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Seriously ill patients' discussions of preparation and life completion: An intervention to assist with transition at the end of life

Published online by Cambridge University Press:  26 November 2009

Karen E. Steinhauser ,
Stewart C. Alexander ,
Ira R. Byock ,
Linda K. George  and
James A. Tulsky
Karen E. Steinhauser*
Affiliation:
Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina Center for Palliative Care, Durham VA Medical Center, Durham, North Carolina Department of Medicine, Duke University, Durham, North Carolina Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
Stewart C. Alexander
Affiliation:
Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina Center for Palliative Care, Durham VA Medical Center, Durham, North Carolina Department of Medicine, Duke University, Durham, North Carolina
Ira R. Byock
Affiliation:
Dartmouth Medical School, Hanover, New Hampshire
Linda K. George
Affiliation:
Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina Department of Sociology, Duke University, Durham, North Carolina
James A. Tulsky
Affiliation:
Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina Center for Palliative Care, Durham VA Medical Center, Durham, North Carolina Department of Medicine, Duke University, Durham, North Carolina Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina Institute on Care at the End of Life, Duke University, Durham, North Carolina
*
Address correspondence and reprint requests to: Karen E. Steinhauser, VA and Duke Medical Centers, Center for Palliative Care, Hock Plaza, 2424 Erwin Rd., Suite 1105, Box 2720, Durham, NC 27705. E-mail: karen.steinhauser@duke.edu
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Abstract

Objective:

Patients approaching the end of life not only face challenges to physical well-being but also threats to emotional and spiritual integrity. Yet, identifying appropriate, effective, and brief interventions to address those concerns has proven elusive. We developed an intervention based on life review and emotional disclosure literatures and conducted a pilot study to determine feasibility and acceptability. This article presents qualitative intervention responses.

Method:

We conducted a three-armed randomized control trial to evaluate the effects of preparation and life completion discussion on health outcomes in patients with advanced serious illness. Hospice-eligible subjects were randomly assigned to one of three groups: (1) intervention (life completion discussion intervention), (2) attention control (relaxation meditation), and control (no intervention). Subjects in the intervention arm met with a facilitator three times. Session 1 focused on life story, Session 2 on forgiveness, and Session 3, on heritage and legacy.

Results:

Eighteen subjects participated in the pilot intervention interviews. Subjects from a range of socioeconomic backgrounds completed the intervention with equal facility. Results from Session 1 demonstrate narrative responses participants gave as they reconnected with previous life roles, values, and accomplishments. The second session illustrated reflections of choices one might have made differently and exploration of forgiveness offered and sought. Content from the first and second sessions laid the foundation for discussing Session 3's lessons learned and heritage and legacy. Responses are summarized to assist clinicians in anticipating life review content that may improve overall quality of life at the end of life.

Significance of results:

Discussions of life completion may improve important health outcomes for patients at the end of life. This intervention may provide a brief, standardized, and transportable means for improving the quality of life of patients with advanced serious illness.

Keywords

Emotional and spiritual integrityLife completionInterventionsGerontology
Type
Original Articles
Information
Palliative & Supportive Care , Volume 7 , Issue 4 , December 2009 , pp. 393 - 404
Copyright
Copyright © Cambridge University Press 2009

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