Pediatric physicians more likely to accept salve of religion when medicine fails the patient

Do pediatric oncologists feel that religion is a bridge or a barrier to their work? Or do they feel it can be either, depending on whether their patients are recovering or deteriorating? A novel Brandeis University study examines these questions in the current issue of Social Problems.

Through in-depth interviews with 30 pediatricians and pediatric oncologists at elite medical centers, the authors discovered that physicians tend to view religion and spirituality pragmatically, considering them resources in family decision-making and in end of life situations, and barriers when they conflict with medical decisions, said lead author Brandeis sociologist Wendy Cadge.

Pediatricians, more than pediatric oncologists, say that religion is outside the purview, or boundary, of their profession, most likely because they deal primarily with healthy children. Pediatric oncologists, on the other hand, say that religion can help families cope with a dying child or an unfavorable medical outcome, said Cadge.

"Physicians view religion and spirituality as a barrier when it impedes medical recommendations and as a bridge when it helps families answer questions medicine inherently cannot," the authors wrote.

Only one physician in the study directly asked patients and their families about religion and spirituality regularly. The other pediatricians said that direct conversations about religion were either not relevant or too personal, drawing a clear boundary between public and private that puts religion on the private side of the line.

Still, religion and spirituality almost always come up when medical treatment fails to cure the patient. As one physician explained, "The old adage that there are very few nonbelievers in fox holes applies in this setting also." The study found that many of the physicians believe religious and spiritual beliefs help patients and their families shift from curative to palliative care.

As one physician said, "-frankly those who do have religious convictions-there's a belief-that there's something beyond this world, they seem to handle better, even the patients quite a bit better. And it's easier to talk about death with those families and those patients. There's an underlying belief that there's something beyond this world that is basically a better world. It is much easier to discuss in a much more helpful manner than with families that do not."

"The study shows that physicians do not want religious beliefs to trump medical care or expertise, and they get frustrated when such beliefs interfere with medical decisions," said Cadge. "But at the end of the day, when a loved one is dying or all medical options are exhausted, physicians often welcome a family's religious beliefs because they help a family answer the "why us" questions that medicine cannot," said Cadge.