A Randomized Control Trial to Evaluate the Effectiveness of Short-term Life Review Intervention in Enhancing Spiritual Well-being and Lowering Anxiety and Depression in Palliative Patients.

BACKGROUND: Psychological and spiritual distresses compounded with physical sufferings are common in palliative care patients. If the spiritual distress of the patients at the end of life left unattended, the psychosocial wellbeing and quality of life of the patients were threatened. Studies found that life review based on Erikson's developmental theory, is an effective intervention to enhance spiritual wellbeing and lower anxiety and depression in palliative care patients. Unfortunately, conventional life review interventions are too lengthy beyond the life expectancy and physical tolerance of these patients. A short term of life review (STLR) intervention was identified through literature search worth for testing for its effectiveness and applicability. Therefore, this study aimed at evaluating the effectiveness of the short term life review intervention in enhancing spiritual well-being, and lowering anxiety and depression in Chinese palliative care patients. Methodology: A mixed method approach with randomized controlled trial (RCT) and qualitative evaluation was adopted. This was a prospective study. Patients meeting the inclusion criteria were recruited and randomly assigned to intervention group or control group. The intervention group received the STLR intervention. The control group received usual care. Both the patients and the outcome assessors were blinded to the group assignment. The outcomes of the STLR were evaluated by means of improvement in spiritual wellbeing, and anxiety and depression using two set of questionnaires, the McGill Quality of Life Questionnaire - Hong Kong version (MQOL-HK) and the Hospital Anxiety and Depression Scale (HADS) Chinese version. The process of the intervention implementation was assessed by means of the observation of patient's response during the life review intervention and postintervention patient interviews. Observational log sheets were used to record the patients' responses during the STLR interventions. Audio-taped semi-structured interviews were conducted to elicit patients' feedbacks and feelings toward the process of the intervention and the performance of the intervener. Result: There were 109 patients recruited (62 men). There were 54 in the intervention group. Twenty patients dropped (18.3% attrition). Metastatic cancer was the predominant diagnosis. The outcome evaluation of the spiritual wellbeing between groups across time found significant difference (p < 0.05) particularly in two components within the spiritual domain of the MQOL-HK, 'life goals achieved' and 'feel good about myself'. The anxiety and depression level between groups across time found no significant difference. The secondary outcome measured quality of life also demonstrated a trend of better score in within group evaluation. The process evaluation found that most patients were highly involved (92.6%), interested (77.8 %) and participated (79.6%) in the STLR discussion. Twelve audio-taped semi-structured interviews were conducted. The patients had positive feelings towards the STLR intervention process. They described the process as 'comfortable', 'relaxing' and 'interesting'. They were enlightened and had raised self-awareness after the STLR intervention. CONCLUSION: In this study, the patients received STLR intervention demonstrated significant improvement in spiritual well-being. Patients' feedbacks were positive and accepting to the intervention. The short term life review intervention seems promising in affirming achievements and securing the sense of satisfaction with self for the patients.