Intercessory Prayer and ICU Outcome
November 1999; Volume 2: 128-130
By V. Jane Kattapong, MD, MPH
"Pray for my soul. More things are wrought by prayer Than this world dreams of."
Alfred Lord Tennyson
"The Passing of Arthur" Idylls of the King
Lay beliefs about the etiology of illness differ substantially from scientific explanations. Dismissing lay beliefs simply because we do not understand or share them, however, is setting ourselves up for failure. Most of what drives alternative medicine is not science, but belief. It makes special sense, then, to investigate faith and its effects on patients’ medical problems.
Intercessory Prayer
In accordance with a belief in God’s power to bring good health, some patients believe that their own prayers may bring improvement in their own illness. However, what happens when others pray for patients? Some believe that intercessory prayer (IP), or praying for the benefit of others, can help the healing process.1,2 This belief is not unique to Judeo-Christian religion, but is also an integral part of the healing process in Native American medicine,3 and figures prominently in Buddhist and other Eastern religions as well.
Prevalence
Few people can say that they have never offered up silent, urgent prayers while experiencing stomach-churning turbulence aboard a bouncing airplane, or in other instances of perceived dire need. Many patients turn to prayer for reassurance, strength, and guidance when they are ill.
The prevalence of prayer in the United States is quite high. Ninety-five percent of Americans believe in God, more than 50% pray daily, and more than 40% attend church weekly.4 Little is known, however, about the prevalence of IP.
Techniques
IP is usually performed by individuals who are acquainted with the patient or with someone who knows the patient. Often IP is performed by individuals who have close personal ties to the patient. Frequently church members request that other members of the congregation perform IP for a family member or friend.
Mechanism of Action
The effect of IP on illness has largely been ignored in the medical literature, perhaps because it is quite difficult to postulate a reasonable scientific explanation for any effects.
One lay theory about the etiology of health and illness is the explanation of "God’s power," in which "health is a product of right living,’ spiritual well-being and God’s power."5 Belief in the power of a Superior Being, or God, to influence and control health and illness is widespread worldwide. One way to communicate with God is through prayer. According to Webster’s Collegiate Dictionary, prayer is "a spiritual communion with God or an object of worship, as in supplication, thanksgiving, or adoration."6 Almost without exception, this spiritual communion, or prayer, has been a meaningful component of all cultures to date.
Medical Explanations
Medical explanations have been proposed for health benefits associated with prayer and religiousness. Levin believes that personal religious beliefs may strengthen coping skills and decrease stress, and thereby decrease morbidity and mortality in patients with such diseases as hypertension, heart disease, and cancer. These direct health benefits may occur through psychoneuroimmunologic mechanisms, and may result in decreased activation of the hypothalamic pituitary axis.7
But it becomes more difficult to postulate scientific explanations for health benefits as the individual performing the prayer becomes further removed from the patient. Far fewer psychoneuroimmunological mechanisms can reasonably be invoked when the individual performing the prayer is not the patient. And when the individual performing the prayer is unknown to the patient, even fewer may be offered. Any health benefits resulting from the efforts of an unseen, unrevealed third party can be considered scientifically enigmatic.
Psychoneuroimmunologic mechanisms that may be involved in health benefits of intercessory prayer are:
a. decreased activation of the hypothalamic pituitary axis.
b. decreased platelet aggregation.
c. serotonin-modulation.
Clinical Studies
A literature search revealed only one blinded study of the effects of IP in a critical care setting. In this study, all patients admitted between August 1982 and May 1983 to the coronary care unit of the San Francisco General Hospital were eligible for study entry.1 Although 393 patients chose to participate, 57 declined because of personal reasons, religious convictions, or unwillingness to sign the consent form. A computer-generated list was used to assign patients randomly to customary care, or customary care plus IP. The intercessors (those praying on behalf of the patients) were members of local Protestant or Roman Catholic churches. Prior to involvement in this study, all intercessors reported daily devotional prayer and active church membership.
Each patient was randomly assigned to three to seven intercessors, who prayed daily outside the hospital until discharge. The site in which the IP was performed was not specified. Each intercessor was given information including the patient’s first name, diagnosis, general condition, and updates in status. Intercessors prayed for rapid recovery and for prevention of complications and death. Patients in the prayer and non-prayer groups were similar with respect to cardiac disease severity, age, and gender.
