Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial

Abstract

Objectives Dignity Therapy is a unique, individualized, brief psychotherapy, developed for patients (and their families) living with life threatening or life limiting illness. The purpose of this study was to determine if Dignity Therapy could mitigate distress and/or bolster end-of-life experience for patients nearing death. Trial Design Multi-site randomized controlled trial, with patients assigned to Dignity Therapy, Client Centred Care or Standard Palliative Care. Study arm assignment was based on a computer-generated table of random numbers. Blinding was achieved using opaque sealed envelopes, containing allocations that were only opened once consent had been obtained. Participants Patients receiving hospital or community (hospice or home) based palliative care, in Winnipeg, New York, or Perth, randomly assigned to, Dignity Therapy [n=108], Client Centered Care [n=107] and Standard Palliative Care (n=111). Main Outcome Measures The primary outcome measures included the FACIT Spiritual Well-Being Scale, the Patient Dignity Inventory, the Hospital Anxiety and Depression Scale; items from the Structured Interview for Symptoms and Concerns, the Quality of Life Scale and a modified Edmonton Symptom Assessment Scale. Mean changes between baseline and end of intervention ratings were determined. Secondary outcomes, examining self-report end-of-life experience, consisted of a post-study survey administered across all study arms. Intervention Dignity Therapy, a novel, brief psychotherapy, provides patients with life threatening and life limiting illnesses an opportunity to speak about things that matter most to them. These recorded conversations form the basis of a generativity document, which patients can bequeath to individuals of their choosing. Client Centred Care is a supportive psychotherapeutic approach, in which research nurse/therapists guide patients through discussions focusing on here and now issues. Findings No significant differences across study arms, between the primary study outcome measures of pre and post distress, were found. However, on the secondary outcomes, comprised of the post study survey, patients reported that Dignity Therapy was significantly more likely to be experienced as helpful (χ2=35.501; p<0.001), improve quality of life (χ2 =14.520; p<0.001), sense of dignity (χ2 =12.655; p=0.002); change how their family sees and appreciates them (χ2 =33.811; p<0.001) and be helpful to their family (χ2=33.864; p<0.001). Interpretation Despite the beneficial effects of Dignity Therapy, its ability to mitigate outright distress, such as depression, desire for death or suicidality, has yet to be proven. However, there is currently ample evidence supporting its clinical application for patients nearing death, as a means of enhancing their end-of-life experience.

The Blessings and the Curses of Filial Piety on Dignity at the End of Life: Lived Experience of Hong Kong Chinese Adult Children Caregivers

“…Thus, in order to help patients and caregivers minimize suffering and to achieve a sense of hope and meaning as death draws near, there is a vital need for a guided, family-focused, dignity-enhancing intervention in Chinese end-of-life care. One established example of dignity-enhancing intervention is the empiricalbased Dignity Therapy (Chochinov et al, 2005(Chochinov et al, , 2011. Employing a narrative approach and containing elements similar to life review and reminiscence, it enables patients to find meaning and reconciliation through examining specific past experiences and achievements so as to bolster their sense of meaning, purpose, and dignity in life.…”

Effect of dignity therapy model on stress, anxiety and depression of hemodialysis patients

“…Dignity Therapy protocol used in present study was developed by Harvey Max Chochinov. Patients were shown the framework of questions for dignity therapy (this was similar to questions used by Chochinov et al [14] ) and asked to consider what they might wish to speak about during their session(s); this initial introduction to, and explanation of dignity therapy took about one hour. The questions framework provides a flexible guide for the researchers delivering the therapy to shape the interview, based on patients' level of interest and responses.…”

Acceptability and Feasibility of a Meaning-Based Intervention for Patients With Advanced Cancer and Their Spouses

“…The intervention, developed by the research team, consisted of experiential activities drawn from clinical practice and extensive literature review of successful meaning-based interventions. 4,15,20,30,31 The intervention consisted of four 60-minute sessions. The use of four sessions allowed enough time to address the three primary themes of the intervention, outlined below, as well as limited the demand on patients with advanced disease and declining health.…”