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


  • The authors sincerely thank the medical directors, administrators, social workers, and nursing staff at the participating dialysis clinics who provided significant supports in participant recruitment. This work was supported by NIH, NINR Grant No. 1R21NR009662 (to M. Song) and K24-NR010244 (to M. B. Happ).


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. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32:260–273, 2009