke University Medical Center, "few people are getting their spiritual needs met by the medical system."
"Many doctors are uncomfortable discussing spirituality and haven't been trained to do so," he said. "And churches have a role, too. Although it's not a popular topic, churches need to talk about the end of life in the pulpit. People don't know theologically what they're supposed to do."
Religious people, Koenig said, are often left to think they should always have hope and should always "give God a chance to provide a miracle." Hospice care, though, can often provide spiritual guidance and help people prepare for death, he said.
Doctors don't need to actually provide spiritual care, Koenig said, but it's important for physicians to acknowledge their patients' spiritual needs and make sure they're addressed by pastoral care or hospice. "The doctor does have to be the one to orchestrate this," he said.
But if someone's spiritual needs are not being met, Koenig and Balboni agreed that the person -- or a friend or family member -- needs to speak up. And if the patient's doctor doesn't feel qualified to discuss end-of-life spiritual issues, the doctor should be able to refer you to someone who can.
The Hospice Foundation of American has more on spiritual care at the end of life.
SOURCES: Tracy Anne Balboni, M.D., M.P.H., radiation oncologist and researcher, Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute, Boston; Harold G. Koenig, M.D., professor, psychiatry and behavioral sciences, and co-director, Center for Spirituality, Theology and Health, Duke University Medical Center, Durham, N.C.; Dec. 14, 2009, Journal of Clinical Oncology, online