Grant Number:	1R21CA218313-01 Interpret this number
Primary Investigator:	Prigerson, Holly
Organization:	Weill Medical Coll Of Cornell Univ
Project Title:	Enhancing & Mobilizing the Potential for Wellness & Emotional Resilience (EMPOWER) in Caregivers of Icu Cancer Patients
Fiscal Year:	2017

Project Summary/Abstract Aggressive care in Intensive Care Units (ICUs) has been shown to impair the quality of life of patients with advanced cancer and increase the risk of Posttraumatic Stress Disorder (PTSD) among the family and friends who serve as informal caregivers. Because a majority of cancer patients in the ICU are unable to communicate, caregivers must often serve as the patient's surrogate and make life-and-death decisions on the patient's behalf while experiencing intense grief and extreme distress. Unfortunately, recent data found that palliative care interventions in the ICU increased, rather than decreased, the caregiver's risk of PTSD at 3- month follow-up. Thus, there is a pressing need for an intervention to assist caregivers in coping with this extremely stressful and potentially psychologically traumatic situation. We propose here to develop further and pilot test a brief mental health intervention called “Enhancing & Mobilizing the POtential for Wellness & Emotional Resilience of Caregivers of ICU Cancer Patients” (EMPOWER). EMPOWER is a cognitive- behavioral, acceptance-based intervention delivered by a trained social worker to informal caregivers in the ICU. Because it is delivered in the ICU, caregiver concerns about leaving the patient are minimized. EMPOWER uses discrete ~15-minute modules that can be delivered flexibly to a vulnerable set of caregivers and can accommodate multiple interruptions and unexpected crises. The EMPOWER intervention targets caregiver symptoms of “peritraumatic stress” (e.g., feeling in shock) and anticipatory grief (e.g., separation distress evoked by the patient's impending death) to reduce “experiential avoidance” (i.e., avoidance of unpleasant thoughts and feelings). Reducing this type of avoidant behavior removes a substantial barrier to appropriate advance care planning for the patient. To refine and pilot EMPOWER, this application seeks to: 1) obtain feedback on EMPOWER from key informants using the Delphi Method; 2) determine the feasibility, tolerability, acceptability, and preliminary effects of EMPOWER on caregiver PTSD symptom severity 3 months from baseline; and 3) determine preliminary effects of EMPOWER on patient outcomes (e.g., intensity of care, quality of life/death) 1 month from baseline. These 3 aims will be accomplished in 2 phases. In Phase 1, bereaved ICU cancer patient caregivers (n=12) and ICU clinicians (n=12) will critique EMPOWER Version 1.0 to inform improvements. In Phase 2, 60 caregivers of critically ill and uncommunicative ICU cancer patients will be randomized to either EMPOWER Version 2.0 (n=30) or usual care (n=30). EMPOWER is expected to: a) reduce experiential avoidance; b) increase rates of advance care planning; c) reduce intensity of patient care/increase palliative care; d) improve patient quality of life/death; and e) reduce severity of caregivers' PTSD symptoms. Hitting any of these targets alone is expected to significantly improve cancer patient and caregiver outcomes; hitting more than one would be a boon to public health.




EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU.
Authors: Lichtenthal W.G. , Lief L. , Rogers M. , Russell D. , Viola M. , Winoker H. , Kakarala S. , Traube C. , Coats T. , Fadalla C. , et al. .
Source: Journal Of Pain And Symptom Management, 2024-03-11 00:00:00.0; , .
EPub date: 2024-03-11 00:00:00.0.
PMID: 38479536
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Associations of financial hardship with suicidal ideation among bereaved cancer caregivers.
Authors: Viola M. , Gang J. , Maciejewski P.K. , Prigerson H.G. .
Source: Journal Of Psychosocial Oncology, 2022-05-05 00:00:00.0; , p. 1-9.
EPub date: 2022-05-05 00:00:00.0.
PMID: 35510901
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Are deaths from COVID-19 associated with higher rates of prolonged grief disorder (PGD) than deaths from other causes?
Authors: Gang J. , Falzarano F. , She W.J. , Winoker H. , Prigerson H.G. .
Source: Death Studies, 2022; 46(6), p. 1287-1296.
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PMID: 35167429
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Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients.
Authors: Lichtenthal W.G. , Viola M. , Rogers M. , Roberts K.E. , Lief L. , Cox C.E. , Brewin C.R. , Xu J.C. , Maciejewski P.K. , Pan C.X. , et al. .
Source: Palliative & Supportive Care, 2021-07-08 00:00:00.0; , p. 1-11.
