%0 Journal Article
%T EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU.
%A Lichtenthal WG
%A Lief L
%A Rogers M
%A Russell D
%A Viola M
%A Winoker H
%A Kakarala S
%A Traube C
%A Coats T
%A Fadalla C
%A Roberts KE
%A Pavao M
%A Osso F
%A Brewin CR
%A Pan CX
%A Maciejewski PK
%A Berlin D
%A Pastores S
%A Halpern N
%A Vaughan SC
%A Cox CE
%A Prigerson HG
%J J Pain Symptom Manage
%V 67
%N 6
%D 2024 Jun 11
%M 38479536
%F 5.576
%R 10.1016/j.jpainsymman.2024.03.002
%X <B>BACKGROUND: </B>Efforts to reduce the psychological distress of surrogate decision-makers of critically ill patients have had limited success, and some have even exacerbated distress.<BR><B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>EMPOWER appeared feasible and acceptable, increased surrogates' satisfaction with critical care, and prevented escalation of posttraumatic stress, grief, and depression 3 months later.