• Karen E Steinhauser, Stewart Alexander, Maren K Olsen, Karen M Stechuchak, Jennifer Zervakis, Natalie Ammarell, Ira Byock, and James A Tulsky.
• J Pain Symptom Manage. 2017 Aug 9.

ContextFew interventions exist to address patients' existential needs.ObjectiveDetermine whether an intervention to address seriously-ill patients' existential concerns improves preparation, completion (elements of quality-of-life at end-of-life) and reduces anxiety and depression.MethodsA randomized control trial comparing: 1)Outlook intervention, 2)Relaxation meditation (RM); and 3)Usual care (UC). Measures included: primary - quality-of-life (QUAL-E) and secondary - FACT-G, anxiety (POMS), depression (CES-D), and spiritual well-being (FACIT-sp). Qualitative interviews assessed Outlook intervention acceptability. Enrolled patients were non-hospice eligible veterans with advanced cancer, congestive heart failure, chronic obstructive pulmonary disease, end-stage renal disease, or end-stage liver disease.FindingsPatients (n= 221) were randomly assigned 1:1:1 to Outlook, RM, and UC. Patients were 96% male; 46% cancer; 58.4% married; and 43.9% African-American. Compared with UC, Outlook participants had higher preparation (QUAL-E)(mean difference=1.1; 95% CI (0.2, 2.0); p=.02) and mean completion (1.6, 95% CI: 0.05, 3.1; p=0.04) at the first but not second post-assessment. Compared with RM, Outlook participants did not show significant differences over time. Exploratory analyses indicated that in subgroups with cancer and low sense of peace, Outlook participants had improved preparation at first and not second post-assessment, as compared with UC (mean difference=1.4; 95% CI (0.03, 2.7); p=0.04), (mean difference =1.8; 95% CI (0.3, 3.3); p=0.02), respectively.ConclusionsOutlook had an impact on social well-being and preparation compared with UC. The lack of impact on anxiety and depression differs from previous results among hospice patients. Results suggest Outlook is not demonstratively effective in populations not experiencing existential or emotional distress.Copyright © 2017. Published by Elsevier Inc.

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