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

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

Providing dignity therapy to patients with advanced cancer: a feasibility study within the setting of a hospital palliative care unit

“…Moreover, DT has been largely studied in Anglo-Saxon cultures; therefore, it is likely that its application in sociocultural contexts with different values requires some adjustments [10][11][12][13][14][15][16]. Studies on DT in Italy are poor and focused on its application by trained psychotherapists [17,18]. Current evidence suggests the need to investigate how DT can comprehensively work in different cultural contexts and real-life settings, to discover the time and resource commitments required to deliver DT and to explore the experience of professionals delivering it [9,[19][20][21][22][23][24].…”

The effects of confronting one’s own end of life on older individuals and those with a life-threatening disease: A systematic literature review

“…62 For dignity-related distress, both significant 63 and nonsignificant decreases were reported. 62,73…”

Does Guided Written Disclosure Reduce Distress and Improve Psychological Functioning in Patients with Skin Diseases?

“…In our study, we also hypothesized that writing about stressful events would have positive effects on the sense of coherence and sense of peace. Previous studies showed that different narrative interventions with patients with severe health conditions were effective in maintaining or increasing the sense of peace [ 38 , 39 ]. The use of narrative interventions designed to promote meaning and hope or to highlight mastery and values can help patients with chronic diseases restore a sense of peace.…”