Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-22T19:24:03.614Z Has data issue: false hasContentIssue false
  • English
  • Français

Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

Published online by Cambridge University Press:  08 July 2021

Wendy G. Lichtenthal Open the ORCID record for Wendy G. Lichtenthal [Opens in a new window] ,
Martin Viola ,
Madeline Rogers ,
Kailey E. Roberts ,
Lindsay Lief ,
Christopher E. Cox ,
Chris R. Brewin ,
Jiehui Cici Xu ,
Paul K. Maciejewski  and
Cynthia X. Pan Open the ORCID record for Cynthia X. Pan [Opens in a new window]
...Show all authors
Wendy G. Lichtenthal*
Affiliation:
Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY
Martin Viola
Affiliation:
Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY
Madeline Rogers
Affiliation:
Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY
Kailey E. Roberts
Affiliation:
Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
Lindsay Lief
Affiliation:
Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY
Christopher E. Cox
Affiliation:
Department of Medicine, Division of Pulmonary & Critical Care Medicine, Duke University School of Medicine, Durham, NC
Chris R. Brewin
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
Jiehui Cici Xu
Affiliation:
Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY
Paul K. Maciejewski
Affiliation:
Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY
Cynthia X. Pan
Affiliation:
Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY Division of Geriatrics & Palliative Care Medicine, NewYork-Presbyterian Queens, Flushing, NY
Taylor Coats
Affiliation:
Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Daniel J. Ouyang
Affiliation:
Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY
Shayna Rabin
Affiliation:
Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
Susan C. Vaughan
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, New York, NY
William Breitbart
Affiliation:
Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Marjorie E. Marenberg
Affiliation:
Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA
Holly G. Prigerson
Affiliation:
Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY
*
Author for correspondence: Wendy G. Lichtenthal, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, New York, NY 10065, USA. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes.

Method

Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments.

Results

Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30).

Significance of results

Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.

