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3. Engaging Mortality: Effective Implementation of Dignity Therapy.

Author

Wilkie, Diana J., Fitchett, George, Yao, Yingwei, Schoppee, Tasha, Delgado Guay, Marvin O., Hauser, Joshua, Kittelson, Sheri, O'Mahony, Sean, Rabow, Michael, Quest, Tammie, Solomon, Sheldon, Handzo, George, Chochinov, Harvey Max, and Emanuel, Linda L.

Subjects
CANCER patient psychology, MULTIPLE regression analysis, DIGNITY therapy, HEALTH outcome assessment, HUMAN services programs, HOSPITAL mortality, PRE-tests & post-tests, QUALITY of life, DESCRIPTIVE statistics, HOSPITAL nursing staff, RESEARCH funding, PALLIATIVE treatment
Abstract

Background: Patients consider the life review intervention, Dignity Therapy (DT), beneficial to themselves and their families. However, DT has inconsistent effects on symptoms and lacks evidence of effects on spiritual/existential outcomes. Objective: To compare usual outpatient palliative care and chaplain-led or nurse-led DT for effects on a quality-of-life outcome, dignity impact. Design/Setting/Subjects: In a stepped-wedge trial, six sites in the United States transitioned from usual care to either chaplain-led or nurse-led DT in a random order. Of 638 eligible cancer patients (age ≥55 years), 579 (59% female, mean age 66.4 ± 7.4 years, 78% White, 61% stage 4 cancer) provided data for analysis. Methods: Over six weeks, patients completed pretest/posttest measures, including the Dignity Impact Scale (DIS, ranges 7–35, low-high impact) and engaged in DT+usual care or usual care. They completed procedures in person (steps 1–3) or via Zoom (step 4 during pandemic). We used multiple imputation and regression analysis adjusting for pretest DIS, study site, and step. Results: At pretest, mean DIS scores were 24.3 ± 4.3 and 25.9 ± 4.3 for the DT (n = 317) and usual care (n = 262) groups, respectively. Adjusting for pretest DIS scores, site, and step, the chaplain-led (β = 1.7, p = 0.02) and nurse-led (β = 2.1, p = 0.005) groups reported significantly higher posttest DIS scores than usual care. Adjusting for age, sex, race, education, and income, the effect on DIS scores remained significant for both DT groups. Conclusion: Whether led by chaplains or nurses, DT improved dignity for outpatient palliative care patients with cancer. This rigorous trial of DT is a milestone in palliative care and spiritual health services research. clinicaltrials.gov: NCT03209440. [ABSTRACT FROM AUTHOR]

Published
2024
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4. Cost considerations for implementing dignity therapy in palliative care: Insights and implications

Author

Al Yacoub, Raed, primary, Rangel, Andrea P., additional, Shum-Jimenez, Adriana, additional, Greenlee, Amelia, additional, Yao, Yingwei, additional, Schoppee, Tasha M., additional, Fitchett, George, additional, Handzo, George, additional, Chochinov, Harvey Max, additional, Emanuel, Linda L., additional, Kittelson, Sheri, additional, and Wilkie, Diana J., additional

Published
2023
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6. Adaptation of the EPEC-EM™ Curriculum in a Residency with Asynchronous Learning

Author

Gisondi, Michael A, Lu, Dave W, Yen, May, Norris, Rachel, Courtney, D Mark, Tanabe, Paula, Engel, Kirsten G, Emanuel, Linda L, and Quest, Tammie E

Subjects
Emergency Medicine, Palliative Care, Graduate Medical Education, Educational Models, Curriculum
Abstract

