In Reply: Dr van Laarhoven and colleagues note that the association we reported between positive religious coping and receipt of intensive life-prolonging care may not be generalizable to non-Christian populations. It is true that many items in the RCOPE1 and Brief RCOPE2 questionnaires presuppose faith in a relational God (eg, “I tried to see how God might be trying to strengthen me in this situation.”). It is also correct that these surveys were validated among predominantly Christian patient samples. Because only 11.6% of participants in the Coping with Cancer study did not endorse a Christian religious affiliation, the Brief RCOPE was a well-suited measurement of religious coping in this sample. We agree that patients who adhere to nonpersonal views of God may have differing attitudes toward death and end-of-life care.
Phelps AC, Maciejewski PK, Prigerson HG. Religious Coping and Life-Prolonging Care—Reply. JAMA. 2009;302(3):257-258. doi:10.1001/jama.2009.1005