Effect of dignity therapy on end-of-life psychological distress in terminally ill Portuguese patients: A randomized controlled trial
- 7 February 2017
- journal article
- research article
- Published by Cambridge University Press (CUP) in Palliative & Supportive Care
- Vol. 15 (6), 628-637
- https://doi.org/10.1017/s1478951516001140
Abstract
Dignity therapy (DT) is a brief form of psychotherapy developed for patients living with a life-limiting illness that has demonstrated efficacy in treating several dimensions of end-of-life psychological distress. Our aim was to determine the influence of DT on demoralization syndrome (DS), the desire for death (DfD), and a sense of dignity (SoD) in terminally ill inpatients experiencing a high level of distress in a palliative care unit. A nonblinded phase II randomized controlled trial was conducted with 80 patients who were randomly assigned to one of two groups: the intervention group (DT + standard palliative care [SPC]) or the control group (SPC alone). The main outcomes were DS, DfD, and SoD, as measured according to DS criteria, the Desire for Death Rating Scale, and the Patient Dignity Inventory (PDI), respectively. All scales were assessed at baseline (day 1) and at day 4 of follow-up. This study is registered with http://www.controlled-trials.com/ISRCTN34354086. Of the 80 participants, 41 were randomized to DT and 39 to SPC. Baseline characteristics were similar between the two groups. DT was associated with a significant decrease in DS compared with SPC (DT DS prevalence = 12.1%; SPC DS prevalence = 60.0%; p < 0.001). Similarly, DT was associated with a significant decrease in DfD prevalence (DT DfD prevalence = 0%; SPC DfD prevalence = 14.3%; p = 0.054). Compared with participants allocated to the control group, those who received DT showed a statistically significant reduction in 19 of 25 PDI items. Dignity therapy had a beneficial effect on the psychological distress encountered by patients near the end of life. Our research suggests that DT is an important psychotherapeutic approach that should be included in clinical care programs, and it could help more patients to cope with their end-of-life experiences.This publication has 24 references indexed in Scilit:
- Prevalence and Factors Associated with Desire for Death in Patients with Advanced Disease: Results from a Portuguese Cross-Sectional StudyPsychosomatics, 2013
- A novel approach to enhancing hope in patients with advanced cancer: a randomised phase II trial of dignity therapyBMJ Supportive & Palliative Care, 2011
- Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trialThe Lancet Oncology, 2011
- Dignity TherapyPublished by Wiley ,2011
- Learning from dying patients during their final days: life reflections gleaned from dignity therapyPalliative Medicine, 2010
- The Patient Dignity Inventory: A Novel Way of Measuring Dignity-Related Distress in Palliative CareJournal of Pain and Symptom Management, 2008
- Dignity and the essence of medicine: the A, B, C, and D of dignity conserving careBMJ, 2007
- Desire for hastened death in patients with advanced disease and the evidence base of clinical guidelines: a systematic reviewPalliative Medicine, 2006
- Desire for death near the end of life: the role of depression, anxiety and painGeneral Hospital Psychiatry, 2005
- Dignity Therapy: A Novel Psychotherapeutic Intervention for Patients Near the End of LifeJournal of Clinical Oncology, 2005