Effects of Spiritual Care on Well-Being of Intensive Care Family Surrogates: A Clinical Trial.

Autor: Torke AM; Indiana University School of Medicine (A.M.T., S.M.M., S.K.B.), Indianapolis, Indiana; Daniel F. Evans Center (A.M.T., S.E.V.P., S.M.M., B.J.P.), Indiana University Health, Indianapolis, Indiana; IU Center for Aging Research (A.M.T., S.E.V.P., E.S.B., T.A.T.), Regenstrief Institute, Indianapolis, Indiana. Electronic address: atorke@iu.edu., Varner-Perez SE; Daniel F. Evans Center (A.M.T., S.E.V.P., S.M.M., B.J.P.), Indiana University Health, Indianapolis, Indiana; IU Center for Aging Research (A.M.T., S.E.V.P., E.S.B., T.A.T.), Regenstrief Institute, Indianapolis, Indiana; Spiritual Care and Chaplaincy Department (S.E.V.P., B.J.P.), Indiana University Health, Indianapolis, Indiana., Burke ES; IU Center for Aging Research (A.M.T., S.E.V.P., E.S.B., T.A.T.), Regenstrief Institute, Indianapolis, Indiana., Taylor TA; IU Center for Aging Research (A.M.T., S.E.V.P., E.S.B., T.A.T.), Regenstrief Institute, Indianapolis, Indiana., Slaven JE; Department of Biostatistics and Health Data Science (J.E.S.), Indiana University School of Medicine, Indianapolis, Indiana., Kozinski KL; Maine General Health (K.L.K.), Augusta, Maine., Maiko SM; Indiana University School of Medicine (A.M.T., S.M.M., S.K.B.), Indianapolis, Indiana; Daniel F. Evans Center (A.M.T., S.E.V.P., S.M.M., B.J.P.), Indiana University Health, Indianapolis, Indiana., Pfeffer BJ; Daniel F. Evans Center (A.M.T., S.E.V.P., S.M.M., B.J.P.), Indiana University Health, Indianapolis, Indiana; Spiritual Care and Chaplaincy Department (S.E.V.P., B.J.P.), Indiana University Health, Indianapolis, Indiana., Banks SK; Indiana University School of Medicine (A.M.T., S.M.M., S.K.B.), Indianapolis, Indiana.
Jazyk: angličtina
Zdroj: Journal of pain and symptom management [J Pain Symptom Manage] 2023 Apr; Vol. 65 (4), pp. 296-307. Date of Electronic Publication: 2022 Dec 14.
DOI: 10.1016/j.jpainsymman.2022.12.007
Abstrakt: Context: Critical illness of a family member is associated with high emotional and spiritual distress and difficult medical decisions.
Objectives: To determine if a semistructured spiritual care intervention improves the well-being of family surrogate decision makers in intensive care (ICU) settings.
Methods: This study is a randomized, allocation-concealed, parallel group, usual care-controlled, single-blind trial of patient/surrogate dyads in five ICUs in one Midwest, academic medical center. Patients were 18 and older admitted to the ICU and unable to make medical decisions. The intervention involved proactive contact from the chaplain, scheduled, semi-structured visits, weekly follow-up, and bereavement calls. The control group received usual care. The primary endpoint was the surrogate's anxiety (Generalized Anxiety Disorders-7 scale), six to eight weeks after discharge.
Results: Of 192 patient/surrogate dyads enrolled, 128 completed outcome assessments. At follow-up, anxiety in the intervention group was lower than control (median score 1 (interquartile range 0,6) vs. 4 (1,9), P = 0.0057). The proportion of patients with a minimal clinically important difference (MCID) in anxiety of 2+ was 65.2% in the intervention group vs. 49.2% in control. The odds of an MCID remained higher in adjusted analysis (Odds Ratio 3.11, 95% confidence interval 1.18, 8.21; P = 0.0218) The adjusted odds of an MCID were higher for spiritual well-being (OR 3.79, CI 1.41,10.17; P = 0.0081). Satisfaction with spiritual care was also higher (adjusted mean 3.5 ± 0.4 vs. 2.9 ± 0.1); P < .0001).
Conclusions: Proactive, semistructured spiritual care delivered by chaplains improves well-being for ICU surrogates. Results provide evidence for inclusion of chaplains in palliative and intensive care teams.
(Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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