Current measures of distress may not account for what's most important in existential care interventions: Results of the outlook trial.
Current measures of distress may not account for what's most important in existential care interventions: Results of the outlook trial.
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DOI：
10.1017/s1478951520001170
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发表时间：
2020-12
影响因子：
2.2
通讯作者：
Olsen MK
中科院分区：
文献类型：
--
作者：
Steinhauser KE;Stechuchak KM;Ramos K;Winger J;Tulsky JA;Olsen MK
比较两种干预措施在早期生命限制性疾病中解决情感和存在幸福感的有效性。主要试验分析（n=135）包括晚期癌症、充血性心力衰竭或终末期肾病患者;第1组接受Outlook干预，解决生命完成和准备问题，第2组接受放松冥想（RM）。第5周（主要终点）和第7周（次要终点）的主要结局：完成和准备（POMS-E）;次要结局：焦虑（POMS）生活质量（FACT-G）和精神健康（FACIT-sp）信仰、意义与和平子量表。平均年龄为62岁; 56%受过高中以上教育，54%已婚，52%为白色，44%为女性，70%被诊断患有癌症。在基线时，参与者表现出较低水平的焦虑（POMS子量表<5）和抑郁（CESD <10）相对于人群标准。主要分析结果显示，在第5周（14.4 Outlook vs. 14.8 RM;组间差异-0.4 [95% CI，-1.6，0.8]，p=0.49）或第7周（15.2 vs. 15.4;组间差异-0.2 [95% CI，-1.5，1.0]，p=0.73）时，各治疗组的平均准备情况无显著差异。在5周（26.6 Outlook vs. 26.3 RM;组间差异0.2[95% CI，−1.2，1.7]，p=0.76）或7周（26.5 vs. 27.5;组间差异−1.0[95% CI，−2.7，0.7]，p=0.23）之间，各治疗组的平均生活完成度也无显著差异。与RM相比，Outlook受试者在总体生活质量、焦虑、抑郁、FACT-G子量表和FACIT-sp子量表的次要结局方面随时间推移没有显著差异。在早期生命限制性疾病中，Outlook与RM相比，在主要或次要结局方面没有显着差异。结果强调了预先筛查痛苦的重要性。定性，展望参与者能够表达压抑的情绪，疾病的背景下，反思适应，并加强身份。筛查痛苦并确定特定的措施痛苦，除了焦虑和抑郁之外，对于我们充分评估减少存在痛苦的多维机制的能力至关重要。
Compare the efficacy of two interventions addressing emotional and existential well-being in early life-limiting illness. Primary trial analysis(n=135) included patients with advanced cancer, congestive heart failure, or end-stage renal disease; Arm 1 received the Outlook intervention, addressing issues of life completion and preparation, Arm 2 received relaxation meditation(RM). Primary outcomes at 5-weeks(primary endpoint) and 7-weeks(secondary): completion and preparation(QUAL-E); secondary outcomes: anxiety(POMS) quality of life(FACT-G) and spiritual well-being(FACIT-sp) subscales of faith, meaning, and peace. Average age was 62; 56% were post-high school-educated, 54% were married, 52% white, 44% female, and 70% had a cancer diagnosis. At baseline, participants demonstrated low levels of anxiety(<5 on POMS subscale) and depression(<10 on CESD) relative to population norms. Results of the primary analysis revealed no significant differences in mean Preparation by treatment arm at 5 weeks(14.4 Outlook vs. 14.8 RM; between-group difference −0.4 [95% CI, −1.6, 0.8], p=0.49) or 7 week (15.2 vs.15.4; between-group difference −0.2 [95% CI, −1.5, 1.0], p=0.73). There were also no significant differences in mean Life Completion by treatment arm between 5 weeks(26.6 Outlook vs. 26.3 RM; between-group difference 0.2[95% CI, −1.2, 1.7], p=0.76) or 7 weeks (26.5 vs. 27.5; between-group difference −1.0[95% CI, −2.7, 0.7], p=0.23). Compared to RM, Outlook participants did not have significant differences over time in the secondary outcomes of overall quality of life, anxiety, depression, FACT-G subscales, and FACIT-sp subscales. In early-stage life-limiting illness, Outlook did not demonstrate a significant difference on primary or secondary outcomes relative to RM. Results underscore the importance of pre-screening for distress. Qualitatively, Outlook participants were able to express suppressed emotions, place illness context, reflect on adaptations, and strengthen identity. Screening for distress and identifying specified measures distress, beyond anxiety and depression, is essential in our ability to adequately assess the multi-dimensional mechanisms that decrease existential suffering.