Effects of dignity therapy on terminally ill patients: a systematic review

Abstract

OBJECTIVE Analyzing the evidence of the effects of dignity therapy onterminally ill patients. METHOD A Systematic review of the literature conducted using the search strategy in six databases. Inclusion criteria were primary studies, excluding literature reviews (systematic or not) and conceptual articles. RESULTS Ten articles were analyzed regarding method, results and evidence level. Dignity therapy improved the sense of meaning andpurpose, will to live, utility, quality of life, dignity and family appreciationin studies with a higher level of evidence. The effects are not well established in relation to depression, anxiety, spirituality and physical symptoms. CONCLUSION Studies with a moderate to high level of evidence have shown increased sense of dignity, will to live and sense of purpose. Further studies should be developed to increase knowledge about dignity therapy.

A Systematic Review in Support of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, Fourth Edition

“…Life review/dignity therapy Adults and mixed samples Patient outcome: meaning and purpose 3 SRs 100,103,107 In one review of life review interventions, two RCTs found no significant differences in purpose in life between life review and control groups. Owing to reported heterogeneity, pooled estimates were not calculated.…”

“…Life review/dignity therapy Adults and mixed samples Patient outcome: will to live 1 SR 100 Dignity therapy was associated with increased will to live in a single RCT described in the review.…”

“…113 One review described evidence that dignity therapy was associated with decreased existential distress, enhanced interpersonal and transpersonal spirituality, and improved spiritual well-being. 100 Another review reported that dignity therapy was associated with higher levels of spiritual well-being. 103 A fifth review reported that life review was associated with improved spiritual well-being and existential distress but that dignity therapy was not associated with significant improvement in existential domains.…”

“…Psychological and Psychiatric Aspects of Care SRs100,101,103,104,107 Five systematic reviews reported depression outcomes related to psychospiritual interventions and found mixed evidence. One review reported evidence that life review interventions can improve depressive symptoms (SMD À0.78; CI À1.46, À0.11; five RCTs) but noted considerable heterogeneity across studies 107.…”

“…Similarly, another review also concluded that additional research is needed to determine the efficacy of dignity therapy. SRs97,98,100,101,103,104,107 Seven reviews reported anxiety outcomes related to psychospiritual interventions and found mixed evidence. Two reviews reported evidence that life review interventions can improve anxiety among patients with life-threatening illnesses.…”