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Relationships Between Advance Care Planning Engagement, Patients' Religious Practices, and Spirituality
Robyn M Axel-Adams1, Emily Fox Ludden2, James E Slaven3
1Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, IN, USA.
The American Journal of Hospice & Palliative Care
|July 3, 2026
Summary
Religious and spiritual individuals show higher engagement in advance care planning (ACP). This contrasts with previous findings on advance directive (AD) completion, suggesting tailored ACP interventions for religious communities may be effective.
Area of Science:
- Medical Sociology
- Bioethics
- Health Psychology
Background:
- Previous research indicates lower advance directive (AD) completion rates among religious individuals.
- Advance care planning (ACP) encompasses broader engagement beyond AD completion.
- Limited research exists on the nexus of spirituality, religion, and ACP engagement.
Purpose of the Study:
- To investigate the association between religiosity, spirituality, and engagement in advance care planning (ACP).
Main Methods:
- Secondary analysis of baseline interview data from a randomized controlled trial.
- Utilized the Duke University Religious Index (DUREL) for religiosity and spirituality.
- Employed the 15-question ACP Engagement Survey to assess multiple facets of ACP engagement.
Main Results:
- A significant positive association was observed between higher DUREL scores (religiosity) and ACP engagement.
- Higher scores on each DUREL domain correlated with increased ACP Engagement.
- Spirituality identification was significantly linked to greater ACP engagement in adjusted models.
Conclusions:
- Contrary to prior AD completion findings, this study demonstrates that religiosity and spirituality correlate with higher ACP engagement.
- ACP interventions tailored for religious congregations and spirituality-focused communities may yield greater success.
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