1
|
Hadler RA, Weeks S, Rosa WE, Choate S, Goldshore M, Julião M, Mergler B, Nelson J, Soodalter J, Zhuang C, Chochinov HM. Top Ten Tips Palliative Care Clinicians Should Know About Dignity-Conserving Practice. J Palliat Med 2024; 27:537-544. [PMID: 37831928 DOI: 10.1089/jpm.2023.0544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023] Open
Abstract
The acknowledgment and promotion of dignity is commonly viewed as the cornerstone of person-centered care. Although the preservation of dignity is often highlighted as a key tenet of palliative care provision, the concept of dignity and its implications for practice remain nebulous to many clinicians. Dignity in care encompasses a series of theories describing different forms of dignity, the factors that impact them, and strategies to encourage dignity-conserving care. Different modalities and validated instruments of dignity in care have been shown to lessen existential distress at the end of life and promote patient-clinician understanding. It is essential that palliative care clinicians be aware of the impacts of dignity-related distress, how it manifests, and common solutions that can easily be adapted, applied, and integrated into practice settings. Dignity-based constructs can be learned as a component of postgraduate or continuing education. Implemented as a routine component of palliative care, they can provide a means of enhancing patient-clinician relationships, reducing bias, and reinforcing patient agency across the span of serious illness. Palliative care clinicians-often engaging patients, families, and communities in times of serious illness and end of life-wield significant influence on whether dignity is intentionally integrated into the experience of health care delivery. Thus, dignity can be a tangible, actionable, and measurable palliative care goal and outcome. This article, written by a team of palliative care specialists and dignity researchers, offers 10 tips to facilitate the implementation of dignity-centered care in serious illness.
Collapse
Affiliation(s)
- Rachel A Hadler
- Department of Anesthesiology, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
- Emory Critical Care Center, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Seth Weeks
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Stephanie Choate
- Emory Palliative Care Center, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Matthew Goldshore
- Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Sintra, Portugal
| | - Blake Mergler
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judith Nelson
- Division of Supportive Care, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill-Cornell Medical College, New York, New York, USA
| | - Jesse Soodalter
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Caywin Zhuang
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Harvey Max Chochinov
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
2
|
Zhang S, Song H, Liu Q, Zhao M, Bai X, Ding Y, Chen L, Yin H. The effectiveness of brief reminiscence-based psychosocial interventions for cancer patients: A systematic review and meta-analysis. J Clin Nurs 2024. [PMID: 38519834 DOI: 10.1111/jocn.17137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/05/2023] [Accepted: 03/14/2024] [Indexed: 03/25/2024]
Abstract
AIM To determine the effectiveness of brief reminiscence-based psychosocial interventions in alleviating psychological distress in cancer patients. BACKGROUND Cancer patients suffer tremendous psycho-spiritual pain, which affects their quality of life. Brief reminiscence-based psychosocial interventions have demonstrated positive effects on the mental health of cancer patients; however, the efficacy of these interventions has been inconsistent. DESIGN A systematic review and meta-analysis. METHODS This review was conducted and reported in accordance with the PRISMA 2020 checklist provided by the EQUATOR network. The Cochrane Library, Web of Science, PsycINFO, PubMed, Embase, CINAHL and Scopus databases were systematically searched from inception to 27 November 2022 to identify randomised controlled trials (RCTs) published in English. RESULTS Twenty studies involving 1744 cancer participants were included. The meta-analysis showed statistically significant effects of brief reminiscence-based psychosocial interventions on hope, anxiety and depression at post-intervention. A separate analysis revealed that brief reminiscence-based psychosocial interventions had a sustainable effect on hope, spiritual well-being, anxiety and depression at 1 month after the intervention. However, no statistically significant effect on quality of life was found in our study either immediately after the intervention or at 1 month. CONCLUSIONS Brief reminiscence-based psychosocial interventions can significantly reduce anxiety and depressive symptoms and improve hope and spiritual well-being in cancer patients. RELEVANCE TO CLINICAL PRACTICE This study further supports that brief reminiscence-based psychosocial interventions should be incorporated into the routine care of cancer patients to address their psychosocial distress. PATIENT OR PUBLIC CONTRIBUTION All authors of this article contributed to the study conception and design. All authors of the included studies provided original data for this paper.
Collapse
Affiliation(s)
- Sitao Zhang
- Jilin University School of Nursing, Changchun, China
| | - Huali Song
- Bethune First Hospital of Jilin University, Changchun, China
| | - Qian Liu
- Jilin University School of Nursing, Changchun, China
| | - Mingzhu Zhao
- Jilin University School of Nursing, Changchun, China
| | - Xuechun Bai
- Jilin University School of Nursing, Changchun, China
| | - Yiwen Ding
- Jilin University School of Nursing, Changchun, China
| | - Li Chen
- Jilin University School of Nursing, Changchun, China
| | - Huiru Yin
- Jilin University School of Nursing, Changchun, China
| |
Collapse
|
3
|
Liu TH, Vernon-Cwik A, Tun S. Examining a Novel Legacy Activity for Elders: Oral Histories as Produced Stories. Palliat Med Rep 2024; 5:25-33. [PMID: 38249833 PMCID: PMC10797308 DOI: 10.1089/pmr.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 01/23/2024] Open
Abstract
Background Many African American elders who participated in The Great Migration are in the latter years of their lives. One way to maintain their memories and those of elders at large is through legacy activities, projects that initiate a life review process resulting in a product surviving after an individual's death. However, literature on culturally attuned legacy activities as well as measurement of impact are limited. Objectives This project sought to introduce a novel legacy activity for elders-the oral history as produced aural self-story-detailing its creation and examining its therapeutic efficacy. Design Setting and Subjects Nine African American elders who experienced The Great Migration receiving care from an urban, geriatric clinic were recruited. Oral histories were conducted, produced into aural self-stories, and examined with follow-up interviews and a project evaluation survey. Qualitative analysis of the follow-up interview and a project evaluation survey were used to ascertain therapeutic outcomes. Results : All participants recommended the project and found self-story listening meaningful or beneficial. Qualitative interviews produced 13 codes; the five most frequent were reflection/contemplation (n = 18), sentimentality/positive affect and affirmation/enlightenment (n = 10), as well as empathy/gratitude and curiosity/intrigue/peculiarity (n = 7). Conclusion : Our project suggests that aural self-stories produced from oral histories enhance the current elder legacy activity landscape by facilitating meaning and existential affirmation, additionally leaving a product for subsequent generations. Future studies include comparison to existing legacy interventions and project examination in additional elder populations.
