Do Preparation and Life Completion Discussions Improve Functioning and Quality of Life in Seriously III Patients? Pilot Randomized Control Trial

Background: 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. Objective: 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. Design: 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. Measurements: 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. Results: 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. Conclusions: 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.