Steinhauser Karen E, Alexander Stewart C, Byock Ira R, George Linda K, Olsen Maren K, Tulsky James A
Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina 27705, USA.
J Palliat Med. 2008 Nov;11(9):1234-40. doi: 10.1089/jpm.2008.0078.
Significant palliative care intervention has focused on physical pain and symptom control; yet less empirical evidence supports efforts to address the psychosocial and spiritual dimensions of experience.
To evaluate the impact of an intervention (Outlook) 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.
A three-arm pilot randomized control trial. Subjects were recruited from inpatient and outpatient hospital, palliative care, and hospice settings. Intervention subjects met with a facilitator three times and discussed issues related to life review, forgiveness, and heritage and legacy. Attention control subjects met with a facilitator three times and listened to a nonguided relaxation CD. True control subjects received no intervention.
Preoutcomes and postoutcomes included the Memorial Symptom Assessment Scale, QUAL-E, Rosow-Breslau ADL Scale, Profile of Mood States anxiety sub-scale, the CESD short version, and the Daily Spiritual Experience Scale.
Eighty-two hospice eligible patients enrolled in the study; 38 were women, 35 were African American. Participants' primary diagnoses included cancer (48), heart disease (5) lung disease (10), and other (19) Ages ranged from 28-96. Participants in the active discussion intervention showed improvements in functional status, anxiety, depression, and preparation for end of life.
The Outlook intervention was acceptable to patients from a variety of educational and ethnic backgrounds and offers a brief, manualized, intervention for emotional and spiritual concerns.
重大的姑息治疗干预主要集中在身体疼痛和症状控制方面；然而，较少的实证证据支持在解决心理社会和精神层面体验方面所做的努力。
评估一种促进临终准备和完成情况讨论的干预措施（展望）对临终患者健康结局的影响，包括疼痛和症状、身体功能、情绪功能（焦虑和抑郁）、精神幸福感以及临终时的生活质量。
一项三臂试点随机对照试验。受试者从住院和门诊医院、姑息治疗机构及临终关怀机构招募。干预组受试者与一名引导者会面三次，讨论与生活回顾、宽恕以及遗产相关的问题。注意力控制组受试者与一名引导者会面三次，收听一张无引导的放松CD。真正的对照组受试者未接受任何干预。
干预前后的指标包括纪念症状评估量表、QUAL-E量表、罗索-布雷斯劳日常生活活动量表、情绪状态剖面图焦虑分量表、CESD简版量表以及每日精神体验量表。
82名符合临终关怀条件的患者参与了该研究；38名女性，35名非裔美国人。参与者的主要诊断包括癌症（48例）、心脏病（5例）、肺病（10例）以及其他疾病（19例）。年龄范围为28至96岁。积极讨论干预组的参与者在功能状态、焦虑、抑郁以及临终准备方面均有改善。
展望干预措施对于来自不同教育和种族背景的患者来说是可以接受的，并且为情感和精神方面的问题提供了一种简短的、有手册指导的干预方法。
