‘Dignity therapy’, a promising intervention in palliative care: A comprehensive systematic literature review

Abstract

Background:Dignity therapy is psychotherapy to relieve psychological and existential distress in patients at the end of life. Little is known about its effect.Aim:To analyse the outcomes of dignity therapy in patients with advanced life-threatening diseases.Design:Systematic review was conducted. Three authors extracted data of the articles and evaluated quality using Critical Appraisal Skills Programme. Data were synthesized, considering study objectives.Data sources:PubMed, CINAHL, Cochrane Library and PsycINFO. The years searched were 2002 (year of dignity therapy development) to January 2016. ‘Dignity therapy’ was used as search term. Studies with patients with advanced life-threatening diseases were included.Results:Of 121 studies, 28 were included. Quality of studies is high. Results were grouped into effectiveness, satisfaction, suitability and feasibility, and adaptability to different diseases and cultures. Two of five randomized control trials applied dignity therapy to patients with high levels of baseline psychological distress. One showed statistically significant decrease on patients’ anxiety and depression scores over time. The other showed statistical decrease on anxiety scores pre–post dignity therapy, not on depression. Nonrandomized studies suggested statistically significant improvements in existential and psychosocial measurements. Patients, relatives and professionals perceived it improved end-of-life experience.Conclusion:Evidence suggests that dignity therapy is beneficial. One randomized controlled trial with patients with high levels of psychological distress shows DT efficacy in anxiety and depression scores. Other design studies report beneficial outcomes in terms of end-of-life experience. Further research should understand how dignity therapy functions to establish a means for measuring its impact and assessing whether high level of distress patients can benefit most from this therapy.

‘Song of Life’: music therapy in terminally ill patients with cancer

“…Another challenge for future trials is the selection of primary and secondary outcomes. Previous studies on dignity therapy faced difficulties in observing significant effects if participants were not screened for the presence of distress or if questionnaires were chosen that included items on physical functioning 2. The LCS subscale also showed ceiling effects in the present baseline data, making it difficult to observe therapeutic change.…”

Stakeholder Perceptions of Dignity Therapy for Children and Young People with Life-Limiting and Life-Threatening Conditions in the UK

“…The growing evidence-base of DT in adult palliative care settings suggests that DT is more likely to improve spiritual wellbeing, overall quality of life, hope and sadness/depression scores that standard care alone [7][8][9][10][11], and has also been positively received by family members [12]. Health professionals report DT is a brief and flexible intervention that can be integrated into established supportive palliative care practices [12].…”

Effectiveness of dignity therapy for patients with advanced cancer: A systematic review and meta‐analysis of 10 randomized controlled trials

“…Fitchett, Emanuel, Handzo, Boyken, and Wilkie (2015) reported robust evidence of the acceptability of dignity therapy, especially in psycho-socialspiritual care. Similarly, Martinez et al (2017) showed that dignity therapy can effectively improve depression and anxiety in patients. However, Bentley, O'Connor, Shaw, and Breen (2017) indicated that although dignity therapy is well accepted in most cases, it may not always be effective, therapeutically valid, or practical, and may cause family or cultural frictions.…”