{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T02:35:49Z","timestamp":1791426949656,"version":"4.3.3"},"reference-count":26,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2020,11,5]],"date-time":"2020-11-05T00:00:00Z","timestamp":1604534400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1478951520001170_sec_a1\"><jats:title>Objective<\/jats:title><jats:p>Compare the efficacy of two interventions addressing emotional and existential well-being in early life-limiting illness.<\/jats:p><\/jats:sec><jats:sec id=\"S1478951520001170_sec_a2\" sec-type=\"methods\"><jats:title>Method<\/jats:title><jats:p>Primary trial analysis (<jats:italic>n<\/jats:italic> = 135) included patients with advanced cancer, congestive heart failure, or end-stage renal disease; Arm 1 received the Outlook intervention, addressing issues of life completion and preparation, and Arm 2 received relaxation meditation (RM). Primary outcomes at five weeks (primary endpoint) and seven weeks (secondary): completion and preparation (QUAL-E); secondary outcomes: anxiety (POMS) quality of life (FACT-G) and spiritual well-being (FACIT-Sp) subscales of faith, meaning, and peace.<\/jats:p><\/jats:sec><jats:sec id=\"S1478951520001170_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Average age was 62; 56% were post-high school-educated, 54% were married, 52% white, 44% female, and 70% had a cancer diagnosis. At baseline, participants demonstrated low levels of anxiety (&lt;5 on POMS subscale) and depression (&lt;10 on CESD) relative to population norms. Results of the primary analysis revealed no significant differences in mean Preparation by treatment arm at five weeks (14.4 Outlook vs. 14.8 RM; between-group difference \u22120.4 [95% CI, \u22121.6, 0.8], <jats:italic>p<\/jats:italic> = 0.49) or seven weeks (15.2 vs.15.4; between-group difference \u22120.2 [95% CI, \u22121.5, 1.0], <jats:italic>p<\/jats:italic> = 0.73). There were also no significant differences in mean Life Completion by treatment arm between five weeks (26.6 Outlook vs. 26.3 RM; between-group difference 0.2 [95% CI, \u22121.2, 1.7], <jats:italic>p<\/jats:italic> = 0.76) or seven weeks (26.5 vs. 27.5; between-group difference \u22121.0 [95% CI, \u22122.7, 0.7], <jats:italic>p<\/jats:italic> = 0.23). Compared to RM, Outlook participants did not have significant differences over time in the secondary outcomes of overall quality of life, anxiety, depression, FACT-G subscales, and FACIT-Sp subscales.<\/jats:p><\/jats:sec><jats:sec id=\"S1478951520001170_sec_a4\" sec-type=\"discussion\"><jats:title>Discussion<\/jats:title><jats:p>In early-stage life-limiting illness, Outlook did not demonstrate a significant difference in primary or secondary outcomes relative to RM. Results underscore the importance of pre-screening for distress. Qualitatively, Outlook participants were able to express suppressed emotions, place illness context, reflect on adaptations, and strengthen identity. Screening for distress and identifying specified measures of distress, beyond anxiety and depression, is essential in our ability to adequately assess the multi-dimensional mechanisms that decrease existential suffering.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1478951520001170","type":"journal-article","created":{"date-parts":[[2020,11,5]],"date-time":"2020-11-05T04:25:22Z","timestamp":1604550322000},"page":"648-657","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":7,"title":["Current measures of distress may not account for what's most important in existential care interventions: Results of the outlook trial"],"prefix":"10.1017","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3084-711X","authenticated-orcid":false,"given":"Karen E.","family":"Steinhauser","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen M.","family":"Stechuchak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Ramos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6278-2560","authenticated-orcid":false,"given":"Joseph","family":"Winger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Tulsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maren K.","family":"Olsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,11,5]]},"reference":[{"key":"S1478951520001170_ref23","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2008.0078"},{"key":"S1478951520001170_ref7","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1993.11.3.570"},{"key":"S1478951520001170_ref20","doi-asserted-by":"publisher","DOI":"10.1089\/10966210260499014"},{"key":"S1478951520001170_ref17","doi-asserted-by":"publisher","DOI":"10.1207\/s15327752jpa4703_14"},{"key":"S1478951520001170_ref12","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2017.0576"},{"key":"S1478951520001170_ref15","doi-asserted-by":"publisher","DOI":"10.1207\/S15324796ABM2401_06"},{"key":"S1478951520001170_ref27","first-page":"1","article-title":"Enhancing meaning in the face of advanced cancer and pain: Qualitative evaluation of a meaning-centered psychosocial pain management intervention","author":"Winger","year":"2020","journal-title":"Palliative and Supportive Care"},{"key":"S1478951520001170_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.conctc.2019.100372"},{"key":"S1478951520001170_ref3","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1556"},{"key":"S1478951520001170_ref22","doi-asserted-by":"publisher","DOI":"10.1177\/0269216306073112"},{"key":"S1478951520001170_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.08.036"},{"key":"S1478951520001170_ref6","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31539"},{"key":"S1478951520001170_ref4","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.36.2517"},{"key":"S1478951520001170_ref11","volume-title":"Man's Search for Meaning","author":"Frankl","year":"1985"},{"key":"S1478951520001170_ref9","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.08.391"},{"key":"S1478951520001170_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(11)70153-X"},{"key":"S1478951520001170_ref26","doi-asserted-by":"publisher","DOI":"10.1207\/S15324796ABM2401_04"},{"key":"S1478951520001170_ref5","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.57.2198"},{"key":"S1478951520001170_ref21","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951504040027"},{"key":"S1478951520001170_ref18","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-132-10-200005160-00011"},{"key":"S1478951520001170_ref19","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.19.2476"},{"key":"S1478951520001170_ref1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1752-9824.2011.01083.x"},{"key":"S1478951520001170_ref8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.17.2253"},{"key":"S1478951520001170_ref16","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1176\/ajp.140.1.41","article-title":"The Center for Epidemiologic Studies Depression Scale: Its use in a community sample","volume":"140","author":"Roberts","year":"1983","journal-title":"American Journal of Psychiatry"},{"key":"S1478951520001170_ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s005200100289"},{"key":"S1478951520001170_ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2017.06.003"}],"container-title":["Palliative and Supportive Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1478951520001170","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,5]],"date-time":"2021-01-05T23:02:58Z","timestamp":1609887778000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1478951520001170\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,5]]},"references-count":26,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["S1478951520001170"],"URL":"https:\/\/doi.org\/10.1017\/s1478951520001170","relation":{},"ISSN":["1478-9515","1478-9523"],"issn-type":[{"value":"1478-9515","type":"print"},{"value":"1478-9523","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,5]]},"assertion":[{"value":"Copyright \u00a9 The Author(s), 2020. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}