Collapse
Affiliation(s)
- Tony H. Liu
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | | | - Sandy Tun
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
4
|
Kelly C, Kynoch K, Ramis MA. Implementing Dignity Therapy Service into an Acute Cancer Care Setting - A Feasibility Study. J Palliat Care 2023; 38:456-464. [PMID: 36740947 DOI: 10.1177/08258597231154221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: Dignity therapy is a short-term psychotherapy used to help patients at end of life through addressing distress and enhancing dignity. The objective of this study was to assess the effectiveness and feasibility of introducing dignity therapy into a hospital-based cancer care service. Methods: A feasibility study was undertaken using a randomised controlled trial design. Participants were adult patients receiving systemic treatment for cancer or haematological malignancy with palliative intent, within an Australian ambulatory cancer treatment centre. Outcomes of interest were patient distress levels and feasibility of intervention delivery. Participants completed two self-reported distress scales at recruitment and four weeks following (control group) or one month after intervention delivery (intervention group). Patients receiving the intervention also completed the dignity therapy patient feedback questionnaire. Feasibility was measured by collecting data on time required to implement the intervention with subsequent crude cost estimates calculated. Study procedures are reported according to CONSORT guidance. Results: Fifteen patients were recruited for the study. Participants in the intervention group reported small but significantly different lower distress scores than those in the control group at 4 weeks. The time taken to deliver the intervention ranged from 5.5 to 11 h with subsequent cost dependent on the remuneration of the dignity therapy therapist. Conclusions: Findings support other studies on the benefit to patients from delivering a dignity therapy intervention at end of life. Feasibility is influenced by multidisciplinary team support, resource availability and the designated therapist delivering the intervention. Larger sample sizes are needed to ascertain effect.
Collapse
Affiliation(s)
- Claire Kelly
- Mater Health, Raymond Terrace, South Brisbane, Australia
| | - Kathryn Kynoch
- Mater Health and Queensland Centre for Evidence Based Nursing and Midwifery: A JBI Centre of Excellence, Newstead, Brisbane, Australia
| | - Mary-Anne Ramis
- Mater Health and Queensland Centre for Evidence Based Nursing and Midwifery: A JBI Centre of Excellence, Newstead, Brisbane, Australia
| |
Collapse
|
5
|
Lin J, Zhao Y, Guo Q. Dignity therapists' experience of conducting dignity therapy with terminal cancer patients in mainland China: A descriptive qualitative study. Eur J Cancer Care (Engl) 2022; 31:e13670. [PMID: 35948415 DOI: 10.1111/ecc.13670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/12/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study investigated the experience of conducting dignity therapy with terminal cancer patients from the perspective of dignity therapists in mainland China. METHODS Semistructured interviews were conducted with 15 trained dignity therapists from across mainland China who have performed at least one time dignity therapy for terminal cancer patients. Data were analysed using content analysis. RESULTS Four main themes emerged. Firstly, therapists reported that they had many culture-specific experiences of conducting dignity therapy with Chinese patients. Secondly, they encountered various challenges while recruiting and delivering dignity therapy to patients. Thirdly, through conducting dignity therapy, therapists gained personal development although sometimes they empathised with patients' negative emotions. Lastly, they perceived great benefits of conducting dignity therapy to the culture of caring in clinical practice and healthcare provider-patient relationship. CONCLUSION Chinese culture influenced dignity therapists' experience of conducting dignity therapy in mainland China. A series of challenges and benefits of conducting dignity therapy to therapists' personal growth and clinical work were perceived. It is suggested that cultural impacts on dignity therapy implementation and the therapists' ability to deal with practical and emotional challenges need to be addressed in dignity therapy training. A more resource-saving dignity therapy protocol would be significant for dignity therapy implementation.
