Details

Autor(en) / Beteiligte

• Lichtenthal, Wendy G.
• Lief, Lindsay
• Rogers, Madeline
• Russell, David
• Viola, Martin
• Winoker, Hillary
• Kakarala, Sophia
• Traube, Chani
• Coats, Taylor
• Fadalla, Carol
• Roberts, Kailey E.
• Pavao, Madison
• Osso, Francesco
• Brewin, Chris R.
• Pan, Cynthia X.
• Maciejewski, Paul K.
• Berlin, David
• Pastores, Stephen
• Halpern, Neil
• Vaughan, Susan C.
• Cox, Christopher E.
• Prigerson, Holly G.

Titel

EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU

Ist Teil von

• Journal of pain and symptom management, 2024-03

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2024

Link zum Volltext

Quelle

Elsevier ScienceDirect Journals

Beschreibungen/Notizen

• Efforts to reduce the psychological distress of surrogate decision-makers of critically ill patients have had limited success, and some have even exacerbated distress. The aim of this study was to determine the feasibility, acceptability, and preliminary efficacy of EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), an ultra-brief (∼2-hour), 6-module manualized psychological intervention for surrogates. Surrogates who reported significant anxiety and/or an emotionally close relationship with the patient (n=60) were randomized to receive EMPOWER or enhanced usual care (EUC) at one of three metropolitan hospitals. Participants completed evaluations of EMPOWER's acceptability and measures of psychological distress pre-intervention, immediately post-intervention, and at 1- and 3-month follow-up assessments. Delivery of EMPOWER appeared feasible, with 89% of participants completing all 6 modules, and acceptable, with high ratings of satisfaction (mean=4.5/5, SD = .90). Compared to EUC, intent-to-treat analyses showed EMPOWER was superior at reducing peritraumatic distress (Cohen's d = –0.21, small effect) immediately post-intervention and grief intensity (d = –0.70, medium-large effect), posttraumatic stress (d = –0.74, medium-large effect), experiential avoidance (d = –0.46, medium effect), and depression (d = –0.34, small effect) 3 months post-intervention. Surrogate satisfaction with overall critical care (d = 0.27, small effect) was higher among surrogates randomized to EMPOWER. EMPOWER appeared feasible and acceptable, increased surrogates’ satisfaction with critical care, and prevented escalation of posttraumatic stress, grief, and depression 3 months later.