• Wendy G Lichtenthal, Lindsay Lief, Madeline Rogers, David Russell, Martin Viola, Hillary Winoker, Sophia Kakarala, Chani Traube, Taylor Coats, Carol Fadalla, Kailey E Roberts, Madison Pavao, Francesco Osso, Chris R Brewin, Cynthia X Pan, Paul K Maciejewski, David Berlin, Stephen Pastores, Neil Halpern, Susan C Vaughan, Christopher E Cox, and Holly G Prigerson.
• University of Miami Miller School of Medicine (W.G.L.), Miami, Florida, USA; Memorial Sloan Kettering Cancer Center (W.G.L., K.E.R., S.P., N.H.), New York, New York, USA. Electronic address: wendy.lichtenthal@miami.edu.
• J Pain Symptom Manage. 2024 Jun 1; 67 (6): 512524.e2512-524.e2.

ContextEfforts to reduce the psychological distress of surrogate decision-makers of critically ill patients have had limited success, and some have even exacerbated distress.ObjectivesThe 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.MethodsSurrogates 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.ResultsDelivery 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.ConclusionsEMPOWER appeared feasible and acceptable, increased surrogates' satisfaction with critical care, and prevented escalation of posttraumatic stress, grief, and depression 3 months later.Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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