title: Do preparation and life completion discussions improve functioning and quality of life in seriously ill patients? Pilot randomized control trial.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina 27705, USA. Karen.steinhauser@duke.edu
authors.forename: Karen E
authors.initials: KE
authors.lastname: Steinhauser
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Alexander
authors.forename: Ira R
authors.initials: IR
authors.lastname: Byock
authors.forename: Linda K
authors.initials: LK
authors.lastname: George
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D029181:Spirituality; D013727:Terminal Care / Q000523:psychology