EPub date: 2021-07-08 00:00:00.0.
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A micro-sociological theory of adjustment to loss.
Authors: Maciejewski P.K. , Falzarano F.B. , She W.J. , Lichtenthal W.G. , Prigerson H.G. .
Source: Current Opinion In Psychology, 2021-07-07 00:00:00.0; 43, p. 96-101.
EPub date: 2021-07-07 00:00:00.0.
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Associations between beta-blocker use and psychological distress in bereaved adults with cardiovascular conditions.
Authors: Viola M. , Ouyang D. , Xu J. , Maciejewski P.K. , Prigerson H.G. , Derry H.M. .
Source: Stress And Health : Journal Of The International Society For The Investigation Of Stress, 2021-05-11 00:00:00.0; , .
EPub date: 2021-05-11 00:00:00.0.
PMID: 33977672
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Suffering and Symptoms At the End of Life in ICU Patients Undergoing Renal Replacement Therapy.
Authors: Ramer S.J. , Viola M. , Maciejewski P.K. , Reid M.C. , Prigerson H.G. .
Source: The American Journal Of Hospice & Palliative Care, 2021-04-08 00:00:00.0; , p. 10499091211005707.
EPub date: 2021-04-08 00:00:00.0.
PMID: 33827273
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Peritraumatic Stress Symptoms during Early Post-Intensive Care Unit Recovery.
Authors: Derry H.M. , Lief L. , Woubeshet N. , Schenck E.J. , Kakarala S. , LaFond E. , Berlin D.A. , Prigerson H.G. .
Source: Annals Of The American Thoracic Society, 2021 02; 18(2), p. 364-367.
PMID: 32870018
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Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale.
Authors: Prigerson H.G. , Boelen P.A. , Xu J. , Smith K.V. , Maciejewski P.K. .
Source: World Psychiatry : Official Journal Of The World Psychiatric Association (wpa), 2021 Feb; 20(1), p. 96-106.
PMID: 33432758
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The neurobiological reward system in Prolonged Grief Disorder (PGD): A systematic review.
Authors: Kakarala S.E. , Roberts K.E. , Rogers M. , Coats T. , Falzarano F. , Gang J. , Chilov M. , Avery J. , Maciejewski P.K. , Lichtenthal W.G. , et al. .
Source: Psychiatry Research. Neuroimaging, 2020-07-03 00:00:00.0; 303, p. 111135.
EPub date: 2020-07-03 00:00:00.0.
PMID: 32629197
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Bereavement Care in the Wake of COVID-19: Offering Condolences and Referrals.
Authors: Lichtenthal W.G. , Roberts K.E. , Prigerson H.G. .
Source: Annals Of Internal Medicine, 2020-06-23 00:00:00.0; , .
EPub date: 2020-06-23 00:00:00.0.
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Peritraumatic Stress among Caregivers of Patients in the Intensive Care Unit.
Authors: Derry H.M. , Lief L. , Schenck E.J. , Berlin D.A. , Prigerson H.G. .
Source: Annals Of The American Thoracic Society, 2020 May; 17(5), p. 650-654.
PMID: 32068429
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Regret and unfinished business in parents bereaved by cancer: A mixed methods study.
Authors: Lichtenthal W.G. , Roberts K.E. , Catarozoli C. , Schofield E. , Holland J.M. , Fogarty J.J. , Coats T.C. , Barakat L.P. , Baker J.N. , Brinkman T.M. , et al. .
Source: Palliative Medicine, 2020 03; 34(3), p. 367-377.
EPub date: 2020-02-05 00:00:00.0.
PMID: 32020837
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Advanced Cancer Patients' Changes in Accurate Prognostic Understanding and Their Psychological Well-Being.
Authors: George L.S. , Maciejewski P.K. , Epstein A.S. , Shen M. , Prigerson H.G. .
Source: Journal Of Pain And Symptom Management, 2019-12-28 00:00:00.0; , .
EPub date: 2019-12-28 00:00:00.0.
PMID: 31887399
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"My doctor says the cancer is worse, but I believe in miracles"-When religious belief in miracles diminishes the impact of news of cancer progression on change in prognostic understanding.
Authors: George L.S. , Balboni T.A. , Maciejewski P.K. , Epstein A.S. , Prigerson H.G. .
Source: Cancer, 2019-10-28 00:00:00.0; , .
EPub date: 2019-10-28 00:00:00.0.
PMID: 31658374
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Emotions in the room: common emotional reactions to discussions of poor prognosis and tools to address them.
Authors: Derry H.M. , Epstein A.S. , Lichtenthal W.G. , Prigerson H.G. .
