Outlook-an intervention to improve quality of life in serious illness

展望——改善严重疾病患者生活质量的干预措施

• 批准号: 8313638
• 负责人: Karen E Steinhauser
• 金额: $ 6.93万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8313638
• 关键词: Address; Advanced Malignant Neoplasm; Anxiety; Attention; Blinded; Caring; Chronic Obstructive Airway Disease; Clinical; Clinical Nursing; Clinical Psychology; Communication; Development; Educational Curriculum; Emotional; Ethnic Origin; Expressed Emotion; Family; Fostering; Gender; Health; Health Communication; Human Development; Individual; Intervention; Interviewer; Learning; Left; Life; Literature; Location; Measures; Medical; Mental Depression; Methods; Nurses; Outcome; Pain; Palliative Care; Participant; Patients; Personal Satisfaction; Persons; Physical Function; Physicians; Preparation; Provider; Publications; Quality of life; Randomized; Randomized Controlled Trials; Regrets; Relaxation; Self Management; Services; Skilled Nursing Facilities; Social Work; Socioeconomic Status; Spirituality; Staging; Stress; Symptoms; Testing; Time; Variant; base; clinical care; cost; demographics; design; effective intervention; end of life; experience; forgiveness; functional status; group intervention; improved; insight; meetings; therapy design

This study will demonstrate whether an end-of-life preparation and completion intervention reduces anxiety, depression, pain and other symptoms and improves functional status, spiritual well-being, and quality of life. If effective, the intervention offers a brief, inexpensive, and transportable non-physician treatment method for improving the experience of individuals in the latter stages of life-limiting illness. Efforts to improve end-of-care often focus on pain and symptom control, but few, if any, effective interventions exist addressing preparation arid completion. We designed an end-of-life preparation and completion intervention, based on the human development literature identifying life completion as a developmental task and the robust evidence in health communication and clinical psychology that addresses the value of expressing emotions and stress on health outcomes. Our specific aims are 1) evaluate the impact of an intervention that promotes discussions of end-of-life preparation and completion on health outcomes in dying persons, including pain and symptoms, physical-function, emotional function (anxiety and depression), spiritual well-being, and quality of life at the end of life and 2) evaluate the content of the such discussions, examining task variation associated with gender, ethnicity, socio-economic status, quality of communication with family, spirituality, and stage of illness to improve understanding of the need for tailored intervention content based on demographics or location in the trajectory of illness. We propose a randomized control trial to evaluate the intervention. 140 patients with advanced cancer, CHF, or COPD will be randomly assigned into one of two intervention groups and complete a brief battery of pre-test measures. Subjects in the first group ("treatment") will meet with a facilitator three times for a period of forty-five minutes each. In the first session, subjects will be asked to discuss issues related to life review. A week later, participants will be asked to speak in more depth about issues such as regret, forgiveness and things left undone. In the final session, a week hence, subjects will focus on heritage and legacy. The subjects in the second group ("attention control") will meet with a facilitator three times for a period of forty-five minutes each and be asked to listen to a non-guided relaxation CD. One week and two weeks later, participants in all groups will receive post-test measures administered by a blinded interviewer.

这项研究将证明寿命终止准备和完成干预是否会减少 焦虑，抑郁，疼痛和其他症状，并改善功能状况，精神健康和 生活质量。如果有效，干预措施会提供短暂，廉价且可运输的非物理学家 在限制生命疾病的后期阶段，改善个人经验的治疗方法。努力 为了改善护理的终结通常专注于疼痛和症状控制，但如果有有效的干预措施，则很少有 解决准备工作完成。我们设计了寿命的准备和完成 干预措施，基于人类发展文献，将生命完成为发展任务 以及健康沟通和临床心理学的强大证据，该证据涉及 表达情绪和对健康结果的压力。我们的具体目的是1）评估 干预措施促进讨论临终准备和完成健康状况的讨论 人，包括疼痛和症状，身体功能，情绪功能（焦虑和抑郁）， 精神福祉和生命结束时的生活质量和2）评估此类讨论的内容， 检查与性别，种族，社会经济地位，交流质量相关的任务变化 有了家庭，灵性和疾病阶段，以提高对量身定制干预需求的理解 基于疾病轨迹中的人口统计或位置的内容。我们提出了一项随机对照试验 评估干预措施。 140例晚期癌症，CHF或COPD患者将随机分配 分为两个干预组之一，并完成短暂的测试措施。第一个主题 组（“治疗”）将与一个协调员会议3次，每次45分钟。在第一个 会议，将要求受试者讨论与生活审查有关的问题。一周后，参与者将 被要求更深入地谈论遗憾，宽恕和剩下的事情等问题。在决赛中 因此，一周的会议将专注于遗产和遗产。第二组中的受试者 （“注意力控制”）将与一个协调员相遇三次，每次四十五分钟，并被询问 收听非引导放松CD。一个星期零两个星期后，所有小组的参与者都会收到 盲人访调员管理的后测措施。