Collapse
Affiliation(s)
- Junyi Lin
- School of Nursing, Capital Medical University, Beijing, China
| | - Yun Zhao
- Department of Nursing, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Qiaohong Guo
- School of Nursing, Capital Medical University, Beijing, China
| |
Collapse
|
6
|
Julião M, Johnston B, Antunes B. Dignity Therapy - past, present and future journey: Beyond end of life cancer care. Responding to Grassi et al. Psychooncology 2022; 31:1431-1432. [PMID: 35719045 DOI: 10.1002/pon.5981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Inválidos do Comércio IPSS, Lisboa, Portugal
| | - Bridget Johnston
- School of Medicine, Dentistry and Nursing, University of Glasgow, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Bárbara Antunes
- Primary Care Unit, Palliative and End of Life Care Research Group, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
7
|
Mailhot MG, Léonard G, Gadoury-Sansfaçon GP, Stout D, Ellefsen É. A Scoping Review on the Experience of Participating in Dignity Therapy for Adults at the End of Life. J Palliat Med 2022; 25:1143-1150. [PMID: 35593917 DOI: 10.1089/jpm.2021.0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: As the proportion of aging population is increasing, so is the need for palliative care services. The end of life is marked by suffering and currently it is not well addressed in palliative care. Dignity therapy (DT) is one of the most popular therapies aimed at reducing suffering at the life and yet the quantitative evidence supporting its effectiveness is mixed. Also, no study has looked extensively at the qualitative literature. Objective: To describe the experience of participating in DT for adults in end of life. Design: A scoping review was conducted on the experience of DT among adults at their end of life. We searched electronic databases between 2002 and 2020. Two reviewers independently screened, extracted, and coded the data. They were analyzed using a thematic framework approach. Results: Twelve articles were included in the final analysis and were published between 2010 and 2019. The articles originated from the United States (3), Canada (3), Poland (2), Australia (2), the United Kingdom (2), Italy (1), and Germany (1). Two main categories of themes emerged from our analysis: themes mentioned during the DT intervention and themes following the DT intervention. The primary themes found during the DT intervention are discussions relating to the end of life, reflection on life, and creating a life narrative. The themes found following the DT intervention are that it opened a reflection on the past, that this was a helpful intervention, and that it was difficult, but important. Conclusions: Few qualitative studies assessed the experience of participating in DT following the intervention. This gap in the literature could explain the difficulties we currently have in understanding the effects of DT. Future studies should aim to assess how the effects of DT are perceived by patients after the intervention.
Collapse
Affiliation(s)
- Mael Gagnon Mailhot
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Guillaume Léonard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Rehabilitation School, Research Center on Aging, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Dale Stout
- Department of Psychology, Faculty of Arts and Sciences, Bishop's University, Sherbrooke, Québec, Canada
| | - Édith Ellefsen
- Faculty of Medicine and Health Sciences, School of Nursing, Université de Sherbrooke, Sherbrooke, Québec, Canada
| |
Collapse
|
8
|
Buonaccorso L, Tanzi S, De Panfilis L, Ghirotto L, Autelitano C, Chochinov HM, Di Leo S, Martucci G. Meanings Emerging From Dignity Therapy Among Cancer Patients. J Pain Symptom Manage 2021; 62:730-737. [PMID: 33621595 DOI: 10.1016/j.jpainsymman.2021.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Abstract
CONTEXT Generativity is a process whereby patients nearing the end of life invest in those they will soon leave behind. In recent years, the trajectory of cancer has changed, as new therapies have prolonged survival and patients often live with metastatic disease for several years. For these patients and for the healthcare professionals who care for them it can be useful to understand if the concept of generativity is clinically salient. OBJECTIVES To explore the meanings emerging from two dignity therapy questions, particularly salient to generativity, amongst cancer patients in different care settings. METHODS We conducted a multicenter, retrospective, qualitative study in 1) home palliative care (life expectancy < 3 months); 2) specialized palliative care provided by team within an oncology hospital (life expectancy > 9-12 months); and 3) oncological day hospital (potentially curable disease). We thematically analyzed the answers of two dignity therapy questions. RESULTS Three themes and related meanings emerged from 37 dignity therapy sessions with respect to the two questions: 1) Meanings concerning the present life and illness, including the experience of suffering; 2) Thoughts and actions towards the self, including ways in which the patients have felt alive; 3) Thoughts and actions towards significant others, especially values that are based mainly on love for oneself and for others. No notable differences across stages and care settings emerged in terms of the meanings emerging from two dignity therapy questions. CONCLUSION Conversations about generativity could inform clinicians on how to communicate about existential and meaning-based issues across different stages of illness.
Collapse
Affiliation(s)
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Luca Ghirotto
- Qualitative Research Unit, Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristina Autelitano
- Palliative Care Unit, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia, Italy
| | - Harvey Max Chochinov
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Silvia Di Leo
- Psycho-Oncology Unit, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia, Italy
| | - Gianfranco Martucci
- Palliative Care Unit, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|
9
|
Abstract
Dignity therapy as an intervention has been used for individuals receiving palliative care. The goal of this review is to explore the current state of empirical support to its use for end-of-life care patients. Data sources were articles extracted from search engines PubMed, Cochrane, Embase, CINAHL, Web of Science, and PsycINFO. The years searched were 2009 to 2019 (10-year period). The review process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results revealed the feasibility, acceptability, satisfaction, and effectiveness of dignity therapy for life-limiting cases/conditions of patients in different age groups. It also highlighted the importance of the therapy setting and the need to apply this in the cultural context. The meaning of dignity therapy to patients and their family care members also emerged. Findings showed most patients displayed the need to leave a legacy and from this their core values surfaced. In conclusion, this review highlighted the contribution of dignity therapy to the holistic care of patients who hope to leave a legacy. The therapy was also relevant to decrease the anxiety; depression, and burden of family members throughout the palliative care period of their loved ones.