Keywords

Critical careGriefIntensive care unitInterventionSurrogate decision-making
Type
Original Article
Information
Palliative & Supportive Care , Volume 20 , Issue 2 , April 2022 , pp. 167 - 177
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Anderson, WG, Arnold, RM, Angus, DC, et al. (2008) Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. Journal of General Internal Medicine 23(11), 1871–1876. doi:10.1007/s11606-008-0770-2CrossRefGoogle ScholarPubMed
Andrews, B, Brewin, CR, Stewart, L, et al. (2009) Comparison of immediate-onset and delayed-onset posttraumatic stress disorder in military veterans. Journal of Abnormal Psychology 118(4), 767–777. doi:10.1037/a0017203CrossRefGoogle ScholarPubMed
Azoulay, E, Pochard, F, Kentish-Barnes, N, et al. (2005) Risk of post-traumatic stress symptoms in family members of intensive care unit patients. American Journal of Respiratory and Critical Care Medicine 171(9), 987–994. doi:10.1164/rccm.200409-1295OCCrossRefGoogle ScholarPubMed
Birur, B, Moore, NC and Davis, LL (2016) An evidence-based review of early intervention and prevention of posttraumatic stress disorder. Community Mental Health Journal. doi:10.1007/s10597-016-0047-xGoogle ScholarPubMed
Bishop, LS, Ameral, VE and Palm Reed, KM (2018) The impact of experiential avoidance and event centrality in trauma-related rumination and posttraumatic stress. Behavior Modification 42(6), 815–837. doi:10.1177/0145445517747287CrossRefGoogle ScholarPubMed
Boelen, PA, de Keijser, J, van den Hout, MA, et al. (2007) Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology 75(2), 277–284. doi:10.1037/0022-006X.75.2.277CrossRefGoogle ScholarPubMed
Briere, J and Lanktree, CB (2013) Integrative Treatment of complex Trauma for Adolescents (ITCT-A): A Guide for the Treatment of Multiply-Traumatized Youth, 2nd ed. Los Angeles, CA: USC Adolescent Trauma Treatment Training Center, National Child Traumatic Stress Network, U.S. Department of Substance Abuse and Mental Health Services Administration.Google Scholar
Brunet, A, Weiss, DS, Metzler, TJ, et al. (2001) The peritraumatic distress inventory: A proposed measure of PTSD criterion A2. The American Journal of Psychiatry 158(9), 1480–1485. doi:10.1176/appi.ajp.158.9.1480CrossRefGoogle ScholarPubMed
Bryant, RA, Moulds, ML and Nixon, RV (2003) Cognitive behaviour therapy of acute stress disorder: A four-year follow-up. Behaviour Research and Therapy 41(4), 489–494.CrossRefGoogle ScholarPubMed
Bryant, RA, Mastrodomenico, J, Felmingham, KL, et al. (2008) Treatment of acute stress disorder: A randomized controlled trial. Archives of General Psychiatry 65(6), 659–667. doi:10.1001/archpsyc.65.6.659CrossRefGoogle ScholarPubMed
Bryant, RA, Kenny, L, Joscelyne, A, et al. (2014) Treating prolonged grief disorder: A randomized clinical trial. JAMA Psychiatry 71(12), 1332–1339. doi:10.1001/jamapsychiatry.2014.1600CrossRefGoogle ScholarPubMed
Bunnell, BE, Davidson, TM and Ruggiero, KJ (2018) The peritraumatic distress inventory: Factor structure and predictive validity in traumatically injured patients admitted through a level I trauma center. Journal of Anxiety Disorders 55, 8–13. doi:10.1016/j.janxdis.2018.03.002CrossRefGoogle ScholarPubMed
Carson, SS, Cox, CE, Wallenstein, S, et al. (2016) Effect of palliative care-Led meetings for families of patients With chronic critical illness: A randomized clinical trial. Jama 316(1), 51–62. doi:10.1001/jama.2016.8474CrossRefGoogle ScholarPubMed
Charmaz, K (2004) Premises, principles, and practices in qualitative research: Revisiting the foundations. Qualitative Health Research 14(7), 976–993. doi:10.1177/1049732304266795CrossRefGoogle ScholarPubMed
Cohen, SR, Mount, BM, Strobel, MG, et al. (1995) The McGill quality of life questionnaire: A measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliative Medicine 9(3), 207–219. doi:10.1177/026921639500900306CrossRefGoogle ScholarPubMed