Objective: The Education in Palliative and End-of-life Care for Emergency Medicine Project (EPEC™-EM) is a comprehensive curriculum in palliative and end-of-life care for emergency providers. We assessed the adaptation of this course to an EM residency program using synchronous and asynchronous learning.Methods: Curriculum adaptation followed Kern’s standardized six-step curriculum design process. Post-graduate year (PGY) 1-4 residents were taught all EPEC™-EM cognitive domains, divided as seven synchronous and seven asynchronous modules. All synchronous modules featured large group didactic lectures and review of EPEC™-EM course materials. Asynchronous modules use only EPEC™-EM electronic course media for resident self-study. Targeted evaluation for EPEC™-EM knowledge objectives was conducted by a prospective case-control crossover study, with synchronous learning serving as the quasi-control, using validated exam tools. We compared de-identified test scores for effectiveness of learning method, using aggregate group performance means for each learning strategy.Results: Of 45 eligible residents 55% participated in a pre-test for local needs analysis, and 78% completed a post-test to measure teaching method effect. Post-test scores improved across all EPEC™-EM domains, with a mean improvement for synchronous modules of +28% (SD=9) and a mean improvement for asynchronous modules of +30% (SD=18). The aggregate mean difference between learning methods was 1.9% (95% CI -15.3, +19.0). Mean test scores of the residents who completed the post-test were: synchronous modules 77% (SD=12); asynchronous modules 83% (SD=13); all modules 80% (SD=12).Conclusion: EPEC™-EM adapted materials can improve resident knowledge of palliative medicine domains, as assessed through validated testing of course objectives. Synchronous and asynchronous learning methods appear to result in similar knowledge transfer, feasibly allowing some course content to be effectively delivered outside of large group lectures. [West J Emerg Med. 2010; 11(5):491-498.]

Published
2010

7. Death Anxiety and Correlates in Cancer Patients Receiving Palliative Care

Author

Emanuel, Linda L., primary, Solomon, Sheldon, additional, Chochinov, Harvey Max, additional, Delgado Guay, Marvin Omar, additional, Handzo, George, additional, Hauser, Joshua, additional, Kittelson, Sheri, additional, O'Mahony, Sean, additional, Quest, Tammie E., additional, Rabow, Michael W., additional, Schoppee, Tasha M., additional, Wilkie, Diana J., additional, Yao, Yingwei, additional, and Fitchett, George, additional

Published
2023
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8. Abstract A032: Dignity therapy effects by race: Chaplain and nurse implementation in pragmatic, multisite stepped-wedge randomized control trial

Author

Wilkie, Diana J., primary, Fitchett, George, additional, Schoppee, Tasha M., additional, Guay, Marvin O. Degado, additional, Hauser, Joshua, additional, Kittelson, Sheri M., additional, O-Mahony, Sean, additional, Rabow, Michael W., additional, Quest, Tammie E., additional, Solomon, Sheldon, additional, Yao, Yingwei, additional, Hadzo, George, additional, Chochinov, Harvey Max, additional, and Emanuel, Linda L., additional

Published
2023
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14. Exploring the Psychological Aspects of Palliative Care: Lessons Learned from an Interdisciplinary Seminar of Experts

Author

Brenner, Keri O., primary, Rosenberg, Leah B., additional, Cramer, Margaret A., additional, Jacobsen, Juliet C., additional, Applebaum, Alison J., additional, Block, Susan D., additional, Doolittle, David B., additional, El-Jawahri, Areej, additional, Emanuel, Linda L., additional, Greer, Joseph A., additional, Margulies, Alfred S., additional, Logeman, Jessica, additional, Rinaldi, Simone P., additional, Ritchie, Christine S., additional, Rodin, Gary M., additional, Sirois, Maria, additional, Tarbi, Elise C., additional, Temel, Jennifer S., additional, and Jackson, Vicki A., additional

Published
2021
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23. Description of a training protocol to improve research reproducibility for dignity therapy: an interview-based intervention.

Author

Schoppee, Tasha M., Scarton, Lisa, Bluck, Susan, Yao, Yingwei, Keenan, Gail, Handzo, George, Chochinov, Harvey M., Fitchett, George, Emanuel, Linda L., and Wilkie, Diana J.

Subjects
RESEARCH evaluation, DIGNITY therapy, RESEARCH funding
Abstract

Background: Dignity Therapy (DT) has been implemented over the past 20 years, but a detailed training protocol is not available to facilitate consistency of its implementation. Consistent training positively impacts intervention reproducibility.Objective: The objective of this article is to describe a detailed method for DT therapist training.Method: Chochinov's DT training seminars included preparatory reading of the DT textbook, in-person training, and practice interview sessions. Building on this training plan, we added feedback on practice and actual interview sessions, a tracking form to guide the process, a written training manual with an annotated model DT transcript, and quarterly support sessions. Using this training method, 18 DT therapists were trained across 6 sites.Results: The DT experts' verbal and written feedback on the practice and actual sessions encouraged the trainees to provide additional attention to eight components: (1) initial framing (i.e., clarifying and organizing of the patient's own goals for creating the legacy document), (2) verifying the patient's understanding of DT, (3) gathering the patient's biographical information, (4) using probing questions, (5) exploring the patient's story thread, (6) refocusing toward the legacy document creation, (7) inviting the patient's expression of meaningful messages, and (8) general DT processes. Evident from the ongoing individual trainee mentoring was achievement and maintenance of adherence to the DT protocol.Discussion: The DT training protocol is a process to enable consistency in the training process, across waves of trainees, toward the goal of maintaining DT implementation consistency. This training protocol will enable future DT researchers and clinicians to consistently train therapists across various disciplines and locales. Furthermore, we anticipate that this training protocol could be generalizable as a roadmap for implementers of other life review and palliative care interview-based interventions. [ABSTRACT FROM AUTHOR]

