Patients nearing death are much more likely to opt for hospice care—forgoing aggressive life-prolonging treatment—if they feel they’ve made their peace with God, a new study shows.

In a survey conducted by the Dana-Farber Cancer Institute in Boston, terminal cancer patients ranked pain management and spiritual support as the two most important end-of-life considerations. On average, patients who felt that their spiritual needs had been met were three-and-a-half times more likely to accept hospice care. Among the highly religious, spiritual satisfaction was five times more likely to end in hospice care. But only 60% of those surveyed felt their religious needs had been met, according to the study.

Churches don’t often provide theological guidance on end-of-life issues, leaving many to believe they should always keep hope and give God the chance to perform a miracle, according to one theologian who commented on the study. Additionally, physicians are often uncomfortable in the role of spiritual adviser. With better spiritual engagement at the end of life, terminal patients can understand that forgoing aggressive treatments and opting for hospice care is not necessarily against their religion. The study appears in the Dec 14 online edition of The Journal of Clinical Oncology.