EMPOWER: A multi-site pilot trial to reduce distress in surrogate decision-makers in the ICU Journal Article
| Authors: | Lichtenthal, W. G.; Lief, L.; Rogers, M.; Russell, D.; Viola, M.; Winoker, H.; Kakarala, S.; Traube, C.; Coats, T.; Fadalla, C.; Roberts, K. E.; Pavao, M.; Osso, F.; Brewin, C. R.; Pan, C. X.; Maciejewski, P. K.; Berlin, D.; Pastores, S.; Halpern, N.; Vaughan, S. C.; Cox, C. E.; Prigerson, H. G. |
| Article Title: | EMPOWER: A multi-site pilot trial to reduce distress in surrogate decision-makers in the ICU |
| Abstract: | Context: Efforts to reduce the psychological distress of surrogate decision-makers of critically ill patients have had limited success, and some have even exacerbated distress. Objectives: 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. Methods: 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. Results: 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. Conclusions: EMPOWER appeared feasible and acceptable, increased surrogates’ satisfaction with critical care, and prevented escalation of posttraumatic stress, grief, and depression 3 months later. © 2024 American Academy of Hospice and Palliative Medicine |
| Keywords: | adult; controlled study; treatment outcome; aged; middle aged; major clinical study; clinical trial; follow up; follow-up studies; randomized controlled trial; palliative therapy; evidence based practice; psychology; depression; intensive care unit; intensive care units; feasibility study; pilot study; feasibility studies; pilot projects; multicenter study; distress syndrome; posttraumatic stress disorder; anxiety; behavior therapy; decision making; therapy; critical care; mental stress; stress, psychological; grief; emotional stress; psychological distress; critical illness; critically ill patient; psychological intervention; trauma; proxy; intention to treat analysis; humans; human; male; female; article; surrogate decision-making; experiential avoidance |
| Journal Title: | Journal of Pain and Symptom Management |
| Volume: | 67 |
| Issue: | 6 |
| ISSN: | 0885-3924 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2024-06-01 |
| Start Page: | 512 |
| End Page: | 524.e2 |
| Language: | English |
| DOI: | 10.1016/j.jpainsymman.2024.03.002 |
| PUBMED: | 38479536 |
| PROVIDER: | scopus |
| PMCID: | PMC11110718 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF -- Source: Scopus |
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