Collapse
Affiliation(s)
- Pearl Ed Cuevas
- Centro Escolar University, College of Nursing, Manila, Philippines
| | - Patricia Davidson
- Johns Hopkins University, School of Nursing, Baltimore, MD, the United States
| | - Joylyn Mejilla
- Centro Escolar University, College of Nursing, Manila, Philippines
| | - Tamar Rodney
- Johns Hopkins University, School of Nursing, Baltimore, MD, the United States
| |
Collapse
|
10
|
Samuels V, Schoppee TM, Greenlee A, Gordon D, Jean S, Smith V, Reed T, Kittelson S, Quest T, O'Mahony S, Hauser J, Guay MOD, Rabow MW, Emanuel L, Fitchett G, Handzo G, Chochinov HM, Yao Y, Wilkie DJ. Interim Analysis of Attrition Rates in Palliative Care Study on Dignity Therapy. Am J Hosp Palliat Care 2021; 38:1503-1508. [PMID: 33557587 DOI: 10.1177/1049909121994309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A routine threat to palliative care research is participants not completing studies. The purpose of this analysis was to quantify attrition rates mid-way through a palliative care study on Dignity Therapy and describe the reasons cited for attrition. Enrolled in the study were a total of 365 outpatients with cancer who were receiving outpatient specialty palliative care (mean age 66.7 ± 7.3 years, 56% female, 72% White, 22% Black, 6% other race/ethnicity). These participants completed an initial screening for cognitive status, performance status, physical distress, and spiritual distress. There were 76 eligible participants who did not complete the study (58% female, mean age 67.9 ± 7.3 years, 76% White, 17% Black, and 7% other race). Of those not completing the study, the average scores were 74.5 ± 11.7 on the Palliative Performance Scale and 28.3 ± 1.5 on the Mini-Mental Status Examination, whereas 22% had high spiritual distress scores and 45% had high physical distress scores. The most common reason for attrition was death/decline of health (47%), followed by patient withdrawal from the study (21%), and patient lost to follow-up (21%). The overall attrition rate was 24% and within the a priori projected attrition rate of 20%-30%. Considering the current historical context, this interim analysis is important because it will serve as baseline data on attrition prior to the outbreak of the COVID-19 pandemic. Future research will compare these results with attrition throughout the rest of the study, allowing analysis of the effect of the COVID-19 pandemic on the study attrition.
Collapse
Affiliation(s)
| | - Tasha M Schoppee
- University of Florida, Gainesville, FL, USA.,Community Hospice & Palliative Care, Jacksonville, FL, USA
| | | | | | | | | | - Tyra Reed
- University of Florida, Gainesville, FL, USA
| | | | - Tammie Quest
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Michael W Rabow
- University of California San Francisco, San Francisco, CA, USA
| | | | | | | | | | | | | |
Collapse
|
11
|
Ounalli H, Mamo D, Testoni I, Belvederi Murri M, Caruso R, Grassi L. Improving Dignity of Care in Community-Dwelling Elderly Patients with Cognitive Decline and Their Caregivers. The Role of Dignity Therapy. Behav Sci (Basel) 2020; 10:bs10120178. [PMID: 33255402 PMCID: PMC7759823 DOI: 10.3390/bs10120178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/01/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
Demographic changes have placed age-related mental health disorders at the forefront of public health challenges over the next three decades worldwide. Within the context of cognitive impairment and neurocognitive disorders among elderly people, the fragmentation of the self is associated with existential suffering, loss of meaning and dignity for the patient, as well as with a significant burden for the caregiver. Psychosocial interventions are part of a person-centered approach to cognitive impairment (including early stage dementia and dementia). Dignity therapy (DT) is a therapeutic intervention that has been shown to be effective in reducing existential distress, mood, and anxiety symptoms and improving dignity in persons with cancer and other terminal conditions in palliative care settings. The aims of this paper were: (i) To briefly summarize key issues and challenges related to care in gerontology considering specifically frail elderly/elderly with cognitive decline and their caregivers; and (ii) to provide a narrative review of the recent knowledge and evidence on DT in the elderly population with cognitive impairment. We searched the electronic data base (CINAHL, SCOPUS, PSycInfo, and PubMed studies) for studies regarding the application of DT in the elderly. Additionally, given the caregiver’s role as a custodian of diachronic unity of the cared-for and the need to help caregivers to cope with their own existential distress and anticipatory grief, we also propose a DT-dyadic approach addressing the needs of the family as a whole.
Collapse
Affiliation(s)
- Heifa Ounalli
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation (formerly Department Biomedical and Specialty Surgical Sciences), University of Ferrara, 44121 Ferrara, Italy; (H.O.); (D.M.); (M.B.M.); (R.C.)
| | - David Mamo
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation (formerly Department Biomedical and Specialty Surgical Sciences), University of Ferrara, 44121 Ferrara, Italy; (H.O.); (D.M.); (M.B.M.); (R.C.)
- Department of Psychiatry, University of Malta, 2080 Msida, Malta
| | - Ines Testoni
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy;
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation (formerly Department Biomedical and Specialty Surgical Sciences), University of Ferrara, 44121 Ferrara, Italy; (H.O.); (D.M.); (M.B.M.); (R.C.)
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation (formerly Department Biomedical and Specialty Surgical Sciences), University of Ferrara, 44121 Ferrara, Italy; (H.O.); (D.M.); (M.B.M.); (R.C.)
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation (formerly Department Biomedical and Specialty Surgical Sciences), University of Ferrara, 44121 Ferrara, Italy; (H.O.); (D.M.); (M.B.M.); (R.C.)