Published
2022
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25. Contributors

Author

Abraham, William T., primary, Acker, Michael A., additional, Ackerman, Michael J., additional, Ades, Philip A., additional, Antman, Elliott M., additional, Anversa, Piero, additional, Balady, Gary J., additional, Baughman, Kenneth L., additional, Beckman, Joshua, additional, Bettmann, Michael A., additional, Bhatt, Deepak L., additional, Boden, William E., additional, Bonow, Robert O., additional, Braunwald, Eugene, additional, Braverman, Alan C., additional, Bremner, J. Douglas, additional, Calkins, Hugh, additional, Cannon, Christopher P., additional, Canty, John M., additional, Castellanos, Agustin, additional, Chaitman, Bernard R., additional, Chen, Ming Hui, additional, Connolly, Heidi M., additional, Creager, Mark A., additional, Cunha-Neto, Edécio, additional, Davidson, Charles J., additional, Dilsizian, Vasken, additional, Dimmeler, Stefanie, additional, Douglas, Pamela S., additional, Eisenhauer, Andrew C., additional, Emanuel, Linda L., additional, Ernst, Edzard, additional, Fang, James C., additional, Felker, G. Michael, additional, Filippatos, Gerasimos S., additional, Fisher, Stacy D., additional, Fleisher, Lee A., additional, Force, Thomas, additional, Gaziano, J. Michael, additional, Gaziano, Thomas A., additional, Genest, Jacques, additional, Gheorghiade, Mihai, additional, Goldberger, Ary L., additional, Goldhaber, Samuel Z., additional, Goldstein, Larry B., additional, Gray, Richard J., additional, Greenberg, Barry, additional, Griffith, Bartley P., additional, Groh, William J., additional, Hare, Joshua M., additional, Hasenfuss, Gerd, additional, Hayes, David L., additional, de Lourdes Higuchi, Maria, additional, Hillis, L. David, additional, Jaffer, Farouc A., additional, Jessup, Mariell, additional, Kahn, Andrew M., additional, Kajstura, Jan, additional, Kaplan, Norman M., additional, Karchmer, Adolf W., additional, Klein, Irwin, additional, Krumholz, Harlan M., additional, Kwong, Raymond Y., additional, L’Allier, Philippe L., additional, Lange, Richard A., additional, Lee, Thomas H., additional, Leri, Annarosa, additional, LeWinter, Martin M., additional, Libby, Peter, additional, Lipshultz, Steven E., additional, Liu, Peter, additional, Mandell, Brian F., additional, Mann, Douglas L., additional, Maron, Barry J., additional, Mattox, Kenneth L., additional, McCullough, Peter A., additional, McGuire, Darren K., additional, McManus, Bruce, additional, Mehra, Mandeep R., additional, Miller, John M., additional, Mirvis, David M., additional, Morady, Fred, additional, Morrow, David A., additional, Mozaffarian, Dariush, additional, Mueller, Paul S., additional, Myerburg, Robert J., additional, Nabel, Elizabeth G., additional, Newby, L. Kristin, additional, O’Gara, Patrick T., additional, Oh, Jae K., additional, Olgin, Jeffrey, additional, Opie, Lionel H., additional, Otto, Catherine M., additional, Popma, Jeffrey J., additional, Pyeritz, Reed E., additional, Raju, B. Soma, additional, Ramires, José A.F., additional, Redfield, Margaret M., additional, Redington, Andrew N., additional, Rich, Stuart, additional, Ridker, Paul M, additional, Roden, Dan M., additional, Rubart, Michael, additional, Sabatine, Marc S., additional, Sanchez, Luis A., additional, Schwartz, Janice B., additional, Seidman, Christine E., additional, Seidman, J.G., additional, Sethna, Dhun H., additional, Smallhorn, Jeffrey F., additional, Somers, Virend K., additional, Sposito, Andrei C., additional, Swerdlow, Charles D., additional, Tardif, Jean-Claude, additional, Taylor, Allen J., additional, Tester, David J., additional, Therrien, Judith, additional, Thompson, Paul D., additional, Thompson, Robert W., additional, Tischler, Marc D., additional, Tsai, Peter I., additional, Turi, Zoltan G., additional, Udelson, James E., additional, Vaccarino, Viola, additional, Victor, Ronald G., additional, Villa-Forte, Alexandra, additional, Wall, Matthew J., additional, Warnes, Carole A., additional, Webb, Gary D., additional, Webb, John G., additional, Weissleder, Ralph, additional, Weitz, Jeffrey I., additional, White, Christopher J., additional, Wiviott, Stephen D., additional, Yancy, Clyde W., additional, Zeiher, Andreas M., additional, and Zipes, Douglas P., additional

