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Addressing Patient Emotional and Existential Needs During Serious Illness: Results of the Outlook Randomized Controlled Trial.

Publication ,  Journal Article
Steinhauser, KE; Alexander, S; Olsen, MK; Stechuchak, KM; Zervakis, J; Ammarell, N; Byock, I; Tulsky, JA
Published in: Journal of pain and symptom management
December 2017

Few interventions exist to address patients' existential needs.Determine whether an intervention to address seriously ill patients' existential concerns improves preparation, completion (elements of quality of life [QOL] at end of life), and reduces anxiety and depression.A randomized controlled trial comparing outlook intervention, relaxation meditation (RM), and usual care (UC). Measures included primary-a validated measure of QOL at the end of life and secondary-Functional Assessment of Cancer Therapy-General, anxiety (Profile of Mood States), depression (Center for Epidemiological Studies-Depression Scale), and spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being). Qualitative interviews assessed outlook intervention acceptability. Enrolled patients were nonhospice eligible veterans with advanced cancer, congestive heart failure, chronic obstructive pulmonary disease, end-stage renal disease, or end-stage liver disease.Patients (n = 221) were randomly assigned 1:1:1 to outlook, RM, and UC. Patients were 96% males, 46% with cancer, 58.4% married, and 43.9% of African American origin. Compared with UC, outlook participants had higher preparation (a validated measure of QOL at the end of life) (mean difference 1.1; 95% CI 0.2, 2.0; P = 0.02) and mean completion (1.6; 95% CI 0.05, 3.1; P = 0.04) at the first but not second postassessment. Compared with RM, outlook participants did not show significant differences over time. Exploratory analyses indicated that in subgroups with cancer and low sense of peace, outlook participants had improved preparation at first and not second postassessment, as compared with UC (mean difference 1.4; 95% CI 0.03, 2.7; P = 0.04) (mean difference = 1.8; 95% CI 0.3, 3.3; P = 0.02), respectively.Outlook had an impact on social well-being and preparation compared with UC. The lack of impact on anxiety and depression differs from previous results among hospice patients. Results suggest that outlook is not demonstratively effective in populations not experiencing existential or emotional distress.

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Published In

Journal of pain and symptom management

DOI

EISSN

1873-6513

ISSN

0885-3924

Publication Date

December 2017

Volume

54

Issue

6

Start / End Page

898 / 908

Related Subject Headings

  • Spirituality
  • Relaxation Therapy
  • Quality of Life
  • Palliative Care
  • Male
  • Interviews as Topic
  • Humans
  • Follow-Up Studies
  • Female
  • Existentialism
 

Citation

APA
Chicago
ICMJE
MLA
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Steinhauser, K. E., Alexander, S., Olsen, M. K., Stechuchak, K. M., Zervakis, J., Ammarell, N., … Tulsky, J. A. (2017). Addressing Patient Emotional and Existential Needs During Serious Illness: Results of the Outlook Randomized Controlled Trial. Journal of Pain and Symptom Management, 54(6), 898–908. https://doi.org/10.1016/j.jpainsymman.2017.06.003
Steinhauser, Karen E., Stewart Alexander, Maren K. Olsen, Karen M. Stechuchak, Jennifer Zervakis, Natalie Ammarell, Ira Byock, and James A. Tulsky. “Addressing Patient Emotional and Existential Needs During Serious Illness: Results of the Outlook Randomized Controlled Trial.Journal of Pain and Symptom Management 54, no. 6 (December 2017): 898–908. https://doi.org/10.1016/j.jpainsymman.2017.06.003.
Steinhauser KE, Alexander S, Olsen MK, Stechuchak KM, Zervakis J, Ammarell N, et al. Addressing Patient Emotional and Existential Needs During Serious Illness: Results of the Outlook Randomized Controlled Trial. Journal of pain and symptom management. 2017 Dec;54(6):898–908.
Steinhauser, Karen E., et al. “Addressing Patient Emotional and Existential Needs During Serious Illness: Results of the Outlook Randomized Controlled Trial.Journal of Pain and Symptom Management, vol. 54, no. 6, Dec. 2017, pp. 898–908. Epmc, doi:10.1016/j.jpainsymman.2017.06.003.
Steinhauser KE, Alexander S, Olsen MK, Stechuchak KM, Zervakis J, Ammarell N, Byock I, Tulsky JA. Addressing Patient Emotional and Existential Needs During Serious Illness: Results of the Outlook Randomized Controlled Trial. Journal of pain and symptom management. 2017 Dec;54(6):898–908.
Journal cover image

Published In

Journal of pain and symptom management

DOI

EISSN

1873-6513

ISSN

0885-3924

Publication Date

December 2017

Volume

54

Issue

6

Start / End Page

898 / 908

Related Subject Headings

  • Spirituality
  • Relaxation Therapy
  • Quality of Life
  • Palliative Care
  • Male
  • Interviews as Topic
  • Humans
  • Follow-Up Studies
  • Female
  • Existentialism