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Fostering hope and enhancing end of life experiences: two Phase II RCTs of dignity therapy
  1. S Hall1,
  2. C Goddard1,
  3. P Speck1,
  4. D Opio2,
  5. H M Chochinov3 and
  6. I J Higginson1
  1. 1King's College London, London, UK
  2. 2Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
  3. 3CancerCare Manitoba, Department of Psychiatry, Manitoba Palliative Care Research Unit, Winnipeg, Canada

Abstract

Introduction and aims Maintaining dignity and having hope are important at the end of life. The aim of these studies is to assess the acceptability and potential effectiveness of Dignity Therapy to reduce psychological and spiritual distress in people (i) with advanced cancer, and (ii) living in care homes for older people.

Methods We randomly allocated 45 cancer patients and 60 care home residents to an intervention (Dignity Therapy) or control group. We collected outcomes in face-to-face interviews at two post intervention follow-ups: 1 and 4 weeks for cancer patients; and 1 and 8 weeks for care home residents (equivalent in the control group). The primary outcome was dignity related distress. Secondary outcomes were: hopefulness; anxiety/depression; quality of life; and acceptability (views on the intervention/taking part in the study).

Results Cancer patients in the intervention group were more hopeful at both follow-ups. Effect sizes were large (partial η2 0.195 and 0.150 respectively). Baseline levels of distress were low in both studies and the two groups did not differ on measures of distress or quality of life. Residents in both groups showed a decrease in dignity-related distress at 8 weeks. Participants in the intervention groups outperformed the control groups on all acceptability items at both follow-ups. Effect sizes (Cohen's d) ranged from 0.25 to 1.09).

Conclusion Dignity Therapy increases hopefulness for people with advanced cancer and enhances their end of life experiences and those of residents of care homes. The impact of Dignity Therapy on more distressed patients needs to be determined.

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