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

Abstract

Background Dignity is a vitally important aspect of the lives of advanced cancer patients. We conducted a systematic review and meta‐analysis of the effectiveness of dignity therapy in this patient population. Methods We searched for randomized controlled trials comparing dignity therapy versus standard care for patients with advanced cancer in five comprehensive databases (March 2019), two clinical trial registries and one gray literature database (August 2019). The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook Version 5.1.0. We used GRADE approach to assess the certainty of evidence. Meta‐analysis was performed with RevMan version 5.3. Outcomes of interest included anxiety, depression, dignity‐related distress and quality of life (QoL). Results Ten trials evaluating 904 patients (control, 449; experimental, 455) were identified. Six trials included patients with different types of advanced cancer, and four trials included patients with a single advanced cancer (lung cancer [20%], breast cancer [10%], and hepatocellular carcinoma [10%]). Compared with the standard care, dignity therapy decreased the score of anxiety, depression, and dignity‐related distress of the advanced cancer patients (SMD = −1.07, 95% CI: [−1.57, −0.58], p < .05; SMD = −1.31, 95% CI: [−1.92, −0.70], p < .05; MD = −7.30, 95% CI: [− 12.04, − 2.56], p < .05). In addition, no significant differences were found in the patient's QoL (p > .05). Conclusion Very low certainty evidence demonstrated that dignity therapy might be a promising treatment, especially in reducing anxiety and depression in advanced cancer patients.

Improving Dignity of Care in Community-Dwelling Elderly Patients with Cognitive Decline and Their Caregivers. The Role of Dignity Therapy

“…Reviews of the many studies carried out in the last years in at least eleven countries confirm that DT is feasible and overall accepted in various clinical and cultural realities, and it is effective in promoting patient/family sense of dignity, meaning, and quality of life, while reducing psychological and dignity related distress [59][60][61][62][63]. A recent meta-analysis examining ten RCT and confronting DT applied in cancer palliative care to standard care demonstrated that DT significantly decreased anxiety, depression, and dignity related distress in advanced cancer patients [64]. A different meta-analysis opposing DT to control conditions further evidenced that DT promoted dignity, existential, and social support domains [60].…”

Dignity Therapy Helps Terminally Ill Patients Maintain a Sense of Peace: Early Results of a Randomized Controlled Trial

“…Moreover, patients with different advanced non-malignant disease had similar ratings of moderate to extreme loss of dignity (Chochinov et al, 2016). Research on the efficacy of DT for dignity-related distress produced mixed results (Donato et al, 2016;Li et al, 2020). For example, previous studies found no significant differences between DT and palliative care on dignity (e.g., Chochinov et al, 2011;Hall et al, 2011;Vuksanovic et al, 2017).…”

“…Whereas terminally ill patients report benefits from DT for themselves and their families, the effects on psychological outcomes are less clear ( Fitchett et al, 2015 ; Donato et al, 2016 ). For instance, a meta-analysis showed that DT did not reduce depression and anxiety of patients compared with the standard care ( Xiao et al, 2019 ), whereas other reviews revealed a significant improvement of these psychological symptoms ( Li et al, 2020 ) or mixed results ( Sposato, 2016 ). The discrepancy between reported benefits and inconclusive evidence of DT may be due to several issues, such as low levels of distress at baseline ( Martínez et al, 2017 ), the possibility of delayed effects ( Fitchett et al, 2015 ), measures not sensitive enough to detect a psychological change ( Sposato, 2016 ; Xiao et al, 2019 ) and lack of high quality study designs ( Li et al, 2020 ).…”

“…For instance, a meta-analysis showed that DT did not reduce depression and anxiety of patients compared with the standard care ( Xiao et al, 2019 ), whereas other reviews revealed a significant improvement of these psychological symptoms ( Li et al, 2020 ) or mixed results ( Sposato, 2016 ). The discrepancy between reported benefits and inconclusive evidence of DT may be due to several issues, such as low levels of distress at baseline ( Martínez et al, 2017 ), the possibility of delayed effects ( Fitchett et al, 2015 ), measures not sensitive enough to detect a psychological change ( Sposato, 2016 ; Xiao et al, 2019 ) and lack of high quality study designs ( Li et al, 2020 ). Overall, further clinical studies are needed along with the use of outcomes focusing on spiritual and existential domains ( Fitchett et al, 2015 ; Donato et al, 2016 ).…”

A mixed methods pilot and feasibility open trial of internet-delivered cognitive behaviour therapy (iCanADAPT Advanced) for people with advanced cancer with depression and/or anxiety

“…The authors are similarly aware of increasing interest in non-structured therapies (such as dignity therapy ( Li et al, 2019 )) for managing depressive and anxious symptomatology in those with advanced cancer. However, there are barriers in transforming many of the meaning-centred therapies into an online intervention.…”