Symptom management in older primary care patients: feasibility of an experimental, written self-disclosure protocol.

Ann Intern Med. 2001 May 1;134(9 Pt 2):905-11.

Klapow JC1, Schmidt SM, Taylor LA, Roller P, Li Q, Calhoun JW, Wallander J, Pennebaker J.

Distress-driven symptoms are prevalent among older primary care patients and account for a large percentage of office visits and increased medical costs. An experimental written self-disclosure protocol has been shown to reduce symptoms and use of health care services in healthy adults. Written self-disclosure as a method for reducing symptoms has not been evaluated in the primary care setting.

OBJECTIVE:

To evaluate the feasibility of adapting an experimental written self-disclosure protocol for the primary care setting.

DESIGN:

Randomized, single-blind feasibility study.

SETTING:

University-based geriatric and internal medicine primary care clinics.

PATIENTS:

45 patients 66 years of age or older without a psychiatric diagnosis.

INTERVENTION:

Three 20-minute writing sessions focusing on distressing experiences (in the intervention group) or health behaviors (in the control group).

MEASUREMENTS:

The feasibility outcomes were patient recruitment, protocol logistics, and patient and provider satisfaction. The clinical outcomes were somatic and distress symptoms, health care utilization, and associated costs.

RESULTS:

One third of patients screened were recruited; 96% of patients recruited completed the protocol. Clinic contact time was an average of 55 minutes per patient. Patients and providers reported high levels of satisfaction with the protocol. Reductions in symptoms were minimal for both groups. Use of outpatient services and associated costs decreased in both groups, but the reduction was twice as great in the treatment group as in the control group.

CONCLUSIONS:

Findings support the feasibility of implementing the protocol as a primary care intervention.

https://www.ncbi.nlm.nih.gov/pubmed/11346327

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Caring for Caregivers (C4C): study protocol for a pilot feasibility randomised control trial of Positive Written Disclosure for older adult caregivers of people with psychosis.

Pilot Feasibility Stud. 2017 Nov 21;3:63. doi: 10.1186/s40814-017-0206-z. eCollection 2017.

Hazell CM1, Jones CJ2, Hayward M3, Bremner SA1, O’Connor DB4, Pinfold V5, Smith HE1,6.

The caregivers of people who experience psychosis are themselves at risk of developing physical and mental health problems. This risk is increased for older adult caregivers who also have to manage the lifestyle and health changes associated with ageing. As a consequence, older adult caregivers are in particular need of support; we propose a Written Emotional Disclosure (WED) intervention, called Positive Written Disclosure (PWD).

METHODS/DESIGN:

This is a pilot randomised controlled trial of PWD compared to a neutral writing control and a no writing condition. We aim to recruit 60 participants, 20 in each arm. This study will utilise a mixed-methods approach and collect quantitative (questionnaires) and qualitative (interviews) data. Quantitative data will be collected at baseline and 1, 3, and 6 months post baseline. Participants who complete a writing task (PWD or neutral writing control) will be invited to complete an exit interview to discuss their experiences of the intervention and study. The study is supported by a patient and public involvement group.

DISCUSSION:

The results of this trial will determine whether a definitive trial is justified. If so, the quantitative and qualitative findings will be used to refine the intervention and study protocols.

TRIAL REGISTRATION:

ISRCTN, ISRCTN79116352. Registered on 23 January 2017.

 

https://www.ncbi.nlm.nih.gov/pubmed/29201390

Does expressive writing reduce stress and improve health for family caregivers of older adults?

Gerontologist. 2007 Jun;47(3):296-306.

Mackenzie CS1, Wiprzycka UJ, Hasher L, Goldstein D.

We examined whether written emotional disclosure reduces stress and improves health outcomes for family caregivers of physically frail and cognitively impaired older adults, as it has been shown to do for certain student and clinical populations.

DESIGN AND METHODS:

Primary caregivers of older adults attending a day program were randomly assigned to expressive-writing (n = 14), time-management (n = 13), or history-writing (n = 13) conditions. Participants wrote for 20 minutes on four occasions over a 2-week period, and they completed self-report measures of caregiver burden and health prior to the intervention, immediately afterward, and at 1-month follow-up.

RESULTS:

Contrary to expectations, expressive-writing and history-writing participants performed similarly across outcomes. Only caregiver participants in the time-management condition experienced significant mental and physical health improvements after writing.

IMPLICATIONS:

The results of this study add to a growing body of research demonstrating equivocal effects of expressive writing with clinical samples, and they suggest the potential benefit of written time management for stressed caregivers.

https://www.ncbi.nlm.nih.gov/pubmed/17565094