Table 3.
Preparedness and Bereavement Outcomes by Treatment Group
| Outcome | SPIRIT | Control | OR or βa (95% CI) | P |
|---|---|---|---|---|
| Preparedness outcomes | (n = 109) | (n = 101) | ||
| Dyad congruentb | 1.4 (0.9 to 2.1)c | 0.2 | ||
| Baseline | 47 (43.1) | 43 (42.6) | — | |
| 2 mo | 64 (63.4) | 48 (48.0) | 1.9 (1.1 to 3.3) | 0.03 |
| 6 mo | 66 (69.5) | 59 (61.5) | 1.4 (0.8 to 2.6) | 0.2 |
| 12 mo | 51 (60.0) | 52 (60.5) | 1.0 (0.5 to 1.8) | 0.9 |
| Patient DCSd | −0.12 (−0.22 to −0.02)c | 0.01 | ||
| Baseline | 1.6 ± 0.5 | 1.7 ± 0.5 | — | |
| 2 mo | 1.7 ± 0.5 | 1.7 ± 0.5 | −0.03 (−0.15 to 0.09) | 0.6 |
| 6 mo | 1.6 ± 0.5 | 1.8 ± 0.4 | −0.16 (−0.28 to −0.04) | 0.007 |
| 12 mo | 1.6 ± 0.4 | 1.8 ± 0.5 | −0.23 (−0.36 to −0.10) | <0.001 |
| Surrogate DMC scalee | 0.09 (−0.02 to 0.19)c | 0.1 | ||
| Baseline | 3.5 ± 0.5 | 3.6 ± 0.4 | — | |
| 2 mo | 3.7 ± 0.4 | 3.6 ± 0.5 | 0.12 (−0.002 to 0.23) | 0.05 |
| 6 mo | 3.7 ± 0.4 | 3.6 ± 0.5 | 0.10 (−0.02 to 0.23) | 0.1 |
| 12 mo | 3.7 ± 0.4 | 3.7 ± 0.5 | 0.03 (−0.10 to 0.16) | 0.7 |
| Composite outcomef | 1.4 (0.9 to 2.2)c | 0.1 | ||
| Baseline | 46 (42.2) | 43 (42.6) | — | |
| 2 mo | 62 (61.4) | 47 (47.0) | 1.8 (1.0 to 3.1) | 0.04 |
| 6 mo | 64 (67.4) | 55 (57.3) | 1.5 (0.9 to 2.8) | 0.2 |
| 12 mo | 51 (60.0) | 49 (57.0) | 1.1 (0.6 to 2.1) | 0.7 |
| Bereavement outcomes | (n = 28) | (n = 17) | ||
| HADS–anxietyg | −1.2 (−2.8 to 0.3)c | 0.1 | ||
| Baseline | 6.1 ± 4.2 | 6.1 ± 4.0 | — | |
| 2 wk | 6.3 ± 2.6 | 6.6 ± 4.0 | −0.4 (−2.5 to 1.8) | 0.7 |
| 3 mo | 5.1 ± 2.6 | 6.4 ± 2.7 | −1.3 (−3.0 to 0.5) | 0.1 |
| 6 mo | 4.7 ± 3.4 | 6.6 ± 2.7 | −1.9 (−4.0 to 0.3) | 0.09 |
| HADS–depressiong | −2.2 (−4.2 to −0.3)c | 0.02 | ||
| Baseline | 4.1 ± 3.1 | 3.1 ± 3.2 | — | |
| 2 wk | 4.8 ± 3.2 | 6.4 ± 4.4 | −1.6 (−4.1 to 0.9) | 0.2 |
| 3 mo | 3.3 ± 3.1 | 5.9 ± 3.2 | −2.7 (−4.7 to −0.6) | 0.01 |
| 6 mo | 3.4 ± 2.8 | 5.9 ± 3.2 | −2.6 (−4.6 to −0.6) | 0.01 |
| PTSS-10h | −4.0 (−10.2 to 2.2)c | 0.2 | ||
| Baseline | 20.2 ± 8.7 | 17.3 ± 8.1 | — | |
| 2 wk | 23.6 ± 11.8 | 27.0 ± 14.0 | −3.4 (−12.1 to 5.2) | 0.4 |
| 3 mo | 19.3 ± 9.9 | 22.5 ± 8.3 | −3.2 (−9.4 to 3.0) | 0.3 |
| 6 mo | 20.3 ± 11.1 | 25.5 ± 12.4 | −5.2 (−13.0 to 2.6) | 0.2 |
Note: Unless otherwise indicated, values for categorical variables are given as number (percentage); for continuous variables, as mean ± standard deviation.
Abbreviations: CI, confidence interval; DCS, Decisional Conflict Scale; DMC, Decision Making Confidence; HADS, Hospital Anxiety and Depression Scale; OR, odds ratio; PTSS-10, Post-Traumatic Stress Symptoms-10; SPIRIT, Sharing Patient’s Illness Representations to Increase Trust.
Unadjusted treatment effect; using all available data; a negative coefficient indicates the intervention was associated with a lower score; significance based on 2-sided P < 0.017 (Bonferroni correction) for the comparison at each time point.
Dyads congruent in both scenarios of the goals-of-care document.
Overall treatment effect, adjusted for time; significance based on 2-sided P < 0.05.
Patient DCS scores range from 1 to 5, with higher score indicating greater conflict.
Surrogate DMC scale scores range from 1 to 4, with a higher score indicating greater confidence.
Dyads were grouped into either dyads congruent in both scenarios and surrogate DMC scale score ≥ 3 or not (being one of the following: dyads congruent in both scenarios and surrogate DMC scale score < 3, dyads congruent in 1 or none of the scenarios and surrogate DMC scale score ≥ 3, or dyads congruent in 1 or none of the scenarios and surrogate DMC scale score < 3). The numbers (%) indicate dyads congruent in both scenarios and surrogate DMC scale score ≥ 3.
HADS anxiety and depression scores each range from 0 to 21, with higher score indicating greater symptom severity.
PTSS-10 scores range from 10 to 70, with a higher score indicating greater symptom severity.