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Engaging Mortality: Effective Implementation of Dignity Therapy.

Diana J Wilkie1, George Fitchett2, Yingwei Yao1

  • 1Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA.

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|September 7, 2023
PubMed
Summary
This summary is machine-generated.

Dignity Therapy (DT), a life review intervention, significantly improved dignity in cancer patients receiving outpatient palliative care. Both chaplain-led and nurse-led DT demonstrated positive impacts on dignity, enhancing quality of life.

Keywords:
Dignity Therapycancerdignity impactolder adultsoutpatientpalliative care

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Area of Science:

  • Palliative Care
  • Quality of Life Research
  • Spiritual Health Services

Background:

  • Dignity Therapy (DT) is a life review intervention perceived as beneficial by patients and families.
  • Existing evidence shows inconsistent effects of DT on symptoms and a lack of impact on spiritual/existential outcomes.
  • There is a need to evaluate DT's effectiveness on dignity, a key quality-of-life indicator in palliative care.

Purpose of the Study:

  • To compare the effects of usual outpatient palliative care versus chaplain-led or nurse-led Dignity Therapy (DT) on dignity impact in cancer patients.
  • To assess the efficacy of DT in improving the quality of life for patients with advanced cancer.
  • To provide rigorous evidence for the role of DT in palliative care settings.

Main Methods:

  • A stepped-wedge trial design was employed across six US sites, with random ordering for transitioning from usual care to either chaplain-led or nurse-led DT.
  • 579 eligible cancer patients (age ≥55 years) completed pretest/posttest measures, including the Dignity Impact Scale (DIS), over six weeks.
  • Data were analyzed using multiple imputation and regression analysis, adjusting for baseline DIS scores, study site, and intervention step.

Main Results:

  • Patients receiving either chaplain-led or nurse-led DT reported significantly higher posttest Dignity Impact Scale (DIS) scores compared to those receiving usual care.
  • The positive effect of DT on DIS scores remained significant after adjusting for demographic factors like age, sex, race, education, and income.
  • Both DT delivery methods, whether by chaplains or nurses, demonstrated a significant improvement in patient dignity.

Conclusions:

  • Dignity Therapy, when delivered by either chaplains or nurses, effectively improves dignity among cancer patients in outpatient palliative care.
  • This study provides robust evidence supporting DT as a valuable intervention for enhancing quality of life and dignity in palliative care.
  • The findings represent a significant advancement in palliative care and spiritual health services research.