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  • Spiritual well-being, dignity-related distress and demoralisation at the end of life-effects of dignity therapy: a randomised controlled trial

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Original research
Spiritual well-being, dignity-related distress and demoralisation at the end of life-effects of dignity therapy: a randomised controlled trial
  1. Francesco De Vincenzo1,
  2. Luigi Lombardo2,
  3. Luca Iani1,
  4. Alice Maruelli3,
  5. Sieva Durante2,
  6. Matilde Ragghianti3,
  7. Crystal L Park4,
  8. Marco Innamorati1 and
  9. Rossella Mattea Quinto1
  1. 1 Department of Human Sciences, European University of Rome, Rome, Italy
  2. 2 U.O. di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
  3. 3 Psychology Unit, LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy
  4. 4 Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
  1. Correspondence to Francesco De Vincenzo, Department of Human Sciences, European University of Rome, Rome 00163, Italy; francesco.devincenzo{at}unier.it

Abstract

Objectives This single-centre prospective randomised controlled study aimed to investigate the effectiveness of dignity therapy on spiritual well-being, demoralisation and dignity-related distress compared with standard palliative care.

Methods A total of 111 terminally ill hospice patients were randomly allocated to one of two groups: dignity therapy plus standard palliative care (intervention group) or standard palliative care alone (control group). The main outcomes were meaning, peace, faith, loss of meaning and purpose, distress and coping ability, existential distress, psychological distress and physical distress. Assessments were conducted at baseline, 7–10 and 15–20 days.

Results Following randomisation, 11 dropped out before baseline assessment and 33 after post-treatment assessment. A total of 67 patients completed the study, 35 in the experimental group and 32 in the control group. Repeated measures general linear model showed significant differences between groups on peace and psychological distress over time, but not on existential distress, physical distress, meaning and purpose, distress and coping ability, meaning and faith. Specifically, patients in the dignity therapy intervention maintained similar levels of peace from baseline to follow-up, whereas patients in the control group significantly declined in peace during the same time period. Moreover, psychological distress significantly decreased from pretreatment to post-treatment in the intervention group and increased in the control group.

Conclusions Dignity therapy may be an effective intervention in maintaining sense of peace for terminally ill patients. The findings of our study are of relevance in palliative care and suggest the potential clinical utility of this psychological intervention.

  • Hospice care
  • Spiritual care
  • Supportive care
  • Terminal care

Data availability statement

Data are available upon reasonable request. All data underlying the findings of this study are available from the corresponding author, FDV, upon reasonable request.

https://doi.org/10.1136/spcare-2022-003696

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    Data availability statement

    Data are available upon reasonable request. All data underlying the findings of this study are available from the corresponding author, FDV, upon reasonable request.

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    Footnotes

    • Twitter @Fr_DeVincenzo

    • Deceased 24 September 2022

    • Contributors FDV analysed the data, wrote the manuscript and collaborated in the editing of the final manuscript. LL designed the study, contributed to data collection and collaborated in the editing of the final manuscript. LI designed the study, analysed the data and wrote the manuscript. AM designed the study and collaborated in the editing of the final manuscript. SD contributed to data collection. MR contributed to data collection and collaborated in the editing of the final manuscript. CLP collaborated in the editing of the final manuscript. MI collaborated in the editing of the final manuscript and in data analysis. RMQ analysed the data, wrote the manuscript and collaborated in the editing of the final manuscript. All authors contributed to the article and approved the submitted version. FDV is responsible for the overall content as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.