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Takahashi J, Cher A, Sheeder J, Teal S, Guiahi M. Disclosure of Religious Identity and Health Care Practices on Catholic Hospital Websites. JAMA. 2019;321(11):1103–1104. doi:10.1001/jama.2019.0133
In 2016, 14.5% of US hospitals were Catholic hospitals, and between 2001 and 2011, the number of Catholic hospitals increased by 16% compared with a 6% decrease for all hospitals.1 The US Conference of Catholic Bishops expects health care facilities affiliated with the Catholic church to abide by the Ethical and Religious Directives for Catholic Health Care Services (hereafter referred to as the directives).1 The directives interpret medical care based on the church’s moral teachings and limit aspects of reproductive and end-of-life care based on concern for human dignity as defined by the Catholic church.1
Some patients may prefer care in line with the church’s teachings; other patients may prefer not to receive care in these facilities because of such restrictions. However, patients cannot make a choice unless they know whether a facility is affiliated with the Catholic church and whether it follows the directives.1 Because many patients use the internet to find health care information,2 we investigated whether Catholic hospital websites describe their religious identity and associated health care practices.
From July 2017 to January 2018, we analyzed the websites of all hospitals listed in the Catholic Health Care Directory (updated June 2017). The Catholic Health Association of the United States serves “to advance Catholic health.”3 Using a structured data abstraction form, we analyzed mission statements, About Us webpages, and home pages to find statements identifying the hospital as Catholic. If undisclosed, we searched for words in the mission statement suggesting religious affiliation. We also searched for the directives and the relevant terms ethic, directives, ERD and, secondarily, for the terms limit, service, end, and abortion, which are suggestive of restrictions. The websites were reviewed by 2 investigators (J.T. and A.C.) and there was an interrater reliability of 96%.
Of 653 hospitals listed, 6 duplicates and 1 without a mission statement were excluded from analysis. Among 646 hospital websites, 297 hospitals (46%) were in the Midwest and 308 (48%) had the word saint in their name (Table). A total of 507 hospitals (79%) reported their Catholic identity on their website. Among the 139 hospital websites that did not, 107 (77%) included the religious terms Jesus, Christ, and gospel. There were 152 hospitals (24%) that cited the directives on their website and 95 (15%) provided a direct link. Among the 494 hospitals that did not cite the directives, 28 (4% of all hospitals) reported care restrictions and cited end-of-life care restrictions. Eight of the 494 hospitals reported reproductive care restrictions.
Among US Catholic hospitals, 21% did not explicitly disclose their Catholic identity on their website, and only 28% specified how religious affiliation might influence patient care. Although it is unknown what proportion of Catholic facilities are in full compliance with the directives, a recent review demonstrated that patients are more likely to encounter reproductive restrictions at Catholic facilities compared with non-Catholic facilities4; less is known about end-of-life care restrictions. Many patients do not realize the implications of Catholic affiliation on their health care.5 If patients are unaware of the affiliation and encounter restrictions, refusal of or delay in care due to the need to go elsewhere can result in increased medical risk and contribute to wasted health care expenditures.
This study was limited to hospitals listed in the Catholic Health Care Directory; some hospitals may have changed ownership or listings may have been inaccurate. The number of search terms was limited, but preliminary work revealed that other reproductive terms were generally linked to external sites and the term abortion appeared sufficient; nevertheless, some disclosures may have been missed. Whether the low proportion of hospitals that did not cite health care restrictions reflects a lack of transparency or nonadherence to the directives is unknown. In addition, some of the hospitals that cited the directives may provide reproductive services. How often patients consult hospital websites for such information is also unknown.
Greater transparency about religious affiliation and care restrictions may allow patients to make more informed choices.1 In the state of Washington, hospitals must provide their reproductive health and end-of-life care policies on publicly available websites.6 Further research on the effect of this initiative on patient satisfaction and health care choices is warranted.
Accepted for Publication: January 4, 2019.
Corresponding Author: Maryam Guiahi, MD, MSc, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, University of Colorado Anschutz Medical Center, 12631 E 17th Ave, Mailstop B192-2, Aurora, CO 80045 (email@example.com).
Author Contributions: Dr Guiahi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Takahashi, Cher, Sheeder, Guiahi.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Takahashi, Sheeder, Guiahi.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Takahashi, Sheeder, Guiahi.
Administrative, technical, or material support: Takahashi, Cher, Guiahi.
Supervision: Takahashi, Teal, Guiahi.
Conflict of Interest Disclosures: Dr Guiahi reported being supported by career grant SFPRF10-JI1 from the Society of Family Planning. No other disclosures were reported.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the Society of Family Planning.