Acceptability and Feasibility of a Meaning-Based Intervention for Patients With Advanced Cancer and Their Spouses

Wagner, Christina; Johns, Shelley A.; Brown, LC; Hanna, Nasser H.; Bigatti, Silvia M.

doi:10.1177/1049909115575709

Cited by 13 publications

(20 citation statements)

References 43 publications

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“…However, studies of whole-person approaches to care in later life have been mainly limited to circumscribed palliative or hospice care at the end of life or for single conditions (eg, cancer). [19][20][21][22][23][24] Much literature on understanding and treating patients with serious illness from a whole-person standpoint has been exploratory, with limited or no follow-up. [23][24][25][26] A smaller number of controlled studies testing multicomponent interventions suggest promising results for quality indicators, family-rated care after death, or quality of life.…”

Section: Introductionmentioning

confidence: 99%

“…[19][20][21][22][23][24] Much literature on understanding and treating patients with serious illness from a whole-person standpoint has been exploratory, with limited or no follow-up. [23][24][25][26] A smaller number of controlled studies testing multicomponent interventions suggest promising results for quality indicators, family-rated care after death, or quality of life. [27][28][29] They have generally not focused on improving patient experience.…”

Section: Introductionmentioning

confidence: 99%

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Effect of a Whole-Person Model of Care on Patient Experience in Patients With Complex Chronic Illness in Late Life

Shippee

Mobley

et al. 2017

Am J Hosp Palliat Care

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Background:Patients with serious chronic illness are at a greater risk of depersonalized, overmedicalized care as they move into later life. Existing intervention research on person-focused care for persons in this transitional period is limited.Objective:To test the effects of LifeCourse, a team-based, whole-person intervention emphasizing listening to and knowing patients, on patient experience at 6 months.Design:This is a quasi-experimental study with patients allocated to LifeCourse and comparison groups based on 2 geographic locations. Robust change-score regression models adjusted for baseline differences and confounding.Setting/Participants:Patients (113 intervention, 99 comparison in analyses) were individuals with heart failure or other serious chronic illness, cancer, or dementia who had visits to hospitals at a large multipractice health system in the United States Midwest.Measurements:Primary outcome was 6-month change in patient experience measured via a novel, validated 21-item patient experience tool developed specifically for this intervention. Covariates included demographics, comorbidity score, and primary diagnosis.Results:At 6 months, LifeCourse was associated with a moderate improvement in overall patient experience versus usual care. Individual domain subscales for care team, communication, and patient goals were not individually significant but trended positively in the direction of effect.Conclusion:Person-focused, team-based interventions can improve patient experience with care at a stage fraught with overmedicalization and many care needs. Improvement in patient experience in LifeCourse represents the sum effect of small improvements across different domains/aspects of care such as relationships with and work by the care team.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of a Whole-Person Model of Care on Patient Experience in Patients With Complex Chronic Illness in Late Life

Shippee

Mobley

et al. 2017

Am J Hosp Palliat Care

View full text Add to dashboard Cite

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“…TACTICs feasibility measures included at least 50% of eligible caregivers enrolling in the study and attendance rates of 70% or greater across the six TACTICs sessions. Acceptability was assessed to be that at least 70% of caregivers enrolled in the study completed the study through T4 and at least 70% of enrolled caregivers reported being mostly to completely satisfied with their experience in TACTICs [45]. The standardized response mean (SRM) effect size for the outcomes was calculated to assess the magnitude of intervention effects at T2, T3, and T4.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and acceptability of an acceptance and commitment therapy intervention for caregivers of adults with Alzheimer’s disease and related dementias