Source: Expert Review Of Anticancer Therapy, 2019 Aug; 19(8), p. 689-696.
EPub date: 2019-08-10 00:00:00.0.
PMID: 31382794
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Enhancing & Mobilizing the POtential for Wellness & Emotional Resilience (EMPOWER) among Surrogate Decision-Makers of ICU Patients: study protocol for a randomized controlled trial.
Authors: Prigerson H.G. , Viola M. , Brewin C.R. , Cox C. , Ouyang D. , Rogers M. , Pan C.X. , Rabin S. , Xu J. , Vaughan S. , et al. .
Source: Trials, 2019-07-09 00:00:00.0; 20(1), p. 408.
EPub date: 2019-07-09 00:00:00.0.
PMID: 31288829
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Prevalence, Severity, and Correlates of Symptoms of Anxiety and Depression at the Very End of Life.
Authors: Kozlov E. , Phongtankuel V. , Prigerson H. , Adelman R. , Shalev A. , Czaja S. , Dignam R. , Baughn R. , Reid M.C. .
Source: Journal Of Pain And Symptom Management, 2019 Jul; 58(1), p. 80-85.
EPub date: 2019-04-17 00:00:00.0.
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Suicidal Ideation in Bereavement: A Systematic Review.
Authors: Molina N. , Viola M. , Rogers M. , Ouyang D. , Gang J. , Derry H. , Prigerson H.G. .
Source: Behavioral Sciences (basel, Switzerland), 2019-05-14 00:00:00.0; 9(5), .
EPub date: 2019-05-14 00:00:00.0.
PMID: 31091772
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When chemotherapy fails: Emotionally charged experiences faced by family caregivers of patients with advanced cancer.
Authors: Rodenbach R.A. , Norton S.A. , Wittink M.N. , Mohile S. , Prigerson H.G. , Duberstein P.R. , Epstein R.M. .
Source: Patient Education And Counseling, 2019 05; 102(5), p. 909-915.
EPub date: 2018-12-12 00:00:00.0.
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Impact of Immigrant Status on Aggressive Medical Care Counter to Patients' Values Near Death among Advanced Cancer Patients.
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Source: Journal Of Palliative Medicine, 2019 01; 22(1), p. 34-40.
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"Caregrieving" in palliative care: Opportunities to improve bereavement services.
Authors: She W.J. , Prigerson H.G. .
Source: Palliative Medicine, 2018 12; 32(11), p. 1635-1636.
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How much time is left? Associations between estimations of patient life expectancy and quality of life in patients and caregivers.
Authors: Trevino K.M. , Maciejewski P.K. , Shen M.J. , Prigerson H.G. , Mohile S. , Kamen C. , Epstein R.M. , Duberstein P. .
Source: Supportive Care In Cancer : Official Journal Of The Multinational Association Of Supportive Care In Cancer, 2018-11-01 00:00:00.0; , .
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The interactive effect of advanced cancer patient and caregiver prognostic understanding on patients' completion of Do Not Resuscitate orders.
Authors: Shen M.J. , Trevino K.M. , Prigerson H.G. .
Source: Psycho-oncology, 2018 07; 27(7), p. 1765-1771.
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Beyond Pain: Nurses' Assessment of Patient Suffering, Dignity, and Dying in the Intensive Care Unit.
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Source: Journal Of Pain And Symptom Management, 2018 Jun; 55(6), p. 1591-1598.e1.
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It's not what you think: Associations between perceived cognitive and physical status and prognostic understanding in patients with advanced cancer.
Authors: Kurita K. , Siegler E.L. , Reid M.C. , Maciejewski R.C. , Prigerson H.G. .
Source: Journal Of Pain And Symptom Management, 2018-05-09 00:00:00.0; , .
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Being present: oncologists' role in promoting advanced cancer patients' illness understanding.
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Source: Cancer Medicine, 2018 Apr; 7(4), p. 1511-1518.
EPub date: 2018-02-26 00:00:00.0.
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Mild cognitive dysfunction of caregivers and its association with care recipients' end-of-life plans and preferences.
Authors: Kurita K. , Lachs M.S. , Adelman R.D. , Siegler E.L. , Reid M.C. , Prigerson H.G. .
Source: Plos One, 2018; 13(4), p. e0196147.
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Bereavement Challenges and Their Relationship to Physical and Psychological Adjustment to Loss.
Authors: Trevino K.M. , Litz B. , Papa A. , Maciejewski P.K. , Lichtenthal W. , Healy C. , Prigerson H.G. .
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