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Abstract：
BACKGROUND: Efforts to reduce the psychological distress of surrogate decision-makers of critically ill patients have had limited success, and some have even exacerbated distress.
OBJECTIVE: The 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.
METHODS: Surrogates 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.
RESULTS: Delivery 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.
CONCLUSIONS: EMPOWER appeared feasible and acceptable, increased surrogates\' satisfaction with critical care, and prevented escalation of posttraumatic stress, grief, and depression 3 months later.
OBJECTIVE: The 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.
METHODS: Surrogates 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.
RESULTS: Delivery 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.
CONCLUSIONS: EMPOWER appeared feasible and acceptable, increased surrogates\' satisfaction with critical care, and prevented escalation of posttraumatic stress, grief, and depression 3 months later.
摘要：
背景：减少危重病人替代决策者心理困扰的努力取得了有限的成功，有些甚至加剧了痛苦。
目的：本研究的目的是确定可行性，可接受性,和EMPOWER（增强和动员健康和复原力的潜力）的初步功效，超简短(2小时)，6个模块的代孕者手动心理干预。
方法：报告患者有显著焦虑和/或情感上亲密关系的代理人（n=60）在三家大都市医院之一随机接受EMPOWER或强化常规护理（EUC）。参与者完成了对EMPOWER的可接受性和干预前心理困扰措施的评估，立即干预后，以及1个月和3个月的随访评估。
结果：EMPOWER的交付似乎是可行的，89%的参与者完成了所有6个模块，并且可以接受,满意度较高（平均值=4.5/5，SD=.90）。与EUC相比，意向治疗分析显示，EMPOWER在减少创伤困扰（Cohen\'sd=-0.21，小效果）后立即干预和悲伤强度（d=-0.70，中大效果），创伤后应激(d=-0.74，中等效应)，经验回避(d=-0.46，中等效应)，和抑郁（d=-0.34，小效果）干预后3个月。在随机分配到EMPOWER的替代患者中，替代患者对整体重症监护的满意度较高（d=0.27，效果较小）。
结论：EMPOWER似乎可行且可接受，提高代理人对重症监护的满意度，并防止创伤后压力的升级，悲伤,3个月后出现抑郁症。
目的：本研究的目的是确定可行性，可接受性,和EMPOWER（增强和动员健康和复原力的潜力）的初步功效，超简短(2小时)，6个模块的代孕者手动心理干预。
方法：报告患者有显著焦虑和/或情感上亲密关系的代理人（n=60）在三家大都市医院之一随机接受EMPOWER或强化常规护理（EUC）。参与者完成了对EMPOWER的可接受性和干预前心理困扰措施的评估，立即干预后，以及1个月和3个月的随访评估。
结果：EMPOWER的交付似乎是可行的，89%的参与者完成了所有6个模块，并且可以接受,满意度较高（平均值=4.5/5，SD=.90）。与EUC相比，意向治疗分析显示，EMPOWER在减少创伤困扰（Cohen\'sd=-0.21，小效果）后立即干预和悲伤强度（d=-0.70，中大效果），创伤后应激(d=-0.74，中等效应)，经验回避(d=-0.46，中等效应)，和抑郁（d=-0.34，小效果）干预后3个月。在随机分配到EMPOWER的替代患者中，替代患者对整体重症监护的满意度较高（d=0.27，效果较小）。
结论：EMPOWER似乎可行且可接受，提高代理人对重症监护的满意度，并防止创伤后压力的升级，悲伤,3个月后出现抑郁症。
