A Multisite Randomized Controlled Trial of EMPOWER for Family Surrogates of Critically Ill Patients

EMPOWER 对危重患者家庭代理人的多中心随机对照试验

基本信息

项目摘要

Project Summary Intensive Care Units (ICUs) are stressful places fraught with grief and potentially traumatic exposures for those witnessing a critically ill family member in pain, struggling to breathe, maintain consciousness, and stay alive. Compounding their distress, family caregivers are often thrust into the position of patient “surrogate,” needing to make life-and-death decisions on the patient's behalf. We have shown that end-of-life (EoL) decision-making is compromised by elevated symptoms of distressing and disabling grief, resulting in family surrogates making suboptimal EoL choices that often prolong patient suffering, further exacerbating surrogates' grief, trauma, and regrets. The coronavirus (COVID-19) pandemic has made this bad situation worse, particularly among Black, Indigenous, and People of Color (BIPOC). Prior efforts to address the plight of these family surrogates have proved disappointing, with some significantly worsening surrogates' psychological trauma. Yet these were not psychological interventions, much less ones using psychological techniques with proven efficacy. To address these shortcomings, we developed a brief, flexibly administered intervention applying empirically supported cognitive-behavioral and acceptance-based techniques. In an R21 pilot, this intervention, EMPOWER (Enhancing & Mobilizing the POtential for Wellness & Emotional Resilience), dramatically reduced experiential avoidance, grief, and traumatic stress, and was associated with higher rates of advance care planning, including among BIPOC. The proposed multisite, mixed-methods trial will randomize 172 family surrogates to receive EMPOWER (N=86) or a standardized supportive conversation (SC; N=86) delivered via videoconferencing. Surrogate symptoms will be assessed pre-intervention, immediately post-intervention, and 3- and 12-months post-intervention. The primary aim of this study is to compare the efficacy of EMPOWER to SC. We hypothesize that, compared to SC, EMPOWER will yield significantly greater declines in H1a. surrogate grief and posttraumatic stress (primary outcomes) and H1b. experiential avoidance, depression, regrets, and increase patients' receipt of value concordant care (secondary outcomes). The secondary aim of this study is to contextualize quantitative RCT results. H2. Qualitative interviews will provide complementary data on perceived barriers to and facilitators of symptom improvement, dissemination, and implementation, as well as insights into the impact of medical mistrust, perceived discrimination and COVID-19 on outcomes. The third aim will explore experiential avoidance as a mediator of intervention effects: H3. Reductions in experien- tial avoidance will mediate reductions in grief and posttraumatic stress. This study is expected to confirm EMPOWER's efficacy and enhance understanding of ways to improve telehealth delivery to psychologically vulnerable and historically underserved surrogates. If successful, EMPOWER will address the urgent need for effective, culturally competent interventions for distressed surrogates, which may improve critically ill patients' EoL experience in the context of extreme challenges that have been exacerbated by the COVID-19 pandemic.
项目总结

项目成果

期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)

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Wendy G. Lichtenthal其他文献

59 – Bereavement care
59 – 丧亲护理
  • DOI:
    10.1016/b978-1-4377-1015-1.00059-x
  • 发表时间:
    2011
  • 期刊:
  • 影响因子:
    1.2
  • 作者:
    Wendy G. Lichtenthal;M. Clark;H. Prigerson
  • 通讯作者:
    H. Prigerson
Meaning-Centered Psychotherapy
以意义为中心的心理治疗
  • DOI:
  • 发表时间:
    2022
  • 期刊:
  • 影响因子:
    0
  • 作者:
    William S. Breitbart;Wendy G. Lichtenthal;Allison J Applebaum
  • 通讯作者:
    Allison J Applebaum
Being a Bereavement-Conscious Hospice and Palliative Care Clinician.
成为一名具有丧亲意识的临终关怀和姑息治疗临床医生。
Family focused grief therapy: From palliative care into bereavement.
以家庭为中心的悲伤治疗:从姑息治疗到丧亲之痛。
  • DOI:
  • 发表时间:
    2008
  • 期刊:
  • 影响因子:
    0
  • 作者:
    D. Kissane;Wendy G. Lichtenthal
  • 通讯作者:
    Wendy G. Lichtenthal
Families “At Risk” of Complicated Bereavement
家庭“面临复杂丧亲之痛的风险”

Wendy G. Lichtenthal的其他文献

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{{ truncateString('Wendy G. Lichtenthal', 18)}}的其他基金

A Multisite Randomized Controlled Trial of EMPOWER for Family Surrogates of Critically Ill Patients
EMPOWER 对危重患者家庭代理人的多中心随机对照试验
  • 批准号:
    10599859
  • 财政年份:
    2022
  • 资助金额:
    $ 84.39万
  • 项目类别:
Meaning-Centered Grief Therapy for Parents Bereaved by Cancer: A Multisite Randomized Controlled Trial
对罹患癌症的父母进行以意义为中心的悲伤治疗:一项多中心随机对照试验
  • 批准号:
    10878563
  • 财政年份:
    2021
  • 资助金额:
    $ 84.39万
  • 项目类别:
Meaning-Centered Grief Therapy for Parents Bereaved by Cancer: A Multisite Randomized Controlled Trial
对罹患癌症的父母进行以意义为中心的悲伤治疗:一项多中心随机对照试验
  • 批准号:
    10298966
  • 财政年份:
    2021
  • 资助金额:
    $ 84.39万
  • 项目类别:
An Investigation of the Clinical Utility of a Prolonged Grief Disorder Diagnosis
长期悲伤障碍诊断的临床实用性调查
  • 批准号:
    8469668
  • 财政年份:
    2013
  • 资助金额:
    $ 84.39万
  • 项目类别:
Meaning-Centered Grief Therapy for Parents Bereaved by Cancer
针对癌症失去亲人的父母进行以意义为中心的悲伤治疗
  • 批准号:
    8423441
  • 财政年份:
    2013
  • 资助金额:
    $ 84.39万
  • 项目类别:
Meaning-Centered Grief Therapy for Parents Bereaved by Cancer
针对癌症失去亲人的父母进行以意义为中心的悲伤治疗
  • 批准号:
    8776927
  • 财政年份:
    2013
  • 资助金额:
    $ 84.39万
  • 项目类别:
Themes of Meaning: Intervention Development for Parents Bereaved by Cancer
意义主题:针对癌症失去亲人的父母的干预发展
  • 批准号:
    7679235
  • 财政年份:
    2009
  • 资助金额:
    $ 84.39万
  • 项目类别:
Themes of Meaning: Intervention Development for Parents Bereaved by Cancer
意义主题:针对癌症失去亲人的父母的干预发展
  • 批准号:
    7792398
  • 财政年份:
    2009
  • 资助金额:
    $ 84.39万
  • 项目类别:
Intervention Development for Complicated Grief
复杂悲伤的干预措施发展
  • 批准号:
    6936904
  • 财政年份:
    2005
  • 资助金额:
    $ 84.39万
  • 项目类别:

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