et al. 2021

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Background Caregivers of patients with Alzheimer’s disease or a related dementia (ADRD) report high levels of distress, including symptoms of anxiety and depression, caregiving burden, and existential suffering; however, those with support and healthy coping strategies have less stress and burden. Acceptance and Commitment Therapy (ACT) aims to foster greater acceptance of internal events while promoting actions aligned with personal values to increase psychological flexibility in the face of challenges. The objective of this single-arm pilot, Telephone Acceptance and Commitment Therapy Intervention for Caregivers (TACTICs), was to evaluate the feasibility, acceptability, and preliminary effects of an ACT intervention on ADRD caregiver anxiety, depressive symptoms, burden, caregiver suffering, and psychological flexibility. Methods ADRD caregivers ≥21 years of age with a Generalized Anxiety Disorder Scale (GAD-7) score ≥ 10 indicative of moderate or higher symptoms of anxiety were enrolled (N = 15). Participants received a telephone-based ACT intervention delivered by a non-licensed, bachelor’s-prepared trained interventionist over 6 weekly 1-h sessions that included engaging experiential exercises and metaphors designed to increase psychological flexibility. The following outcome measures were administered at baseline (T1), immediately post-intervention (T2), 3 months post-intervention (T3), and 6 months post-intervention (T4): anxiety symptoms (GAD-7; primary outcome); secondary outcomes of depressive symptoms (Patient Health Questionnaire–9), burden (Zarit Burden Interview), suffering (The Experience of Suffering measure), psychological flexibility/experiential avoidance (Acceptance and Action Questionnaire-II), and coping skills (Brief COPE). Results All 15 participants completed the study and 93.3% rated their overall satisfaction with their TACTICs experience as “completely satisfied.” At T2, caregivers showed large reduction in anxiety symptoms (SRM 1.42, 95% CI [0.87, 1.97], p < 0.001) that were maintained at T3 and T4. At T4, psychological suffering (SRM 0.99, 95% CI [0.41, 1.56], p = 0.0027) and caregiver burden (SRM 0.79, 95% CI [0.21, 1.37], p = 0.0113) also decreased. Conclusions Despite a small sample size, the 6-session manualized TACTICs program was effective in reducing anxiety, suggesting that non-clinically trained staff may be able to provide an effective therapeutic intervention by phone to maximize intervention scalability and reach. Trial registration Institutional Review Board (IRB) protocol #1904631305 version 05-14-2019. Recruitment began 06-14-2019 and was concluded on 12-09-2019. Recruitment began 06-14-2019 and was concluded on 12-09-2019.

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“…Feasibility benchmarks included (1) at least 50% of eligible dyads enrolling in the study and (2) attendance rates of 70% or greater across the 6 sessions. Acceptability benchmarks included (1) at least 70% of participants completing the study 66 and (2) at least 70% of participants reporting being mostly to completely satisfied with their intervention experience. The standardized response mean (SRM) effect size was calculated to assess the magnitude of intervention effects at T2 and T3 for both patients and FCGs separately.…”

Section: Methodsmentioning

confidence: 99%

Mindfulness Training Supports Quality of Life and Advance Care Planning in Adults With Metastatic Cancer and Their Caregivers: Results of a Pilot Study

Johns

Beck-Coon

Stutz

et al. 2019

Am J Hosp Palliat Care

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Background: Emotional distress often causes patients with cancer and their family caregivers (FCGs) to avoid end-of-life discussions and advance care planning (ACP), which may undermine quality of life (QoL). Most ACP interventions fail to address emotional barriers that impede timely ACP. Aim: We assessed feasibility, acceptability, and preliminary effects of a mindfulness-based intervention to facilitate ACP for adults with advanced-stage cancer and their FCGs. Design: A single-arm pilot was conducted to assess the impact of a 6-week group mindfulness intervention on ACP behaviors (patients only), QoL, family communication, avoidant coping, distress, and other outcomes from baseline (T1) to post-intervention (T2) and 1 month later (T3). Participants: Eligible patients had advanced-stage solid malignancies, limited ACP engagement, and an FCG willing to participate. Thirteen dyads (N = 26 participants) enrolled at an academic cancer center in the United States. Results: Of eligible patients, 59.1% enrolled. Attendance (70.8% across 6 sessions) and retention (84.6% for patients; 92.3% for FCGs) through T3 were acceptable. Over 90% of completers reported high intervention satisfaction. From T1 to T3, patient engagement more than doubled in each of 3 ACP behaviors assessed. Patients reported large significant decreases in distress at T2 and T3. Family caregivers reported large significant improvements in QoL and family communication at T2 and T3. Both patients and FCGs reported notable reductions in sleep disturbance and avoidant coping at T3. Conclusions: The mindfulness intervention was feasible and acceptable and supported improvements in ACP and associated outcomes for patients and FCGs. A randomized trial of mindfulness training for ACP is warranted. The study is registered at ClinicalTrials.gov with identifier NCT02367508 ( https://clinicaltrials.gov/ct2/show/NCT02367508 ).

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Acceptability and Feasibility of a Meaning-Based Intervention for Patients With Advanced Cancer and Their Spouses

Abstract: Background: Constructing meaning in cancer leads to improved psychosocial outcomes for

Cited by 13 publications

References 43 publications

Effect of a Whole-Person Model of Care on Patient Experience in Patients With Complex Chronic Illness in Late Life

Effect of a Whole-Person Model of Care on Patient Experience in Patients With Complex Chronic Illness in Late Life

Feasibility and acceptability of an acceptance and commitment therapy intervention for caregivers of adults with Alzheimer’s disease and related dementias

Mindfulness Training Supports Quality of Life and Advance Care Planning in Adults With Metastatic Cancer and Their Caregivers: Results of a Pilot Study

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