Supplementary Material for: Matters of Life and Death: An Experimental Study Investigating Psychological Interventions to Encourage the Readiness for End-of-Life Conversations

Introduction: Talking about death and dying is evoking discomfort in many persons, resulting in avoidance of this topic. However, end-of-life discussions can alleviate distress and uncertainties in both old and young adults, but only a minority uses this option in palliative care. Even in healthy populations, talking about death is often seen as alleviative and worthwhile, but rarely initiated. Objective: To investigate different psychological interventions (a) encouraging the readiness for end-of-life discussions and (b) changing death attitudes in healthy adults of different ages. Methods: 168 participants were randomized to four different interventions (IG1: value-based intervention with end-of-life perspective, IG2: motivation-based intervention with end-of-life perspective, IG3: combination of IG1 and IG2, CG: control group). Primary outcome was the readiness to engage in end-of-life topics. Secondary outcomes were fear of death, fear of dying and death acceptance. Assessments took place before, directly after the intervention and at 2 weeks of follow up. Results: IG2 and IG3 reported significantly more changes in the readiness to engage in end-of-life discussions than the CG (F[5.61, 307] = 4.83, p < 0.001, ηp2 = 0.081) directly after the intervention. The effect of IG3 remained stable at the follow-up. There were no significant effects of the interventions on end-of-life fears or death acceptance. Acceptability of the interventions was very high. Conclusions: Short interventions can be useful to encourage end-of-life discussions and could be integrated in health care programs. The efficacy and effectiveness of these short interventions in palliative patients are currently examined.

引言：谈及死亡与濒死议题常会令多数人产生不适感，进而导致人们回避该话题。尽管临终话题讨论（end-of-life discussions）能够缓解各年龄段成年人的痛苦与不确定感，但在姑息治疗（palliative care）中仅有少数人群会选择开展此类讨论。即便在健康人群中，谈及死亡常被认为具有舒缓作用且颇具价值，但相关讨论仍极少主动发起。
研究目的：探讨两类不同心理干预（psychological interventions）的效果：一是提升人们开展临终话题讨论的意愿，二是改变不同年龄段健康成年人的死亡态度。
研究方法：本研究共招募168名受试者，将其随机分配至四组：IG1为结合临终视角的价值导向干预组，IG2为结合临终视角的动机导向干预组，IG3为IG1与IG2的联合干预组，CG为对照组（control group）。主要结局指标为参与临终话题讨论的意愿；次要结局指标包括死亡恐惧、濒死恐惧以及死亡接纳度。评估分别在干预前、干预结束即刻以及2周随访时开展。
研究结果：干预结束即刻，IG2与IG3组受试者在临终话题讨论意愿上的改善程度显著优于对照组（F(5.61, 307) = 4.83, p < 0.001, ηp² = 0.081）。IG3组的干预效果在随访阶段仍保持稳定。各干预措施对临终恐惧或死亡接纳度均未产生显著影响。受试者对各类干预的接受度均极高。
研究结论：简短的心理干预可有效助力临终话题讨论的开展，可被整合至医疗保健方案中。目前这类简短干预在姑息治疗患者中的疗效与有效性仍在研究当中。