Cox, CE, Wysham, NG, Walton, B, et al. (2015) Development and usability testing of a Web-based decision aid for families of patients receiving prolonged mechanical ventilation. Annals of Intensive Care 5, 6. doi:10.1186/s13613-015-0045-0CrossRefGoogle ScholarPubMed
Cox, CE, White, DB, Hough, CL, et al. (2019) Effects of a personalized Web-based decision Aid for surrogate decision makers of patients With prolonged mechanical ventilation: A randomized clinical trial. Annals of Internal Medicine. doi:10.7326/M18-2335CrossRefGoogle ScholarPubMed
Curtis, JR, Back, AL, Ford, DW, et al. (2013) Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: A randomized trial. Jama 310(21), 2271–2281. doi:10.1001/jama.2013.282081CrossRefGoogle ScholarPubMed
de Meyrick, J (2003) The Delphi method and health research [journal; peer reviewed journal]. Health Education 103(1). doi:10.1108/09654280310459112CrossRefGoogle Scholar
Derry, HM, Lief, L, Schenck, EJ, et al. (2020) Peritraumatic stress among caregivers of patients in the intensive care unit. Annals of the American Thoracic Society 17(5), 650–654. doi:10.1513/AnnalsATS.201908-647RLCrossRefGoogle ScholarPubMed
Dionne-Odom, JN, Ejem, DB, Wells, R, et al. (2020) Effects of a telehealth early palliative care intervention for family caregivers of persons With advanced heart failure: The ENABLE CHF-PC randomized clinical trial. JAMA Network Open 3(4), e202583. doi:10.1001/jamanetworkopen.2020.2583CrossRefGoogle ScholarPubMed
Dunlap, WP, Cortina, JM, Vaslow, JB, et al. (1996) Meta-analysis of experiments with matched groups or repeated measures designs [peer reviewed]. Psychological Methods 1(2). doi:10.1037/1082-989X.1.2.170CrossRefGoogle Scholar
Fernandez-Rodriguez, C, Paz-Caballero, D, Gonzalez-Fernandez, S, et al. (2018) Activation vs. experiential avoidance as a transdiagnostic condition of emotional distress: An empirical study. Frontiers in Psychology 9, 1618. doi:10.3389/fpsyg.2018.01618CrossRefGoogle ScholarPubMed
Foa, EB, Hembree, EA and Rothbaum, BO (2007) Prolonged Exposure Therapy for PTSD : Emotional Processing of Traumatic Experiences : Therapist Guide. Oxford University Press. Table of contents available at: http://www.loc.gov/catdir/toc/ecip072/2006032823.html. Publisher description: http://www.loc.gov/catdir/enhancements/fy0725/2006032823-d.html.CrossRefGoogle Scholar
Gamez, W, Chmielewski, M, Kotov, R, et al. (2011) Development of a measure of experiential avoidance: The multidimensional experiential avoidance questionnaire. Psychological Assessment 23(3), 692–713. doi:10.1037/a0023242CrossRefGoogle ScholarPubMed
Gamez, W, Chmielewski, M, Kotov, R, et al. (2014) The brief experiential avoidance questionnaire: Development and initial validation. Psychological Assessment 26(1), 35–45. doi:10.1037/a0034473CrossRefGoogle ScholarPubMed
Garrido, MM and Prigerson, HG (2014) The end-of-life experience: Modifiable predictors of caregivers’ bereavement adjustment. Cancer 120(6), 918–925. doi:10.1002/cncr.28495CrossRefGoogle ScholarPubMed
Gartlehner, G, Forneris, CA, Brownley, KA, et al. (2013) AHRQ Comparative Effectiveness Reviews. In Interventions for the Prevention of Posttraumatic Stress Disorder (PTSD) in Adults After Exposure to Psychological Trauma. Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
Glick, DR, Motta, M, Wiegand, DL, et al. (2018) Anticipatory grief and impaired problem solving among surrogate decision makers of critically ill patients: A cross-sectional study. Intensive and Critical Care Nursing 49, 1–5. doi:10.1016/j.iccn.2018.07.006CrossRefGoogle ScholarPubMed
Gough, K and Hudson, P (2009) Psychometric properties of the hospital anxiety and depression scale in family caregivers of palliative care patients. Journal of Pain and Symptom Management 37(5), 797–806. doi:10.1016/j.jpainsymman.2008.04.012CrossRefGoogle ScholarPubMed
