Efficacy of dignity therapy for depression and anxiety in terminally ill patients: Early results of a randomized controlled trial

Abstract

Objective: Dignity therapy (DT) is a short-term psychotherapy developed for patients living with a life-limiting illness. Our aim was to determine the influence of DT on symptoms of depression and anxiety in people with a life-threatening disease with high level of distress, referred to an inpatient palliative care unit.Method:This was an open-label randomized controlled trial. Sixty terminally ill patients were randomly assigned to one of two groups: intervention group (DTþ standard palliative care [SPC]) or control group (SPC alone). The main outcomes were symptoms of depression and anxiety, measured with the Hospital Anxiety and Depression Scale, assessed at baseline, day 4, day 15, and day 30 of follow-up.Results: Of the 60 participants, 29 were randomized to DTand 31 to SPC. Baseline characteristics were similar between the two groups. DT was associated with a significant decrease in depressive symptoms at day 4 and day 15 (mean ¼ 24.46, 95% CI, 26.91-2.02, p ¼ 0.001; mean¼ 23.96, 95% CI, 27.33 to 20.61; p ¼ 0.022, respectively), but not at day 30 (mean ¼ 23.33, 95% CI, 27.32-0.65, p ¼ 0.097). DTwas also associated with a significant decrease in anxiety symptoms at each follow-up (mean¼ 23.96, 95% CI, 26.66 to 21.25, p ¼ 0.005; mean¼ 26.19, 95% CI, 210.49 to 21.88, p ¼ 0.006; mean ¼ 25.07, 95% CI, 210.22 to 20.09, p ¼ 0.054, respectively).Significance of results: DT appears to have a short-term beneficial effect on the depression and anxiety symptoms that often accompany patients at the end of their lives. Future research with larger samples compared with other treatments is needed to better understand the potential benefits of this psychotherapy.

Effects of Dignity Interventions on Psychosocial and Existential Distress in Terminally ill Patients: A Meta-analysis

“…말기 환자의 품위 있는 죽음(well-dying)과 건강상태를 고려하여 단기적으로 적용하는 심리중재법으로 호스피스완화 돌봄의 핵심 가치인 존엄성과 실존적 의미에 초점을 두고 생애회고요법을 적용 한 것을 의미한다 [11,12]. 본 연구에서는 단기생애회고요법(Shortterm life review)과 존엄요법(Dignity therapy)을 의미한다.…”

Effects of dignity therapy on terminally ill patients: a systematic review

“…As the main contribution of therapy is the building of a legacy, patients are guided by a therapist (a trained health professional) to raise important questions -wishes, memories and/or unfinished business -audio recorded by the professional, who subsequently transcribes and edits them in the form of a document, and according to the patient's choice it can be delivered during their life or after their death to relatives or other loved ones (6) . The palliative care team can also make use of this material to better understand end-of-life issues and provide care focused on the specifics of each patient.…”

“…Through these studies, we have hypothesized that loss of dignity may diminish as terminally ill patients are cared for in a comprehensive environment with quality support that provides holistic care associated to a symptomatic effective treatment; considering that the preservation of dignity is related to the care provided, the sensitivity of health professionals and caregivers, and the intensity of care (6) . According to the World Health Organization, palliative care strategy should be developed by a multiprofessional team that focuses attention not on the disease to be cured/ controlled, but on the patient/person, who are understood as active biographical beings, with the right to information and full autonomy for decisions regarding their treatment.…”

Avaliação De Sintomas Do Paciente Com Câncer De Bexiga Em Cuidados Paliativos: Estudo De Caso

“…Os principais sítios de metástase são fígado, pulmão e ossos (1) . Um estudo randomizado mostrou que os pacientes submetidos a CP associados com terapia da dignidade (psicoterapia de curta duração para pacientes com doença limitante de vida) apresentaram efeito benéfico na intensidade de depressão e ansiedade, comparado aos que foram encaminhados somente aos CP (10) .…”

“…O uso de metilfenidato e modanafil, agentes estimuladores de eritropoietina em casos de anemia e corticoides são utilizados na fase final de vida com fadiga grave; bem como terapias cognitivo-comportamentais (conservação de energia e organização de atividades diárias realizadas), exercícios físicos e terapias do sono (10) .…”