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Nurse-Facilitated Preparation and Life Completion Interventions Are Acceptable and Feasible in the Australian Palliative Care Setting: Results From a Phase 2 Trial

Keall, Robyn M. MS, RN; Butow, Phyllis N. PhD, M ClinPsych, BA(Hons); Steinhauser, Karen E. PhD, MA, BA; Clayton, Josephine M. PhD, MBBS(Hons), FRACP, FAChPM

doi: 10.1097/NCC.0b013e3182664c7a

Background: Existential/spiritual needs of advanced cancer patients are not always met in healthcare. Potential barriers for health professionals exploring existential concerns include lack of time, training, tools, and confidence. Yet patients with life-threatening illnesses require holistic care, and interest in their existential/spiritual needs is growing. Preparation and life completion interventions have shown positive results in the existential/spiritual care of hospice-eligible patients in the United States. Nurses are in the ideal position to deliver such interventions, but have not been previously evaluated in this context.

Objective: The objective of this study was to explore the acceptability and feasibility of a nurse-facilitated preparation and life completion intervention (Outlook) in an Australian palliative care patient population.

Methods: Patients discussed their life story, forgiveness, and heritage and legacy over 3 audiotaped sessions. Preintervention/postintervention outcome measures included the Memorial Symptom Assessment Scale, Functional Assessment of Cancer Therapy–Spirituality Well-being, Profile of Mood States, Quality of Life at End of Life Scale, and Center for Epidemiological Depression Scale. Participant feedback was subjected to thematic analysis to understand the patient experience of receiving the intervention.

Results: Ten palliative care patients with advanced cancer completed the study. Patients reported the intervention and assessments to be acceptable and feasible and to be overall positively received although with nonsignificant improvements in measures of “meaning and peace” and “preparation for end of life.”

Conclusion: A nurse-facilitated preparation and life completion intervention is acceptable and feasible for palliative care patients with advanced cancer in Australia.

Implications for Practice: Outlook is a novel, portable, and feasible tool for use by nurses when addressing existential and spiritual domains of care with patients with advanced cancer.

Author Affiliations: Centre for Medical Psychology and Evidence-Based Decision Making, University of Sydney (Ms Keall and Drs Butow and Clayton), and Hammond Care Palliative and Supportive Care Service, Greenwich Hospital (Ms Keall and Dr Clayton), Sydney, Australia; Center for Health Services Research in Primary Care, Center for Palliative Care Duke University, Durham, North Carolina (Dr Steinhauser); Department of Palliative Care, Royal North Shore Hospital, Sydney, Australia (Dr Clayton).

This study was presented orally at the Biennial Australian Palliative Care Nurses Conference, Brisbane, Australia, in 2010.

This work was supported in part by a Cancer Institute NSW Clinical Research Fellowship for Ms Clayton. The work received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

The authors have no conflicts of interest to disclose.

Correspondence: Robyn M. Keall, MS, RN, Department of Cancer Medicine, Blackburn Bldg, University of Sydney, New South Wales 2060, Australia (

Accepted for publication June 22, 2012.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins