3 results
Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients
- Wendy G. Lichtenthal, Martin Viola, Madeline Rogers, Kailey E. Roberts, Lindsay Lief, Christopher E. Cox, Chris R. Brewin, Jiehui Cici Xu, Paul K. Maciejewski, Cynthia X. Pan, Taylor Coats, Daniel J. Ouyang, Shayna Rabin, Susan C. Vaughan, William Breitbart, Marjorie E. Marenberg, Holly G. Prigerson
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- Journal:
- Palliative & Supportive Care / Volume 20 / Issue 2 / April 2022
- Published online by Cambridge University Press:
- 08 July 2021, pp. 167-177
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Objective
The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes.
MethodPart 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments.
ResultsPart 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30).
Significance of resultsPreliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.
Contributors
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- By Linda S. Aglio, Cyrus Ahmadi Yazdi, Syed Irfan Qasim Ali, Caryn Barnet, Jessica Bauerle, Felicity Billings, Evan Blaney, Beverly Chang, Christopher Chen, Zinaida Chepurny, Hyung Sun Choi, Allison Clark, Lauren J. Cornella, Lisa Crossley, Michael D’Ambra, Galina Davidyuk, Whitney de Luna, Manisha S. Desai, Sukumar P. Desai, Kelly G. Elterman, Michaela K. Farber, Iuliu Fat, Jaida Fitzgerald, Devon Flaherty, John A. Fox, Gyorgy Frendl, Rejean Gareau, Joseph M. Garfield, Andrea Girnius, Laverne D. Gugino, J. Tasker Gundy, Carly C. Guthrie, Lisa M. Hammond, M. Tariq Hanifi, James Hardy, Philip M. Hartigan, Thomas Hickey, Richard Hsu, Mohab Ibrahim, David Janfaza, Yuka Kiyota, Suzanne Klainer, Benjamin Kloesel, Hanjo Ko, Bhavani Kodali, Vesela Kovacheva, J. Matthew Kynes, Robert W. Lekowski, Joyce Lo, Jeffrey Lu, Alvaro A. Macias, Zahra M. Malik, Erich N. Marks, Brendan McGinn, Jonathan R. Meserve, Annette Mizuguchi, Srdjan S. Nedeljkovic, Ju-Mei Ng, Michael Nguyen, Olutoyin Okanlawon, Jennifer Oliver, Krishna Parekh, Jessica Patterson, Christian Peccora, Pete Pelletier, Sujatha Pentakota, James H. Philip, Marc Philip T. Pimentel, Timothy D. Quinn, Elizabeth M. Rickerson, Susan L. Sager, Julia Serber, Shaheen Shaikh, Stanton Shernan, David Silver, Alissa Sodickson, Pingping Song, George P. Topulos, Agnieszka Trzcinka, Richard D. Urman, Rosemary Uzomba, Joshua Vacanti, Assia Valovska, Michael Vaninetti, Scott W. Vaughan, Kamen Vlassakov, Christopher Voscopoulos, Emily L. Wang, Laura Westfall, Zhiling Xiong, Stephanie Yacoubian, Dongdong Yao, Martin Zammert, Maksim Zayaruzny, Jose Luis Zeballos, Natthasorn Zinboonyahgoon, Jie Zhou
- Edited by Linda S. Aglio, Robert W. Lekowski, Richard D. Urman
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- Book:
- Essential Clinical Anesthesia Review
- Published online:
- 05 February 2015
- Print publication:
- 08 January 2015, pp xi-xvi
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Contributors
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- By Saleh H. Alwasel, Susan P. Bagby, David J. P Barker, Richard Boyd, Robert Boyd, Graham Burdge, Graham J Burton, Anthony M Carter, Irene Cetin, Zoe Cole, Cyrus Cooper, Hilary Critchley, Elaine Dennison, Susie Earl, Johan G Eriksson, Caroline H. D Fall, Anne C. Ferguson-Smith, Tom P. Fleming, Alison J. Forhead, Abigail L. Fowden, Dino Giussani, Laura Goodfellow, Nicholas Harvey, Christopher Holroyd, Joan Hunt, Alan A. Jackson, Thomas Jansson, Eric Jauniaux, Rosalind John, Eero Kajantie, Michelle Lampl, Karen Lillycrop, Charlie Loke, Samantha Louey, Per Magnus, Ashley Moffett, Lorna G. Moore, Terry Morgan, Clive Osmond, Perrie F. O'Tierney, Robert Pijnenborg, Lucilla Poston, Theresa L. Powell, Elizabeth J. Radford, Tessa J. Roseboom, Amanda Sferruzzi-Perri, Colin P. Sibley, Gordon C. S. Smith, Emanuela Taricco, Kent Thornburg, Benjamin Tycko, Owen R. Vaughan, Lisbeth Vercruysse
- Edited by Graham J. Burton, David J. P. Barker, Ashley Moffett, Kent Thornburg
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- Book:
- The Placenta and Human Developmental Programming
- Published online:
- 04 February 2011
- Print publication:
- 16 December 2010, pp vii-x
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