Published
2012
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28. Preface

Author

Emanuel, Linda L., primary and Librach, S. Lawrence, additional

Published
2011
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30. Contributors

Author

Alexander, Carla S., primary, Anderson, Wendy G., additional, Angelos, Peter, additional, Arnold, Robert M., additional, Bailey, F. Amos, additional, Benson, Al B., additional, Berger, Ann M., additional, Bernstein, Richard H., additional, Blacker, Susan, additional, Boni-Saenz, Alexander A., additional, Bonow, Robert O., additional, Bowman, Kerry W., additional, Bruera, Eduardo, additional, Buckman, Robert, additional, Campbell, Toby C., additional, Chaitin, Elizabeth K., additional, Chakraborty, Anita, additional, Chochinov, Harvey Max, additional, Cintron, Alexie, additional, Covinsky, Kenneth E., additional, Danilychev, Maria, additional, De Lima, Liliana, additional, Santina, Christopher Della, additional, Derse, Arthur R., additional, Downing, G. Michael, additional, Dudgeon, Deborah J., additional, Dunn, Geoffrey P., additional, Emanuel, Linda L., additional, Fainsinger, Robin L., additional, Ferris, Frank D., additional, Goldman, Russell, additional, Groninger, Hunter, additional, Gwyther, Liz, additional, Hart, Melissa J., additional, Hauser, Joshua M., additional, Hawryluck, Laura A., additional, Hunt, Susan, additional, Husain, Amna F., additional, Johnston, Bridget Margaret, additional, Kapo, Jennifer M., additional, Kenny, Nuala P., additional, Knight, Sara J., additional, Kundu, Tapas, additional, Liben, Stephen, additional, Librach, S. Lawrence, additional, Loscalzo, Matthew J., additional, Mah, Bill, additional, Marshall, Denise, additional, Martinez, Jeanne Marie, additional, Mehta, Rohtesh S., additional, Meier, Diane E., additional, Modi, Seema, additional, Moody, Sandra Y., additional, Mosoiu, Daniela, additional, Moss, Alvin H., additional, Moynihan, Timothy J., additional, Muir, J. Cameron, additional, Myers, Jeff, additional, Paice, Judith A., additional, Pearlman, Robert Allan, additional, Quest, Tammie E., additional, Rajagopal, M.R., additional, Reitschuler-Cross, Eva B., additional, Scandrett, Karen Glasser, additional, Schroder, Corinne D., additional, Sibbald, R. Gary, additional, Siegel, Arthur, additional, Simon, Melissa, additional, Soto, Eliezer, additional, Starks, Helene, additional, Stein, Regina M., additional, Thai, Vincent, additional, Vergo, Maxwell T., additional, Vig, Elizabeth K., additional, Vollrath, Annette M., additional, von Gunten, Charles F., additional, von Roenn, Jamie H., additional, Wenk, Roberto Daniel, additional, and Woo, Kevin Y., additional

Published
2011
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34. Advance care planning

Author

Tulsky, James A., primary, Emanuel, Linda L., additional, Martin, Douglas K., additional, and Singer, Peter A., additional

Published
2008
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35. Understanding the experience of pain in terminally ill patients

Author

Weiss, Stefan C., Emanuel, Linda L., Fairclough, Diane L., and Emanuel, Ezekiel J.

