By Howell Sasser, PhD
Associate, Performance Measurement, American College of Physicians, Philadelphia, PA
Dr. Sasser reports no financial relationships relevant to this field of study.
Synopsis: Tested under rigorous conditions, the benefit of intercessory prayer is a small step, not a giant leap.
Source: Olver IN, Dutney A. A randomized, blinded study of the impact of intercessory prayer on spiritual well-being in patients with cancer. Alt Ther Health Med 2012;18:18-27.
Researchers in Australia recruited 999 patients with a diagnosis of cancer. No restriction was
placed on the type or stage of cancer, although one inclusion criterion was an expected survival time of more than 6 months. Participants were assigned to intercessory prayer (the active intervention) or a comparison group that received standard care and support. Study group assignment was triple-blinded — it was unknown to participants, their physicians, and study staff (except those who made the assignments).
The names and limited personal information of those in the intervention group were provided to an existing Christian intercessory prayer group. This group prayed for the well-being of those whose names they were given, but the study report does not describe how often or for how long they prayed.
The main outcome of the study was assessed using the FACIT-Sp, which combines a general quality-of-life scale with questions designed to measure a number of dimensions of well-being. It includes 12 items for spiritual well-being that are reported as a summary score and as subscale scores for peace, meaning, and faith. All study participants completed the FACIT-Sp at baseline and again 6 months later.
Of the original 999 participants, 665 (66.6%) provided follow-up data. Of the 334 participants lost from the study, 117 (11.7% of the original total) died before completing the follow-up period. There were no significant differences in demographic characteristics between the original study groups. A comparison of those who completed the study with those who dropped out or died showed that completers had significantly higher physical, emotional, and functional — but not spiritual — well-being scores at baseline. No information is provided as to how those lost from the study scored in any of the outcome dimensions at the time they were lost, so it is not possible to assess how they responded to the study intervention as compared with those who remained.
Comparing the 6-month follow-up with baseline, the intervention group showed a statistically significantly larger increase in overall spiritual well-being than did the control group (P = 0.03). Differences in the spirituality sub-scales (peace, meaning, and faith) and in the other domains of well-being did not reach statistical significance, with the exception of spiritual well-being, in which the intervention group also showed a larger gain (P = 0.04).
The field of prayer research has faced considerable skepticism both from believers and agnostics (however each may be defined). Prayer is difficult to define in measurable units. It is not a practice in which cause and effect can be reproduced reliably. Supporters and detractors have an almost equal interest in not delving too deeply into its underlying mechanism(s). This has not forestalled a succession of larger and more rigorous studies of the subject. Recent studies have shown little or no benefit of prayer by any measure.1,2 Their use of careful study methods, such as random assignment, blinding, and at least some attempts at standardization of the intervention, lends credence to this, at least from a scientific perspective.
The present study uses these methods too, and comes to a different conclusion. There are a number of potential explanations. The rate of attrition was quite high (33.4%). Perhaps those who survived had a better outlook on life and this either contributed to or resulted from the success of their treatment. It is conceivable that this was manifested in their sense of well-being. The study’s outcome — spiritual well-being — was more narrowly, and arguably more modestly (because limited to spiritual well-being), focused than in prior studies. It may be that the field is continuing to evolve toward a cause-and-effect model that more accurately reflects the true "state of nature." In addition to, or despite, these possibilities, the observed benefit was negligible. The effect size, as measured by the eta-squared statistic, was very small (0.01). It may represent a chance finding that will not stand up to replication.
Whatever the truth of this and other studies, the issue remains that patients — and their physicians — struggle to find ways to talk about hope. The spirit of medical care is grounded in pragmatism and its language is heavy on percentages and probabilities. The constant, necessary search for what works can distract from what the patient wants and expects. Finding meaning in illness may seem to run counter to the dominant narrative in which illness is to be eliminated or at least minimized (such that the patient can live a "relatively normal life"). Yet with chronic and progressive diseases, the definition of "normal life" must be expanded to include the disease state, its management, and the consequences of both. This makes well-being, and the hope of achieving it or returning to it, of great importance.
What studies of prayer share is an understanding that patient goals such as hope for the future and a sense of whole-person well-being are influenced only imperfectly by anything a physician does. Instead, they are driven in large part by the beliefs and attitudes that the patient brings into the medical encounter. Some early studies of prayer tried to make the most of this, by informing study participants that they would (or would not) be prayed for, thereby recruiting the patients’ own capacity to participate in building or rebuilding their lives.3 This plainly violated the usual practice of minimizing bias in scientific assessment. But it may be that more recent studies have erred in seeking to treat intercessory prayer as a therapeutic intervention, and thus under medical control, rather than as a means of bridging the gap between what medicine can provide and what the patient needs.