Greenberg, JA, Basapur, S, Quinn, TV, et al. (2021) Psychological symptoms among surrogates of critically Ill patients during and before the COVID-19 pandemic. Chest. doi:10.1016/j.chest.2020.12.056CrossRefGoogle ScholarPubMed
Haydar, SA, Strout, TD, Bond, AG, et al. (2019) Prognostic value of a modified surprise question designed for use in the emergency department setting. Clinical and Experimental Emergency Medicine 6(1), 70–76. doi:10.15441/ceem.17.293CrossRefGoogle ScholarPubMed
Hickman, RL Jr., Daly, BJ and Lee, E (2012) Decisional conflict and regret: Consequences of surrogate decision making for the chronically critically ill. Applied Nursing Research 25(4), 271–275. doi:10.1016/j.apnr.2011.03.003CrossRefGoogle ScholarPubMed
Higgins, PC, Garrido, MM and Prigerson, HG (2015) Factors predicting bereaved caregiver perception of quality of care in the final week of life: Implications for health care providers. Journal of Palliative Medicine 18(10), 849–857. doi:10.1089/jpm.2015.29001.hpCrossRefGoogle ScholarPubMed
Hill, CE, Knox, S, Thompson, BJ, et al. (2005) Consensual qualitative research: An update [journal; peer reviewed journal]. Journal of Counseling Psychology 52(2), 196–205.CrossRefGoogle Scholar
Johnson, JG, Vanderwerker, LC, Bornstein, RF, et al. (2006) Development and validation of an instrument for the assessment of dependency among bereaved persons. Journal of Psychopathology and Behavioral Assessment 28(4), 26–641.CrossRefGoogle Scholar
Johnson, JG, Zhang, B, Greer, JA, et al. (2007) Parental control, partner dependency, and complicated grief among widowed adults in the community. The Journal of Nervous and Mental Disease 195(1), 26–30. doi:10.1097/01.nmd.0000252009.45915.b2CrossRefGoogle ScholarPubMed
Kelly, MM, Sido, H, Forsyth, JP, et al. (2015) Acceptance and commitment therapy smoking cessation treatment for veterans with posttraumatic stress disorder: A pilot study. Journal of Dual Diagnosis 11(1), 50–55. doi:10.1080/15504263.2014.992201CrossRefGoogle ScholarPubMed
Kentish-Barnes, N, Chaize, M, Seegers, V, et al. (2015) Complicated grief after death of a relative in the intensive care unit. European Respiratory Journal 45(5), 1341–1352. doi:10.1183/09031936.00160014CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL and Williams, JB (2001) The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine 16(9), 606–613. doi:10.1046/j.1525-1497.2001.016009606.xCrossRefGoogle ScholarPubMed
Lautrette, A, Darmon, M, Megarbane, B, et al. (2007) A communication strategy and brochure for relatives of patients dying in the ICU. New England Journal of Medicine 356(5), 469–478. doi:10.1056/NEJMoa063446CrossRefGoogle ScholarPubMed
Levin, ME, Krafft, J, Pierce, B, et al. (2018) When is experiential avoidance harmful in the moment? Examining global experiential avoidance as a moderator. Journal of Behavior Therapy and Experimental Psychiatry 61, 158–163. doi:10.1016/j.jbtep.2018.07.005CrossRefGoogle ScholarPubMed
Lichtenthal, WG, Catarozoli, C, Masterson, M, et al. (2019) An open trial of Meaning-centered grief therapy: Rationale and preliminary evaluation. Palliative and Supportive Care 17(1), 2–12. doi:10.1017/s1478951518000925CrossRefGoogle ScholarPubMed
Litz, BT, Schorr, Y, Delaney, E, et al. (2014) A randomized controlled trial of an internet-based therapist-assisted indicated preventive intervention for prolonged grief disorder. Behaviour Research and Therapy 61, 23–34. doi:10.1016/j.brat.2014.07.005CrossRefGoogle ScholarPubMed
Lovell, GP, Smith, T and Kannis-Dymand, L (2015) Surrogate end-of-life care decision makers’ postbereavement grief and guilt responses. Death Studies 39(10), 647–653. doi:10.1080/07481187.2015.1047062CrossRefGoogle ScholarPubMed
Mack, JW, Weeks, JC, Wright, AA, et al. (2010) End-of-life discussions, goal attainment, and distress at the end of life: Predictors and outcomes of receipt of care consistent with preferences. Journal of Clinical Oncology 28(7), 1203–1208. doi:10.1200/JCO.2009.25.4672CrossRefGoogle ScholarPubMed