By the time of discharge, on univariate analysis, the prayer group was less likely than the control group to have experienced congestive heart failure, cardiopulmonary arrest, and pneumonia, or to have required diuretics, antibiotics, or intubation and mechanical ventilation (P < 0.05). Multivariate analysis demonstrated that the group receiving IP was significantly less likely to require ventilatory support, antibiotics, or diuretics (P < 0.0001). Based on outcome, defined criteria were used to grade hospital course as good, intermediate, or bad. Good outcome was determined to have occurred in 85% of the intercessory prayer group vs. 73% of the control group. Intermediate outcome occurred in 1% of the prayer group and 5% of the controls. Bad outcome occurred in 14% of the prayer group and 22% of the controls. A chi-square analysis demonstrated significantly better outcome in the prayer group (P < 0.01). No information was available about the religiousness of the patients.
Prayer in Other Illness Settings
To determine the effect of religious affiliation on obstetric outcome, King examined 1,919 obstetric records at a university medical center in North Carolina, and obtained demographic information, prenatal history, labor and delivery records, and religious affiliation.8 "Mainline" Christians (defined as Catholics, Methodists, and Episcopals) had the lowest neonatal intensive care unit admission and maternal complication rates. Evangelical Christians (Baptists, Free Will Baptists, Pentecostals, and Holinesses) had intermediate rates. Rates were highest for patients with no religious preference. These complication rates were significantly lower in the two Christian groups than in the non-religious group (P < 0.05).
In a review, Sherrill discusses the role of religion in the recovery process for adult burn patients.9 Although only a review of the literature and anecdotal evidence in the form of case reports are presented, she concludes that religiousness may improve the recovery process for burn patients. She believes that further investigation into the role of religion in burn recovery is warranted.
In contrast, a review of the effectiveness of IP on improvements to health problems and an evaluation of the effectiveness of IP on wound healing found little significant benefit associated with IP.10,11 The authors found that the results of these studies were inconclusive.
Conclusion
Little attention has been devoted to the effects of IP on the recovery process. However, based on one randomized, double-blind study, praying for the benefit of others appears to confer patient benefits. Specifically, good outcome after admission to a coronary care unit was found to be more likely in the group receiving IP.
Recommendation
Intercessory prayer is an intervention that can easily be offered to every ICU patient. In fact, it can easily be offered to every patient with any degree of illness. Because it is unlikely that IP would ever hurt, and might help, there is no reason to dissuade interested patients from it. Whether IP may be recommended to patients depends on patient interest and better data. Although we have, at best, an incomplete scientific explanation for the benefits of prayer, we can "take it on faith" that prayer may improve the healing process.
Dr. Kattapong is a neurologist and principal in MediCat Consulting, a health services consulting firm in Tucson, AZ.
Outcome of intercessory prayer (IP) for CCU patients is:
a. good outcome in 85% of the IP group and 73% of the control group.
b. good outcome in 1% of the IP group and 5% of the control group.
c. good outcome in 14% of the IP group and 22% of the control group.
References
1. Byrd RC. Positive therapeutic effects of intercessory prayer in a coronary care unit population. South Med J 1988;81:826-829.
2. Collipp PJ. The efficacy of prayer: A triple-blind study. Med Times 1969;97:201-204.
3. Cohen K. Native American medicine. Altern Ther Health Med 1998;4:45-57.
4. Matthews DA, et al. Religious commitment and health status: A review of the research and implications for family medicine. Arch Fam Med 1998;7:118-124.
5. Stainton-Rogers W. Explaining Health and Illness: An Exploration of Diversity. London: Wheatsheaf; 1991.
6. Webster’s Collegiate Dictionary. 2nd edition. New York, NY: Random House; 1997.
7. Levin JS, et al. Is religiousness a correlate of absorption? Implications for psychophysiology, coping, and morbidity. Altern Ther Health Med 1998;4:72-76.
8. King DE, et al. Religious affiliation and obstetric outcome. South Med J 1994;87:1125-1128.
9. Sherrill KA, Larson DB. Adult burn patients: The role of religion in recovery. South Med J 1988;81:821-825.
10. Roberts L, et al. Intercessory prayer for ill health: A systematic review. Forsch Komplementarmed 1998;5(SupplS1):82-86.
11. Wirth DP, et al. Wound healing and complementary therapies: A review. J Altern Complement Med 1996;2:493-502.
November 1999; Volume 2: 128-130
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