Life Program: Pilot Testing a Palliative Psychology Group Intervention.

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Psychosocial interventions for palliative care populations, individuals with life-limiting illness, improve distress; however, less is known about these interventions among military Veterans.


This quality improvement project evaluated a palliative psychology group intervention to reduce depression, anxiety, and stress among Veterans with advanced life-limiting illness.


Veterans receiving palliative care at a mid-Atlantic VA healthcare system were referred by a mental health provider. The group intervention was delivered face-to-face in six to eight weekly sessions, with groups of four to eight participants. The intervention (Life Program), was a hybrid of cognitive-behavioral therapy and acceptance and commitment therapy that targeted: personal values, mindfulness, and psychological flexibility. A single-arm pre-post-test design was used to assess depression, anxiety, and stress, and satisfaction with the intervention.


Seventy-five percent (39/52) of all Veterans who were contacted expressed interest and agreed to participate. Seventeen of 39 enrolled Veterans completed all sessions. The mean age of participants who completed the program was 63.06 (standard deviation = 8.47). Most participants were male (88%), Caucasian (58%), and had a cancer diagnosis (65%). Mean pre-post reductions in depression (18.82 vs. 13.20), anxiety (16.59 vs. 14.59), stress (19.18 vs. 13.88), and psychological inflexibility were observed. Mean differences in symptom severity were clinically meaningful. Barriers to feasibility included transportation issues and illness burden.


Veterans who completed all sessions of a palliative psychology group intervention had reductions in depression, anxiety, and stress. Estimates of the treatment effects may be inflated using completer data alone. Further research is needed to inform ways to improve program engagement and adherence and examine efficacy in Veterans with advanced life-limiting illness.





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Ramos, Katherine, S Nicole Hastings, Hayden B Bosworth and Jessica J Fulton (2018). Life Program: Pilot Testing a Palliative Psychology Group Intervention. Journal of palliative medicine, 21(11). pp. 1641–1645. 10.1089/jpm.2017.0454 Retrieved from

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Katherine Ramos

Assistant Professor in Psychiatry and Behavioral Sciences

Jessica Jade Fulton

Assistant Professor in Psychiatry and Behavioral Sciences

Clinical Practice:

I specialize in the assessment and treatment of issues common in patients and family members of patients with chronic, life-threatening, or terminal illness focusing on symptom management (e.g., pain, depression, anxiety) and end-of-life issues (e.g., suffering, anticipatory grief, existential angst). Additionally, I have expertise in the assessment and treatment of behavioral and psychological aspects of disability and chronic health conditions with interventions focused on increasing meaning, independence and choice, functional abilities, and social role participation.

Clinical Teaching:

I offer clinical training to Duke psychology and psychiatry trainees and am a member of the Durham VA Medical Center Psychology Training Program, supervising psychology residents on the Rehabilitation, Geriatric, Palliative, and Hospice Care Rotation. 

Research interests:

  • Health policy and systems research related to rehabilitation and palliative mental health services

  • Psychological, sociocultural, interpersonal, and spiritual factors in chronic disease and life-threatening or terminal illness

  • Prevention of and adjustment to amputation/limb loss

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