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09-08-2011 | Article

Dignity therapy improves end-of-life experience versus standard care


Free abstract

MedWire News: Terminally ill patients who are given dignity therapy report an improved quality of life, an increased sense of dignity, and less sadness and depression compared with their counterparts who receive standard or client-centered palliative care, say researchers.

"Dignity therapy, a unique, individualized, brief psychotherapy, was developed for the purpose of relieving distress and enhancing end-of-life experiences of terminally ill patients," explain study authors Harvey Max Chochinov (University of Manitoba, Winnipeg, Canada) and colleagues.

"It provides these patients with an opportunity to reflect on things that matter most to them or that they would most want remembered," the team explains in the Lancet Oncology.

The researchers found that patients' distress levels were not greatly improved after dignity therapy compared with before it, however, the cohort showed "an absence of initial distress," making changes difficult to see, Chochinov and team explain.

The team randomly assigned 326 cancer patients, with a terminal prognosis and a life expectancy of 6 months or less, to dignity therapy (n=108), standard palliative care (n=111, where patients had access to a complete range of palliative support services including social workers, nurses, and psychiatrists), or client-centered care (n=107, where a nurse-therapist guides the patient through discussions that focus on the here and now).

Patients' outcomes were measured using instruments such as the Palliative Performance Scale and Patient Dignity Inventory, both before and after their assigned care protocol.

Overall, 49% of the participants were men, and the whole group was aged an average of 65 years. The majority (60%) received home-based palliative care.

The survey after the study showed no significant differences in Palliative Performance Scale (indicating physical performance) ratings for patients in any study group. No differences were noted among the three groups in terms of distress levels before and after the study either, however, most patients were not distressed at baseline, as indicated by the psychometric testing, say Chochinov et al.

Nevertheless, the team did see evidence of significant differences between the three study groups. Patients who received dignity therapy were significantly more likely than those in either of the other groups to report that the study had been helpful to them, that it had improved their quality of life, that it increased their sense of dignity, was helpful to their family, and had the capacity to change the way their family saw or appreciated them.

Patients in the dignity therapy group were also significantly more likely to report being satisfied with the study group, and that their sense of sadness and depression had lessened, compared with those who received standard palliative care.

The researchers caution that patients who are delirious or otherwise cognitively impaired should not be given dignity therapy, and that future studies should focus on research in more distressed patients to determine whether the method improves distress levels.

They conclude: "Psychotherapeutic support can help patients cope with disappointments, process the reality of leaving behind loved ones, deal with feelings of sadness, loss, isolation, and a damaged sense of identity and personal value."

By Sarah Guy