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: 7546907
• 负责人: Karen E Steinhauser
• 金额: $ 5.99万
• 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/7546907
• 关键词: Address; Advanced Malignant Neoplasm; Anxiety; Attention; Blinded; Caring; Chronic Obstructive Airway Disease; Clinical; Clinical Nursing; Clinical Psychology; Communication; Depth; 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; Services; Skilled Nursing Facilities; Social Work; Socioeconomic Status; Spirituality; Staging; Stress; Symptoms; Testing; Time; Variant; Week; base; cost; demographics; design; end of life; experience; forgiveness; functional status; improved; insight; 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.

这项研究将证明临终准备和完成干预是否会减少 焦虑、抑郁、疼痛等症状，改善功能状态、精神健康， 生活质量。如果有效，该干预措施将提供一个简短、廉价且可移动的非医生治疗 改善生命限制疾病后期个体体验的治疗方法。努力 改善临终关怀通常侧重于疼痛和症状控制，但有效的干预措施很少（如果有的话） 解决准备和完成问题。我们设计了临终准备和完成 基于人类发展文献的干预，将生命的完成确定为一项发展任务 以及健康传播和临床心理学方面的有力证据证明了 表达对健康结果的情绪和压力。我们的具体目标是 1) 评估 促进临终准备和完成临终健康结果讨论的干预措施 人，包括疼痛和症状、身体功能、情绪功能（焦虑和抑郁）、 精神健康和临终时的生活质量，以及 2) 评估此类讨论的内容， 检查与性别、种族、社会经济地位、沟通质量相关的任务变化 与家庭、灵性和疾病阶段相结合，以提高对定制干预需求的理解 基于人口统计或疾病轨迹位置的内容。我们提出一项随机对照试验 来评估干预措施。 140 名患有晚期癌症、CHF 或 COPD 的患者将被随机分配 分为两个干预组之一，并完成一系列简短的预测试措施。科目在第一 小组（“治疗”）将与辅导员会面三次，每次四十五分钟。在第一个 会议期间，受试者将被要求讨论与生活回顾相关的问题。一周后，参与者将 要求更深入地谈论遗憾、宽恕和未完成的事情等问题。在决赛中 一周后的会议，主题将集中于遗产和遗产。第二组受试者 （“注意力控制”）将与协调员会面三次，每次四十五分钟，并被询问 聆听非引导放松 CD。一两周后，所有组的参与者都会收到 由盲态访谈员实施的测试后措施。