What Works Best For Whom? Exploring the Efficacy of Two Psychosocial Interventions in Palliative Care (FR419D)

Abstract

•Understand two approaches to addressing emotional well-being and preparation for end of life in patients living with serious illness.•Understand sub-population differences in which approach works best for whom, among two interventions. Attention to psychosocial aspects of care are central to comprehensive palliative care. Yet, our understanding of which interventions are best applied to which patient populations is in its infancy requiring increased evidence. Identify the optimal treatment to address psychosocial well-being by comparing the efficacy of two psychosocial interventions among palliative care patients. This secondary analysis of a trial (n=135) included patients with advanced cancer, CHF, or ESRD; one arm received the Outlook intervention, designed to address issues of life completion and preparation, and a second arm received relaxation meditation (RM). Primary outcomes: completion and preparation (QUAL-E); secondary outcomes: anxiety (POMS) quality of life (FACT-G) and spiritual well-being (FACITsp) sub-scales of faith, meaning, and peace. This study employed QUINT analyses to examine these RCT data to determine how best to address preparation for end-of-life and emotional well-being. This recently developed methodology explores and identifies which patient subgroup(s) shows greater improvements with which intervention. Sample: 56% male; 70% cancer; 54% married; and 51% White. Different sub-groups of patients responded variably to the different treatments. For example, those with low spiritual well-being at baseline showed greater improvements in emotional well-being and decreases in anxiety with RM compared to Outlook. In contrast, for those with high spiritual well-being at baseline, Outlook resulted in greater improvements in emotional well-being and decreases in anxiety. Outlook showed greater improvements in preparation for the end of life for those with low preparation at baseline; RM showed greater improvement in preparation for patients with high preparation at baseline but poor ADL function. Identifying the optimal treatment for a given patient is a primary goal of palliative care. We demonstrated that different interventions work variably for unique patient sub-populations.