Subjects
Terminally ill persons -- Care and treatment, Terminally ill persons -- Psychological aspects, Pain -- Care and treatment, Pain -- Research
Published
2001

37. Preface

Author

Emanuel, Linda L., primary and Librach, S. Lawrence, additional

Published
2007
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39. Contributors

Author

Alexander, Carla S., primary, Anderson, Wendy Gabrielle, additional, Angelos, Peter, additional, Arnold, Robert M., additional, Benson, Al B., additional, Berger, Ann M., additional, Berger, Stephen L., additional, Bernstein, Richard H., additional, Boni-Saenz, Alexander A., additional, Bonow, Robert O., additional, Bowman, Kerry, additional, Brescia, Frank J., additional, Bruera, Eduardo, additional, Buckman, Robert, additional, Campbell, Toby C., additional, Casarett, David J., additional, Chaitin, Elizabeth, additional, Cintron, Alexie, additional, Coleman, Sharon, additional, Covinsky, Kenneth E., additional, Danilychev, Maria, additional, de Lima, Liliana, additional, Della Santina, Christopher, additional, Derse, Arthur R., additional, Dudgeon, Deborah J., additional, Emanuel, Linda L., additional, Fainsinger, Robin L., additional, Douglas Ferris, Frank, additional, Groninger, J. Hunter, additional, Gwyther, Elizabeth, additional, Hart, Melissa J., additional, Hauser, Joshua M., additional, Hawryluck, Laura, additional, Hunt, Susan, additional, Jenkinson, Stephen, additional, Jones, Charmaine M., additional, Kapo, Jennifer, additional, P. Kenny, Nuala, additional, Knight, Sara J., additional, Liben, Stephen, additional, Librach, S. Lawrence, additional, Loscalzo, Matthew J., additional, Martinez, Jeanne M., additional, E. Meier, Diane, additional, Modi, Seema, additional, Moody-Ayers, Sandra Y., additional, Mosoiu, Daniela, additional, Moss, Alvin H., additional, Moynihan, Timothy J., additional, Muir, J. Cameron, additional, Paice, Judith A., additional, A. Pearlman, Robert, additional, Quest, Tammie E., additional, Rajagopal, M.R., additional, Schroder, Corinne D., additional, Siegel, Arthur, additional, Starks, Helene, additional, Stefaniuk, Kim, additional, Stein, Regina M., additional, Thai, Vincent, additional, Vig, Elizabeth K., additional, Vollrath, Annette M., additional, von Gunten, Charles F., additional, Von Roenn, Jamie H., additional, and Wenk, Roberto, additional

Published
2007
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44. Medical professionalism in society

Author

Wynia, Matthew K., Latham, Stephen R., Kao, Audiey C., Berg, Jessica W., and Emanuel, Linda L.

Subjects
Professional ethics -- Analysis, Physicians -- Ethical aspects
Abstract

There are three core elements to professionalism that doctors can adopt in a managed care environment: devotion to medical service, a profession of values, and negotiation of priorities. Doctors operating within this model of professionalism, doctors can participate in various degrees of activism. The most basic form of activism is acting as the patient's advocate. Doctors may have to speak out against managed care policies that are not in the patient's best interest. The opposite end of the activism spectrum is deliberately disobeying a law.

Published
1999

45. Assistance from family members, friends, paid care givers, and volunteers in the care of terminally ill patients

Author

Emanuel, Ezekiel J., Fairclough, Diane L., Slutsman, Julia, Alpert, Hillel, Baldwin, DeWitt, and Emanuel, Linda L.

Subjects
Terminal care -- Statistics, Caregivers -- Statistics
Abstract

Most dying patients receive care from family members and friends, according to a survey of 998 terminally ill patients. Eighty-seven percent needed assistance and in 96% of the cases, that assistance was provided by a family member. Seventy-two percent of the caregivers were women. Only 15% of the patients received paid assistance from a non-family member for more than half of their care. Un-paid volunteers who were not friends or family provided less than 3% of all care.

Published
1999

47. Facing Requests for Physician-Assisted Suicide

Author

Emanuel, Linda L.

Subjects
Assisted suicide -- Analysis
Abstract

An 8-step plan is presented for physicians to help them deal with requests for physician-assisted suicide. Patients who make such requests should be evaluated for depression and other treatable conditions that could be affecting their mood. Their competence to make decisions should also be tested. Physicians should discuss the goals for care and should evaluate the degree of patient suffering, including physical, mental, social and spiritual. The patient should be given complete information about this option and professional colleagues should be consulted.

Published
1998

48. The promise of a good death

Author

Emanuel, Ezekiel J. and Emanuel, Linda L.

Subjects
Terminal care -- Analysis, Euthanasia -- Usage, Assisted suicide -- Usage, Hospice care -- Usage, Death -- Social aspects
Published
1998

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