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

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，疼痛和其他症状，并改善功能状态，精神健康， 生活质量如果有效，干预提供了一个简短的，廉价的，可移动的非医生 治疗方法，以改善个人的经验，在后期阶段的生命限制性疾病。努力 改善护理结束往往侧重于疼痛和症状控制，但很少，如果有的话，有效的干预措施存在 解决准备和完成问题。我们设计了一个临终准备和完成 干预，基于人类发展文献，将完成生命视为一项发展任务 以及健康传播和临床心理学方面的有力证据， 表达对健康结果的情绪和压力。我们的具体目标是：1）评估 促进讨论临终准备和完成临终健康结果的干预措施 人，包括疼痛和症状，身体功能，情绪功能（焦虑和抑郁）， 精神健康和生命结束时的生活质量，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差异 与家庭，精神和疾病阶段，以提高对需要量身定制的干预的理解 基于人口统计学或疾病轨迹中的位置的内容。我们提出了一个随机对照试验 评估干预措施。将随机分配140例晚期癌症、CHF或COPD患者 分为两个干预组，并完成一系列简短的预测试措施。第一个主题 小组（“治疗”）将与协调员会面三次，每次45分钟。上 在这节课中，受试者将被要求讨论与生活回顾有关的问题。一周后，参与者将 被要求更深入地谈论后悔、宽恕和未完成的事情等问题。在决赛中 一周后，会议的主题将集中在遗产和遗产上。第二组的受试者 （“注意力控制”）将与协调员会面三次，每次45分钟， 听一张没有指导的放松CD一周和两周后，所有小组的参与者将获得 测试后的措施由一个盲面试官管理。

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.