- Correspondence: ; Tel.: +39-0532-455813; Fax: +39-0532-212240
| |
Collapse
|
12
|
Testoni I, Baroni V, Iacona E, Zamperini A, Keisari S, Ronconi L, Grassi L. The Sense of Dignity at the End of Life: Reflections on Lifetime Values through the Family Photo Album. Behav Sci (Basel) 2020; 10:E177. [PMID: 33238420 DOI: 10.3390/bs10110177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 01/29/2023] Open
Abstract
This study focuses on the dimensions of dignity, linking Chochinov's Dignity Therapy to Schwartz's Theory of Values. The use of family photo albums has enriched the application of dignity therapy. Seven terminal patients in home-based palliative care participated in the therapeutic intervention. To measure the effects of the intervention, we administered the Edmonton Symptom Assessment Scale and the Patient Dignity Inventory, then, at the end of the meetings, collected the opinions of participants, available nurses, and relatives who attended the sessions. The resulting generativity documents were then analyzed through thematic analysis, which revealed three main themes linked to both fundamental values and the dimensions of dignity: The relationship between continuity of self and myriad values in the context of family relationships; personal dignity as characterized by the values of personal success, hope, and wisdom; and hope and generativity. The fourth theme reflected the participants' final judgements on the intervention, which were highly positive and greatly encouraged further use of photographs in similar therapeutic interventions. The assessment protocol highlighted a significant decrease in tiredness amongst the participants and a trend towards a significant decrease in drowsiness after the intervention.
Collapse
|
13
|
Bentley B, O'Connor M, Williams A, Breen LJ. Dignity therapy online: Piloting an online psychosocial intervention for people with terminal illness. Digit Health 2020; 6:2055207620958527. [PMID: 33014409 PMCID: PMC7509717 DOI: 10.1177/2055207620958527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Dignity therapy is a life review intervention shown to reduce distress and enhance the quality of life for people with a terminal illness and their families. Dignity therapy is not widely used in clinical practice because it is time and cost prohibitive. This pilot study examined the feasibility and acceptability of dignity therapy delivered through therapist-supported web-based delivery to reduce costs, increase time efficiency, and promote access to treatment. Methods This study employed a one-group pre-test post-test design to pilot methods. Australian adults diagnosed with a terminal illness with a prognosis of six months or less were recruited for the study. The primary outcome measure was a Participant Feedback Questionnaire used in previous face-to-face dignity therapy studies. Data regarding therapist time and details about final documents were recorded. Results Six people were recruited; four chose to complete the intervention via videoconference and two chose email. Participants reported high levels of acceptability and efficacy comparable to face-to-face delivery; meanwhile therapist time was about 40% less and legacy documents were longer. Participants described dignity therapy online as convenient, but technological issues may create challenges. Conclusions Online delivery of dignity therapy is feasible and acceptable, reduces therapist time and clinical cost, and appears to reach people who would not otherwise receive the therapy. Dignity therapy via email may have the greatest potential to reduce time and cost barriers. This pilot study demonstrates a need for further research to determine the full benefits of online delivery of dignity therapy.
Collapse
Affiliation(s)
- Brenda Bentley
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
| | - Moira O'Connor
- School of Psychology, Curtin University, Perth, Australia
| | - Anne Williams
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
| | - Lauren J Breen
- School of Psychology, Curtin University, Perth, Australia
| |
Collapse
|
14
|
Abstract
Objective: To report our first case series of Dignity Therapy modified for a pediatric palliative care population. Background: Dignity Therapy has been utilized successfully with terminally ill adult patients to help restore a sense of dignity and personhood as well as cope with existential distress near the end of life. To our knowledge, there are no published reports of this treatment modality in pediatric patients. Methods: The authors report the experience of a single-center case series of Dignity Therapy in a pediatric palliative care population. The adult Dignity Therapy process was adapted to fit the pediatric population and their families. Modifications are explained in some detail, and specific cases are shared to illustrate the process. The goal of this case series is to report on the application of Dignity Therapy to the pediatric population. Setting/subjects: Inclusion criteria for the cases series consisted of children and their families who were aware that death may occur soon, were English speaking, admitted to the hospital, and receiving care from the palliative care service. Results: Eight patients or their caregivers have completed Dignity Therapy thus far through our program. Four consented to publication of their experience. Three patients were adolescents and told their own story and the story of one younger nonverbal child was told by her family. All four participants reported that the intervention was acceptable and expressed gratitude for their final generativity document. No patient or family reported distress or negative effects from participation in Dignity Therapy. Conclusions: This case series describes how Dignity Therapy is possible with adaptations in the pediatric population, and how Dignity Therapy by proxy may be possible for caregivers of patients unable to tell their own story.
Collapse
Affiliation(s)
- Taryn Schuelke
- Palliative Care, Texas Children's Hospital, Houston, Texas, USA
| | - Jared Rubenstein
- Palliative Care, Texas Children's Hospital, Houston, Texas, USA.,Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
15
|
Iani L, De Vincenzo F, Maruelli A, Chochinov HM, Ragghianti M, Durante S, Lombardo L. Dignity Therapy Helps Terminally Ill Patients Maintain a Sense of Peace: Early Results of a Randomized Controlled Trial. Front Psychol 2020; 11:1468. [PMID: 32670169 PMCID: PMC7330164 DOI: 10.3389/fpsyg.2020.01468] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction: Dignity Therapy (DT) is a brief, individualized, narrative psychotherapy developed to reduce psychosocial and existential distress, and promote dignity, meaning, and hope in end of life patients. Previous studies have shown that DT was effective in reducing anxiety and depression, and improving dignity-related distress. However, less is known about its efficacy on spiritual well-being. The aim of this study is to contribute to the existing literature by investigating the effects of DT on specific dimensions of spiritual well-being, demoralization and dignity-related distress in a sample of terminally ill patients. Methods: A randomized, controlled trial was conducted with 64 terminally ill patients who were randomly assigned to the intervention group (DT + standard palliative care) or the control group (standard palliative care alone). The primary outcome measures were Meaning, Peace, and Faith whereas the secondary outcome measures were (loss of) Meaning and purpose, Distress and coping ability, Existential distress, Psychological distress, and Physical distress. All measures were assessed at baseline (before the intervention), 7-10 and 15-20 days after the baseline assessment. The trial was registered with ClinicalTrials.gov (Protocol Record NCT04256239). Results: The MANOVA yielded a significant effect for the Group X Time interaction. ANOVA with repeated measures showed a significant effect of time on peace and a significant Group X Time interaction effect on peace. Post hoc comparisons revealed that, while there was a decrease in peace from pre-treatment to follow-up and from post-treatment to follow-up in the control group, there was no such trend in the intervention group. Discussion: This study provides initial evidence that patients in the DT intervention maintained similar levels of peace from pre-test to follow-up, whereas patients in the control group showed a decrease in peace during the same time period. We did not find significant longitudinal changes in measures of meaning, faith, loss of meaning and purpose, distress and coping ability, existential, psychological and physical distress. The findings of our study are of relevance in palliative care and suggest the potential clinical utility of DT, since they offer evidence for the importance of this intervention in maintaining peace of mind for terminally ill patients.
