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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Charles E. Gessert, MD, MPH, Division of Education and Research, St. Mary's/Duluth Clinic Health System, 400 East 3rd Street, Duluth, MN 55805-1853, 218-786-8176, cgessert@smdc.org, Barry K. Baines, MD, Medicare Medical Director, UCare Minnesota, 200 Summer Street NE, PO Box 52, Minneapolis, MN 55440-0052, Steven Kuross, MD, Hematology/Oncology, St. Mary's/Duluth Clinic Health System, 400 East 3rd Street, Dultuh, MN 55805-1983, and Cinda Dowling, PHN, MA, Quality Improvement, St. Mary's/Dultuh Clinic Health System, 400 East Third Street, Duluth, MN 55805-1983.
An Ethical Will is a statement, usually written, capturing one’s values, wisdom, hopes and advice. We undertook a pilot study of Ethical Wills (EW) to determine the best methods for examining the role of EW in reducing suffering at the end of life. While suffering at the end of life may be due to many factors, including pain and other symptoms, distress about family and friends, and the loss of control of one’s life, many authors have suggested that loss of meaning is pivotal in all suffering. In this study, Ethical Wills were seen as a vehicle for strengthening patients’ sense of meaning near the end of life. Methods: Oncology clinic patients 65+ years of age in active therapy for cancer were randomized to one of two arms: EW or control. Subjects in both arms underwent a similar intervention, with 3 home visits, writing assignments, and exit interviews. Suffering was measured at baseline and at the time of the exit interview, using a series of Likert-like scales. Results: Twenty four subjects (10 EW and 14 control) completed the intervention. Subjects completing EW reported a range of experiences, from profoundly meaningful to tedious, but most recorded new insights and most stated their intention to give the completed EW to relatives. No effect on suffering was documented in this pilot study. Conclusions: The study of interventions designed to reduce suffering at the end of life requires careful attention to study design, subject selection and measurement instrument.
Learning Objectives:
Keywords: End-of-Life Care, Quality of Care
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.