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Res Nurs Health. 2009 Jun;32(3):260-73. doi: 10.1002/nur.20320.

Randomized controlled trial of SPIRIT: an effective approach to preparing African-American dialysis patients and families for end of life.

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School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460, USA.


This randomized controlled trial tested an intervention, Sharing Patients' Illness Representations to Increase Trust (SPIRIT), designed to enhance communication regarding end-of-life care between African Americans with end-stage renal disease (ESRD) and their chosen surrogate decision makers (N = 58 dyads). We used surveys and semi-structured interviews to determine the feasibility, acceptability, and preliminary effects of SPIRIT on patient and surrogate outcomes at 1 week and 3 months post-intervention. We also evaluated patients' deaths and surrogates' end-of-life decision making to assess surrogates' perceptions of benefits and limitations of the SPIRIT while facing end-of-life decisions. We found that SPIRIT promoted communication between patients and their surrogates and was effective and well received by the participants.

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