Collapse
Affiliation(s)
- Luca Iani
- Department of Human Sciences, European University of Rome, Rome, Italy
| | | | - Alice Maruelli
- Psychology Unit, LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy
| | | | - Matilde Ragghianti
- Psychology Unit, LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy
| | - Sieva Durante
- U.O. di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
| | - Luigi Lombardo
- U.O. di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
| |
Collapse
|
16
|
Li Y, Li X, Hou L, Cao L, Liu G, Yang K. Effectiveness of dignity therapy for patients with advanced cancer: A systematic review and meta-analysis of 10 randomized controlled trials. Depress Anxiety 2020; 37:234-246. [PMID: 31808977 DOI: 10.1002/da.22980] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/16/2019] [Accepted: 11/28/2019] [Indexed: 11/05/2022] Open
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.
Collapse
Affiliation(s)
- Yanfei Li
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xiuxia Li
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Liangying Hou
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Liujiao Cao
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Guanghua Liu
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.,Law School of Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.,Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| |
Collapse
|
17
|
Xiao J, Chow KM, Liu Y, Chan CWH. Effects of dignity therapy on dignity, psychological well-being, and quality of life among palliative care cancer patients: A systematic review and meta-analysis. Psychooncology 2019; 28:1791-1802. [PMID: 31243850 DOI: 10.1002/pon.5162] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/23/2019] [Accepted: 06/21/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The review aims to identify available evidence related to the effects of dignity therapy on dignity, psychological well-being, and quality of life (QoL) among patients with cancer under palliative care. METHODS Thirteen electronic databases were searched for published articles in English or Chinese from inception to May 2018. Methodological rigour was assessed through the Joanna Briggs Institute (JBI) checklist for randomised controlled trials and quasi-experimental studies. Sufficient data from four trials were statistically pooled with Review Manager; otherwise, a narrative summary was used. RESULTS Ten articles describing eight studies met the selection criteria and were included in the review. None of the studies met all JBI checklist criteria. Meta-analysis results revealed that dignity therapy significantly improved dignity-related distress in existential distress domain (mean differences [MD]: -0.26, 95% CI, -0.50 to -0.02, .03) and social support domain (MD: -0.23, 95% CI, -0.39 to -0.07, .004), but nonsignificant improved depression and anxiety. Narrative summaries indicated that dignity therapy exerted positive effects on patients' dignity, psychological well-being, and QoL. CONCLUSIONS Dignity therapy is a promising approach to improve psychological well-being among patients with cancer under palliative care. However, the effects of dignity therapy on dignity and QoL are inconsistent. Further extensive studies should measure the impact of dignity therapy through qualitative and quantitative approaches to establish outcomes in psychological well-being. Studies with sensitivity to the cultural context within which dignity therapy applied should be conducted to explore its effects on patients with cancer at the early stages of illness trajectory.
Collapse
Affiliation(s)
- Jinnan Xiao
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Ka Ming Chow
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yunhong Liu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
18
|
Skinner S, Bonnet K, Schlundt D, Karlekar M. Life Story Themes: A Qualitative Analysis of Recordings From Patients Approaching the End of Life. Am J Hosp Palliat Care 2019; 36:753-759. [PMID: 31117801 DOI: 10.1177/1049909119851717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To identify common themes and topics that patients nearing the end of life want to discuss when sharing their life stories. METHODS Twenty audio-recorded transcripts of open-ended interviews of patients cared for by a palliative care team when approaching the end of life were analyzed using a qualitative analysis. RESULTS Qualitative analysis revealed that the primary contextual factors that patients drew upon to generate his or her life story are life events (including upbringing, job, education, travel, trauma, hardships, special events, military history, and hobbies), family and support system, and values and beliefs. Participants used their current medical condition, which included mortality, morbidity, and prognosis, to frame their life story. CONCLUSION Patients facing serious illness incorporate four major themes when reflecting upon their lives to create their personal life story: life events, family and support system, values and beliefs, and current medical condition.