Marx, BP and Sloan, DM (2005) Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology. Behaviour Research and Therapy 43(5), 569–583. doi:10.1016/j.brat.2004.04.004CrossRefGoogle ScholarPubMed
McAdam, JL and Erikson, A (2016) Bereavement services offered in adult intensive care units in the United States. American Journal of Critical Care 25(2), 110–117. doi:10.4037/ajcc2016981CrossRefGoogle ScholarPubMed
McLean, C and Follette, VM (2016) Acceptance and commitment therapy as a nonpathologizing intervention approach for survivors of trauma. Journal of Trauma & Dissociation 17(2), 138–150. doi:10.1080/15299732.2016.1103111CrossRefGoogle ScholarPubMed
Mitchell, JT and Everly, GS Jr. (1995) The critical incident stress debriefing (CISD) and the prevention of work-related traumatic stress among high risk occupational groups. In Everly, GS Jr. & Lating, JM (eds.), Plenum Series on Stress and Coping. Psychotraumatology: Key Papers and Core Concepts in Post-Traumatic Stress. New York, NY: Plenum Press, pp. 267–280.Google Scholar
Morse, JM (1994) Designing funded qualitative research. In Denzin, NK & Lincoln, YS (eds.), Handbook of Qualitative Research. Thousand Oaks, CA: Sage Publications, Inc., pp. 220–235.Google Scholar
Neimeyer, RA (2012) Techniques of Grief Therapy: Creative Practices for Counseling the Bereaved. New York, NY: Routledge.CrossRefGoogle Scholar
Neimeyer, RA (2016) Techniques of Grief Therapy: Assessment and Intervention. New York, NY: Routledge.Google Scholar
Nolan, MT, Hughes, MT, Kub, J, et al. (2009) Development and validation of the family decision-making self-efficacy scale. Palliative Support Care 7(3), 315–321. doi:10.1017/s1478951509990241CrossRefGoogle ScholarPubMed
Orsillo, SM and Batten, SV (2005) Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification 29(1), 95–129. doi:10.1177/0145445504270876CrossRefGoogle ScholarPubMed
Plumb, JC, Orsillo, SM and Luterek, JA (2004) A preliminary test of the role of experiential avoidance in post-event functioning. Journal of Behavior Therapy and Experimental Psychiatry 35(3), 245–257. doi:10.1016/j.jbtep.2004.04.011CrossRefGoogle ScholarPubMed
Prigerson, HG, Vanderwerker, LC and Maciejewski, PK (Eds) (2008) A Case for the Inclusion of Prolonged Grief Disorder in DSM-V. In M. S. Stroebe, R. O. Hansson, H. Schut, & W. Stroebe (Eds.), Handbook of bereavement research and practice: Advances in theory and intervention (p. 165–186). Washington, DC: American Psychological Association Press.CrossRefGoogle Scholar
Prigerson, HG, Horowitz, MJ, Jacobs, SC, et al. (2009) Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine 6(8), e1000121. doi:10.1371/journal.pmed.1000121CrossRefGoogle ScholarPubMed
Prigerson, HG, Viola, M, Brewin, CR, et al. (2019) Enhancing & Mobilizing the POtential for Wellness & Emotional Resilience (EMPOWER) among surrogate decision-makers of ICU patients: Study protocol for a randomized controlled trial. Trials 20(1), 408. doi:10.1186/s13063-019-3515-0CrossRefGoogle ScholarPubMed
Rodriguez Villar, S, Sanchez Casado, M, Prigerson, HG, et al. (2012) Prolonged grief disorder in the next of kin of adult patients who die during or after admission to intensive care. Chest 141(6), 1635–1636.CrossRefGoogle ScholarPubMed
Rounsaville, BJ, Carroll, KM and Onken, LS (2001) A stage model of behavioral therapies research: Getting started and moving on from stage I. Clinical Psychology: Science and Practice 8, 133–142.Google Scholar
Schenker, Y, Crowley-Matoka, M, Dohan, D, et al. (2012) I don't want to be the one saying ‘we should just let him die': Intrapersonal tensions experienced by surrogate decision makers in the ICU. Journal of General Internal Medicine 27(12), 1657–1665. doi:10.1007/s11606-012-2129-yCrossRefGoogle ScholarPubMed
Serrano-Ibanez, ER, Ruiz-Parraga, GT, Gomez-Perez, L, et al. (2021) The relationship between experiential avoidance and posttraumatic stress symptoms: A moderated mediation model involving dissociation, guilt, and gender. Journal of Trauma & Dissociation, 1–15. doi:10.1080/15299732.2020.1869647Google ScholarPubMed
