Table 1.

Elements and Goals of the SPIRIT Intervention

Element	Goal
1. Representational assessment	Both patient and surrogate describe illness representations along with the following dimensions: identity, timeline, consequences, controllability, and spiritual and emotional representations. The goal for all parties is to achieve a deeper understanding of patient’s illness experience and the surrogate’s experience with his/her loved one’s illness.
2. Identifying and exploring gaps and concerns	The interventionist identifies and explores gaps and concerns the dyad may have regarding illness progression, life- sustaining treatment and decision making. The goal for each member of the dyad is to exchange own values and concerns about life-sustaining treatment at the end-of-life.
3. Creating conditions for conceptual change	The interventionist encourages the dyad to share their views and ideas about death and dying and end-of-life care. She assists the patient to identify his/her threshold for unacceptable outcomes of life-sustaining treatment. The goal is to gain a good understanding of the dyad’s values of treatment outcomes and concerns.
4. Introducing replacement Information	The interventionist presents end-of-life scenarios and encourages the patient to clarify goals of care and express concerns. The interventionist assists the surrogate to examine her/his willingness to take the responsibility to act on them and to appreciate surrogate roles.
5. Summary	The interventionist summarizes the value of the discussion and the need for future discussions. She also assesses any additional support they need such as consultation with social worker at the clinic and spiritual advisor.