Collapse
Affiliation(s)
- Shannon Skinner
- 1 Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kemberlee Bonnet
- 2 Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - David Schlundt
- 2 Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Mohana Karlekar
- 1 Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
19
|
Warth M, Kessler J, Koehler F, Aguilar-Raab C, Bardenheuer HJ, Ditzen B. Brief psychosocial interventions improve quality of life of patients receiving palliative care: A systematic review and meta-analysis. Palliat Med 2019; 33:332-345. [PMID: 30648926 DOI: 10.1177/0269216318818011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Patients with a terminal disease report a high need for psychosocial and spiritual support. Previous literature reviews on psychosocial interventions in palliative care were restricted to certain subtypes of techniques, included a wide range of patients, conditions, and settings, or required a number of sessions unrealistic to be achieved in patients nearing the end of their lives. Aim: The aim of this study was to review and synthesize the evidence on brief psychosocial interventions (i.e. four sessions or less and less than 21 days) for patients receiving palliative treatment. Design: We performed a systematic review and meta-analysis in accordance with standard guidelines and a pre-registered protocol (PROSPERO: CRD42018082713). Data sources: Electronic databases, journals, and references were searched for controlled clinical trials. We used the Cochrane criteria to assess the risk of bias within studies. Results: In total, 15 studies met the eligibility criteria and reported the effects of 17 interventions and a total of 1248 patients. The most frequently used techniques were life review techniques and music therapy. After exclusion of outliers, psychosocial interventions showed to be superior with regard to the improvement of quality of life (effect size = 0.36, confidence interval = 0.08 to 0.64), and the reduction of emotional (effect size = −0.51, confidence interval = −0.77 to −0.26) and existential distress (effect size = −0.40, confidence interval = −0.71 to −0.07) compared to the control groups. Conclusion: Brief psychosocial interventions can improve clinically relevant health outcomes and should therefore be made available for patients receiving palliative care.
Collapse
Affiliation(s)
- Marco Warth
- 1 Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jens Kessler
- 2 Center of Pain Therapy and Palliative Care Medicine, Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Friederike Koehler
- 1 Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Corina Aguilar-Raab
- 1 Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Hubert J Bardenheuer
- 2 Center of Pain Therapy and Palliative Care Medicine, Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- 1 Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
20
|
Scarton L, Oh S, Sylvera A, Lamonge R, Yao Y, Chochinov H, Fitchett G, Handzo G, Emanuel L, Wilkie D. Dignity Impact as a Primary Outcome Measure for Dignity Therapy. Am J Hosp Palliat Care 2018; 35:1417-1420. [PMID: 29793345 DOI: 10.1177/1049909118777987] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Feasibility of dignity therapy (DT) is well established in palliative care. Evidence of its efficacy, however, has been inconsistent and may stem from DT's primary effects differing from the outcomes measured in previous studies. We proposed that DT effects were in the spiritual domain and created a new outcome measure, Dignity Impact Scale (DIS), from items previously used in a large randomized controlled trial (RCT). OBJECTIVE The purpose of this secondary analysis study was to examine properties of a new measure of dignity impact. DESIGN Using the DIS, we conducted reanalysis of posttest data from a large 3-arm, multi-site RCT study. SETTING/PARTICIPANTS Participants were receiving hospice/palliative care (n = 326, 50.6% female, mean age = 65.1 years, 89.3% white, all with a terminal illness with 6 months or less life expectancy). They had been randomized to standard palliative care (n = 111), client-centered care (n = 107), or DT (n = 108). MEASUREMENT The 7-item DIS was derived from selected items in a posttest DT Patient Feedback Questionnaire. The DIS had strong internal consistency (α = 0.85). RESULTS The DT group mean DIS score (21.4 ± 5.0) was significantly higher than the usual care group mean score (17.7 ± 5.5; t = 5.2, df = 216, P < .001) and a client-centered intervention group mean score (17.9 ± 4.9; t = 5.2, df = 213, P < .001). CONCLUSION We found that, compared to both other groups, patients who received DT reported significantly higher DIS ratings, which is consistent with the DT focus on meaning-making, preparation for death, and life completion tasks. We propose that the DIS be used as the primary outcome measure in evaluating the effects of DT.
Collapse
Affiliation(s)
- Lisa Scarton
- 1 University of Florida College of Nursing, Gainesville, FL, USA
| | - Sungho Oh
- 1 University of Florida College of Nursing, Gainesville, FL, USA
| | - Ashley Sylvera
- 1 University of Florida College of Nursing, Gainesville, FL, USA
| | - Ralph Lamonge
- 1 University of Florida College of Nursing, Gainesville, FL, USA
| | - Yingwei Yao
- 1 University of Florida College of Nursing, Gainesville, FL, USA
| | - Harvey Chochinov
- 2 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,3 Manitoba Palliative Care Research Unit, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Linda Emanuel
- 6 Buehler Center on Health, Aging & Society Northwestern University, Chicago, IL, USA
| | - Diana Wilkie
- 1 University of Florida College of Nursing, Gainesville, FL, USA
| |
Collapse
|
21
|
Rullán M, Carvajal A, Núñez-Córdoba JM, Martínez M, Carrasco JM, García I, Arantzamendi M, Belar A, Centeno C. Spanish Version of the Patient Dignity Inventory: Translation and Validation in Patients With Advanced Cancer. J Pain Symptom Manage 2015; 50:874-81.e1. [PMID: 26342725 DOI: 10.1016/j.jpainsymman.2015.07.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/24/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT The Patient Dignity Inventory (PDI) is an instrument to measure sources of distress related to dignity at the end of life. OBJECTIVES To obtain a Spanish version of the PDI and measure psychometric aspects in patients with advanced cancer. METHODS A back-translation method was used to obtain the Spanish version. Inpatients and outpatients with advanced cancer were included. Patients completed the Spanish versions of the PDI (PDI-s), Edmonton Symptom Assessment System (ESAS), Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp-12) instruments. The psychometric properties evaluated were internal consistency; concurrent validity between PDI-s/ESAS, PDI-s/HADS, and PDI-s/FACIT-Sp-12; discriminant validity, test-retest reliability, and factor analysis. The usefulness of the instrument also was tested. RESULTS A Spanish version of the PDI was obtained. One hundred twenty-four patients completed the study. Cronbach's alpha coefficient for the PDI-s was 0.89. The PDI-s significantly correlated with the ESAS (rs = 0.669; P < 0.001), HADS (rs = 0.788; P < 0.001), and FACIT-Sp-12 (rs = -0.442; P = 0.008). The instrument distinguished outpatients from inpatients and between patients with differing Karnofsky Performance Status scores (rs = -0.328; P < 0.001). The test-retest method indicated excellent reproducibility (intraclass correlation coefficient = 0.931). Factor analysis showed three factors accounting for 79.4% of the variance. Factors were labeled psychological and existential distress, physical symptoms and dependency, and social support. Patients had no difficulties in understanding or completing the questionnaire (mean time to complete: 7.2 minutes). CONCLUSION The Spanish version of the PDI showed adequate psychometric properties when tested with advanced cancer patients. This research provides a three-factor alternative in Spanish to the PDI.