Siegel, MD, Hayes, E, Vanderwerker, LC, et al. (2008) Psychiatric illness in the next of kin of patients who die in the intensive care unit. Critical Care Medicine 36(6), 1722–1728. doi:10.1097/CCM.0b013e318174da72CrossRefGoogle ScholarPubMed
Simons, JS and Gaher, RM (2005) The distress tolerance scale: Development and validation of a self-report measure. Motivation and Emotion 29, 83–102.CrossRefGoogle Scholar
Sperry, L and Binensztok, V (2019) Ultra-brief Cognitive Behavioral Interventions: A new Practice Model for Mental Health and Integrated Care. New York, NY: Routledge.CrossRefGoogle Scholar
Spinhoven, P, Drost, J, de Rooij, M, et al. (2016) Is experiential avoidance a mediating, moderating, independent, overlapping, or proxy risk factor in the onset, relapse and maintenance of depressive disorders? Cognitive Therapy and Research 40, 150–163. doi:10.1007/s10608-015-9747-8CrossRefGoogle ScholarPubMed
Spinhoven, P, van Hemert, AM and Penninx, B (2017) Experiential avoidance and bordering psychological constructs as predictors of the onset, relapse and maintenance of anxiety disorders: One or many? Cognitive Therapy and Research 41(6), 867–880. doi:10.1007/s10608-017-9856-7CrossRefGoogle ScholarPubMed
Spitzer, RL, Kroenke, K, Williams, JB, et al. (2006) A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine 166(10), 1092–1097. doi:10.1001/archinte.166.10.1092CrossRefGoogle ScholarPubMed
Tunzi, M (2012) A new standard for incapacitated patient decision making: The clinical standard of surrogate empowerment. Journal of Clinical Ethics 23(4), 316–330.CrossRefGoogle ScholarPubMed
Walser, RD and Westrup, D (2007) Acceptance and Commitment Therapy for the Treatment of Post-Traumatic Stress Disorder and Trauma-Related Problems: A Practitioner's Guide to Using Mindfulness and Acceptance Strategies. New Harbinger Publications. Table of contents only available at: http://www.loc.gov/catdir/toc/ecip077/2006102707.html.Google Scholar
Weiss, DS and Marmar, CR (1996) The impact of event scale - revised. In Wilson, J & Keane, TM (eds.), Assessing Psychological Trauma and PTSD. New York, NY: Guildford, pp. 399–411.Google Scholar
White, DB, Cua, SM, Walk, R, et al. (2012) Nurse-led intervention to improve surrogate decision making for patients with advanced critical illness. American Journal of Critical Care 21(6), 396–409. doi:10.4037/ajcc2012223CrossRefGoogle ScholarPubMed
White, DB, Angus, DC, Shields, AM, et al. (2018) A randomized trial of a family-support intervention in intensive care units. New England Journal of Medicine 378(25), 2365–2375. doi:10.1056/NEJMoa1802637CrossRefGoogle ScholarPubMed
Williams, JL, Hardt, MM, Henschel, AV, et al. (2019) Experiential avoidance moderates the association between motivational sensitivity and prolonged grief but not posttraumatic stress symptoms. Psychiatry Research 273, 336–342. doi:10.1016/j.psychres.2019.01.020CrossRefGoogle Scholar
Wright, AA, Zhang, B, Ray, A, et al. (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. Jama 300(14), 1665–1673. doi:10.1001/jama.300.14.1665CrossRefGoogle ScholarPubMed
Wright, AA, Keating, NL, Balboni, TA, et al. (2010) Place of death: Correlations with quality of life of patients with cancer and predictors of bereaved caregivers’ mental health. Journal of Clinical Oncology 28(29), 4457–4464. doi:10.1200/JCO.2009.26.3863CrossRefGoogle ScholarPubMed
Zhang, B, El-Jawahri, A and Prigerson, HG (2006) Update on bereavement research: Evidence-based guidelines for the diagnosis and treatment of complicated bereavement. Journal of Palliative Medicine 9(5), 1188–1203. doi:10.1089/jpm.2006.9.1188CrossRefGoogle ScholarPubMed
Zigmond, AS and Snaith, RP (1983) The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67(6), 361–370. doi:10.1111/j.1600-0447.1983.tb09716.xCrossRefGoogle ScholarPubMed