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Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients.

Publication ,  Journal Article
Lichtenthal, WG; Viola, M; Rogers, M; Roberts, KE; Lief, L; Cox, CE; Brewin, CR; Xu, JC; Maciejewski, PK; Pan, CX; Coats, T; Ouyang, DJ ...
Published in: Palliat Support Care
April 2022

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. METHOD: Part 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. RESULTS: Part 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 RESULTS: Preliminary 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.

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Published In

Palliat Support Care

DOI

EISSN

1478-9523

Publication Date

April 2022

Volume

20

Issue

2

Start / End Page

167 / 177

Location

England

Related Subject Headings

  • Oncology & Carcinogenesis
  • Intensive Care Units
  • Humans
  • Grief
  • Decision Making
  • Critical Illness
  • Critical Care
  • 4203 Health services and systems
  • 1117 Public Health and Health Services
 

Citation

APA
Chicago
ICMJE
MLA
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Lichtenthal, W. G., Viola, M., Rogers, M., Roberts, K. E., Lief, L., Cox, C. E., … Prigerson, H. G. (2022). Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients. Palliat Support Care, 20(2), 167–177. https://doi.org/10.1017/S1478951521000626
Lichtenthal, Wendy G., Martin Viola, Madeline Rogers, Kailey E. Roberts, Lindsay Lief, Christopher E. Cox, Chris R. Brewin, et al. “Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients.Palliat Support Care 20, no. 2 (April 2022): 167–77. https://doi.org/10.1017/S1478951521000626.
Lichtenthal WG, Viola M, Rogers M, Roberts KE, Lief L, Cox CE, et al. Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients. Palliat Support Care. 2022 Apr;20(2):167–77.
Lichtenthal, Wendy G., et al. “Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients.Palliat Support Care, vol. 20, no. 2, Apr. 2022, pp. 167–77. Pubmed, doi:10.1017/S1478951521000626.
Lichtenthal WG, Viola M, Rogers M, Roberts KE, Lief L, Cox CE, Brewin CR, Xu JC, Maciejewski PK, Pan CX, Coats T, Ouyang DJ, Rabin S, Vaughan SC, Breitbart W, Marenberg ME, Prigerson HG. Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients. Palliat Support Care. 2022 Apr;20(2):167–177.
Journal cover image

Published In

Palliat Support Care

DOI

EISSN

1478-9523

Publication Date

April 2022

Volume

20

Issue

2

Start / End Page

167 / 177

Location

England

Related Subject Headings

  • Oncology & Carcinogenesis
  • Intensive Care Units
  • Humans
  • Grief
  • Decision Making
  • Critical Illness
  • Critical Care
  • 4203 Health services and systems
  • 1117 Public Health and Health Services