The effectiveness of a nurse-led short term life review intervention in enhancing the spiritual and psychological well-being of people receiving palliative care: A mixed method study

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Abstract

Background

A life review is a promising intervention to enhance spiritual well-being in older people. Conventional life review interventions are lengthy and often led by psychologists.

Objectives

This is the first randomised controlled trial study to examine the effectiveness and applicability of a nurse-led short term life-review intervention in people with life limiting diseases, the purpose being to enhance their spiritual well-being and lower their anxiety and depression.

Design

A sequential mixed method approach, randomised controlled trial and qualitative evaluation, was adopted. The intervention group received the short version life review, and the control group attention placebo. Participants were randomly assigned to either intervention or control groups by computerised randomisation. Both participants and outcome assessors were blinded to the group assignment.

Settings

The study was conducted in three publicly funded regional hospitals in Hong Kong.

Participants

The target population were people suffering from life-limiting diseases, and receiving hospitalised, day hospice or outreach home care from the palliative care team.

Methods

Two sets of questionnaires were used: the spiritual sub-scale of the McGill Quality of Life Questionnaire, Hong Kong version and the Hospital Anxiety and Depression Scale, Chinese version. The intervention process was assessed by means of observation log sheets and semi-structured interviews of 12 participants.

Results

A total of 109 participants were recruited (54 in the intervention group, 55 in the control group). The intervention group showed significantly more improvement in spiritual well-being than the control group, with a Cohen’s d-effect size of 0.65. Although there were improvements in both anxiety and depression levels in the intervention group, statistical significance in between-group comparisons was not reached. The process evaluation found that most participants were highly involved (92.6%), interested (77.8%) and participated in the intervention (79.6%). The participants described the intervention process as ‘comfortable’, ‘relaxing’ and ‘interesting’, and felt enlightened, with raised self-awareness, after it.

Conclusion

The nurse-led short term life-review intervention demonstrated significant improvement effects in spiritual well-being. Participant feedback on nurses’ performance was positive, finding the intervention acceptable and useful. The setting of the intervention has now been extended from bedside to home. It is recommended to incorporate life review into palliative nursing specialty training, empowering more nurses to deliver the intervention in their daily practice.

Section snippets

What is already known about the topic?

  • Life-review interventions have demonstrated their value for older people to re-evaluate their life events and promote their spiritual well-being.

  • Conventional life-review interventions are too lengthy, beyond the physical tolerance of people receiving palliative care, and often conducted by psychologists

What this paper adds

  • This research paper documents the first randomised controlled trial to test a nurse-led, short term life-review intervention for people receiving palliative care.

  • The results demonstrate the effectiveness, acceptability and feasibility of short-term life-review intervention in enhancing the spiritual well-being of people receiving palliative care.

  • The intervention settings are extended from hospital to day hospice care and home settings.

Aims & objectives

The aim of this interventional study is to evaluate the effectiveness of short term life review intervention and its implementation in palliative care settings. The objectives of the study are as follows:

  • i

    To evaluate the effectiveness of short term life review intervention in enhancing spiritual well-being and lowering anxiety and depression in people receiving palliative care; and

  • ii

    To evaluate the delivery of interventions, and subjects’ participation and acceptance of short term life review

Outcome evaluation

A randomised control trial was employed to evaluate outcome variables with the following hypotheses:

  • i

    People receiving palliative care receiving the short term life review intervention would have higher levels of spiritual well-being than those without such an intervention;

  • ii

    People receiving palliative care receiving the short term life review intervention would have lower levels of anxiety and depression than those without such an intervention.

In this study, people receiving palliative care from

Results

Data collection lasted for one year from February 2016 to January 2017. A total of 167 subjects were referred to join the study by primary doctors or nurses, and 109 subjects were successfully recruited. The intervention group was reduced by five after the first session interview because of a death, physical deterioration in another and three withdrawals. Fifteen participants from the control group dropped out because of death (n = 2), physical deterioration (n = 9) and withdrawal (n = 4). The

Effect on spiritual well-being and anxiety and depression

The findings of this study support the first hypothesis, that people receiving palliative care receiving the short term life review intervention would have enhanced spiritual well-being compared with those without such intervention. However, the second hypothesis, concerned with lowered anxiety and depression levels, was rejected.

The results of the current study are similar to those of previous empirical studies conducted in Japan (Ando et al., 2010, Ando et al., 2008; Sakaguchi and Okamura,

Conclusion

The nurse-led short term life review intervention is effective in enhancing the spiritual well-being of people receiving palliative care, particularly in two components of the spiritual domain, “life goals achieved” and “feeling good about oneself”. Individuals are able to reflect on their life stories and find new perspectives and joy through the process of life review. The implementation of short term life review requires the intervener to be an experienced nurse who has competent

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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