Collapse
Affiliation(s)
- María Rullán
- Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain; ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Ana Carvajal
- Faculty of Nursing, University of Navarra, Pamplona, Spain.
| | - Jorge M Núñez-Córdoba
- Department of Preventive Medicine and Public Health, Medical School, University of Navarra, Pamplona, Spain; Research Support Service, University of Navarra Clinic, Pamplona, Spain; Public Health and Epidemiology Area, University of Navarra, Navarra's Health Research Institute (IdiSNA), Pamplona, Spain; Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
| | - Marina Martínez
- Palliative Medicine Unit, University of Navarra Hospital, Pamplona, Spain
| | - José Miguel Carrasco
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Palliative Medicine Group, Area of Oncology and Hematology, Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
| | - Irene García
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Palliative Medicine Group, Area of Oncology and Hematology, Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
| | - María Arantzamendi
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Faculty of Nursing, University of Navarra, Pamplona, Spain; Palliative Medicine Group, Area of Oncology and Hematology, Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
| | - Alazne Belar
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Aita Meni Hospital, Guipuzcoa, Spain
| | - Carlos Centeno
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Palliative Medicine Group, Area of Oncology and Hematology, Navarra's Health Research Institute (IdiSNA), Pamplona, Spain; Palliative Medicine Unit, University of Navarra Hospital, Pamplona, Spain
| |
Collapse
|
22
|
Bernat JK, Helft PR, Wilhelm LR, Hook NE, Brown LF, Althouse SK, Johns SA. Piloting an abbreviated dignity therapy intervention using a legacy-building web portal for adults with terminal cancer: a feasibility and acceptability study. Psychooncology 2015; 24:1823-5. [PMID: 25753612 DOI: 10.1002/pon.3790] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/29/2015] [Accepted: 02/08/2015] [Indexed: 11/08/2022]
Affiliation(s)
| | - Paul R Helft
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Laura R Wilhelm
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Charleston, WV, USA
| | | | - Linda F Brown
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Sandra K Althouse
- Department of Biostatistics, Indiana University, Indianapolis, IN, USA
| | - Shelley A Johns
- School of Medicine, Indiana University, Indianapolis, IN, USA
| |
Collapse
|
23
|
Abstract
Palliative care psychiatry is an emerging subspecialty field at the intersection of Palliative Medicine and Psychiatry. The discipline brings expertise in understanding the psychosocial dimensions of human experience to the care of dying patients and support of their families. The goals of this review are (1) to briefly define palliative care and summarize the evidence for its benefits, (2) to describe the roles for psychiatry within palliative care, (3) to review recent advances in the research and practice of palliative care psychiatry, and (4) to delineate some steps ahead as this sub-field continues to develop, in terms of research, education, and systems-based practice.
Collapse
Affiliation(s)
- Nathan Fairman
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA, USA.
| | | |
Collapse
|
24
|
Hall S, Goddard C, Martin P, Opio D, Speck P. Exploring the impact of dignity therapy on distressed patients with advanced cancer: three case studies. Psychooncology 2012; 22:1748-52. [PMID: 23055454 DOI: 10.1002/pon.3206] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 07/24/2012] [Accepted: 09/12/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dignity therapy (DT) has been developed to help reduce distress experienced by people nearing the end of life; however, evaluations of this novel intervention have largely involved non-distressed samples. OBJECTIVE The objective of this study was to explore in detail the impact of DT on distressed patients with advanced cancer. METHODS We used a case study approach. Three patients with the highest levels of dignity-related distress who received DT were explored in depth. We collected quantitative and qualitative outcomes from patients in face-to-face interviews at baseline and at 1 and 4 weeks after completion of the intervention. We assessed dignity-related distress using the Patient Dignity Inventory. Patients rated the benefits of DT at completion of the intervention and at both follow-ups. We conducted qualitative interviews exploring experiences of DT with patients and with two recipients of generativity documents produced by patients. RESULTS These patients were experiencing a wide range of major or overwhelming physical and psychosocial problems when they received the intervention, most of which would not be expected to be helped by DT. All felt that DT had helped them and had helped or would help their families; however, patients' concerns about their current situation made delivering the intervention challenging, and DT-relevant problems returned when a patients' condition deteriorated. CONCLUSIONS The extent to which DT can help these patients and their families, either as a stand-alone therapy or as an adjunct to other therapies, needs to be determined in studies focussing on distressed patients, particularly those with problems likely to be helped by the therapy.
Collapse
Affiliation(s)
- Sue Hall
- King's College London, Department of Palliative Care, Policy & Rehabilitation, London, UK.
| | | | | | | | | |
Collapse
|