Abstract
Background: Our goal is to improve psychosocial and spiritual care outcomes for elderly patients with cancer by optimizing an intervention focused on dignity conservation tasks such as settling relationships, sharing words of love, and preparing a legacy document. These tasks are central needs for elderly patients with cancer. Dignity therapy (DT) has clear feasibility but inconsistent efficacy. DT could be led by nurses or chaplains, the 2 disciplines within palliative care that may be most available to provide this intervention; however, it remains unclear how best it can work in real-life settings. Objective: We propose a randomized clinical trial whose aims are to (1) compare groups receiving usual palliative care for elderly patients with cancer or usual palliative care with DT for effects on (a) patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness); and (b) processes of delivering palliative spiritual care services (satisfaction and unmet spiritual needs); and (2) explore the influence of physical symptoms and spiritual distress on the outcome effects (dignity impact and existential tasks) of usual palliative care and nurse- or chaplain-led DT. We hypothesize that, controlling for pretest scores, each of the DT groups will have higher scores on the dignity impact and existential task measures than the usual care group; each of the DT groups will have better peaceful awareness and treatment preference more consistent with their cancer prognosis than the usual care group. We also hypothesize that physical symptoms and spiritual distress will significantly affect intervention effects. Methods: We are conducting a 3-arm, pre- and posttest, randomized, controlled 4-step, stepped-wedge design to compare the effects of usual outpatient palliative care and usual outpatient palliative care along with either nurse- or chaplain-led DT on patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness). We will include 560 elderly patients with cancer from 6 outpatient palliative care services across the United States. Using multilevel analysis with site, provider (nurse, chaplain), and time (step) included in the model, we will compare usual care and DT groups for effects on patient outcomes and spiritual care processes and determine the moderating effects of physical symptoms and spiritual distress. Results: The funding was obtained in 2016, with participant enrollment starting in 2017. Results are expected in 2021. Conclusions: This rigorous trial of DT will constitute a landmark step in palliative care and spiritual health services research for elderly cancer patients.
| Original language | English (US) |
|---|---|
| Article number | e12213 |
| Journal | Journal of medical Internet research |
| Volume | 21 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2019 |
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Keywords
- Cancer
- Elderly
- Palliative care
- Religion
- Therapy
ASJC Scopus subject areas
- Health Informatics
Cite this
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Dignity therapy led by nurses or chaplains for elderly cancer palliative care outpatients : Protocol for a randomized controlled trial. / Kittelson, Sheri; Scarton, Lisa; Barker, Paige; Hauser, Joshua M; O'Mahony, Sean; Rabow, Michael; Guay, Marvin Delgado; Quest, Tammie E.; Emanuel, Linda L; Fitchett, George; Handzo, George; Yao, Yingewi; Chochinov, Harvey Max; Wilkie, Diana.
In: Journal of medical Internet research, Vol. 21, No. 4, e12213, 01.04.2019.Research output: Contribution to journal › Article
TY - JOUR
T1 - Dignity therapy led by nurses or chaplains for elderly cancer palliative care outpatients
T2 - Protocol for a randomized controlled trial
AU - Kittelson, Sheri
AU - Scarton, Lisa
AU - Barker, Paige
AU - Hauser, Joshua M
AU - O'Mahony, Sean
AU - Rabow, Michael
AU - Guay, Marvin Delgado
AU - Quest, Tammie E.
AU - Emanuel, Linda L
AU - Fitchett, George
AU - Handzo, George
AU - Yao, Yingewi
AU - Chochinov, Harvey Max
AU - Wilkie, Diana
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Background: Our goal is to improve psychosocial and spiritual care outcomes for elderly patients with cancer by optimizing an intervention focused on dignity conservation tasks such as settling relationships, sharing words of love, and preparing a legacy document. These tasks are central needs for elderly patients with cancer. Dignity therapy (DT) has clear feasibility but inconsistent efficacy. DT could be led by nurses or chaplains, the 2 disciplines within palliative care that may be most available to provide this intervention; however, it remains unclear how best it can work in real-life settings. Objective: We propose a randomized clinical trial whose aims are to (1) compare groups receiving usual palliative care for elderly patients with cancer or usual palliative care with DT for effects on (a) patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness); and (b) processes of delivering palliative spiritual care services (satisfaction and unmet spiritual needs); and (2) explore the influence of physical symptoms and spiritual distress on the outcome effects (dignity impact and existential tasks) of usual palliative care and nurse- or chaplain-led DT. We hypothesize that, controlling for pretest scores, each of the DT groups will have higher scores on the dignity impact and existential task measures than the usual care group; each of the DT groups will have better peaceful awareness and treatment preference more consistent with their cancer prognosis than the usual care group. We also hypothesize that physical symptoms and spiritual distress will significantly affect intervention effects. Methods: We are conducting a 3-arm, pre- and posttest, randomized, controlled 4-step, stepped-wedge design to compare the effects of usual outpatient palliative care and usual outpatient palliative care along with either nurse- or chaplain-led DT on patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness). We will include 560 elderly patients with cancer from 6 outpatient palliative care services across the United States. Using multilevel analysis with site, provider (nurse, chaplain), and time (step) included in the model, we will compare usual care and DT groups for effects on patient outcomes and spiritual care processes and determine the moderating effects of physical symptoms and spiritual distress. Results: The funding was obtained in 2016, with participant enrollment starting in 2017. Results are expected in 2021. Conclusions: This rigorous trial of DT will constitute a landmark step in palliative care and spiritual health services research for elderly cancer patients.
AB - Background: Our goal is to improve psychosocial and spiritual care outcomes for elderly patients with cancer by optimizing an intervention focused on dignity conservation tasks such as settling relationships, sharing words of love, and preparing a legacy document. These tasks are central needs for elderly patients with cancer. Dignity therapy (DT) has clear feasibility but inconsistent efficacy. DT could be led by nurses or chaplains, the 2 disciplines within palliative care that may be most available to provide this intervention; however, it remains unclear how best it can work in real-life settings. Objective: We propose a randomized clinical trial whose aims are to (1) compare groups receiving usual palliative care for elderly patients with cancer or usual palliative care with DT for effects on (a) patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness); and (b) processes of delivering palliative spiritual care services (satisfaction and unmet spiritual needs); and (2) explore the influence of physical symptoms and spiritual distress on the outcome effects (dignity impact and existential tasks) of usual palliative care and nurse- or chaplain-led DT. We hypothesize that, controlling for pretest scores, each of the DT groups will have higher scores on the dignity impact and existential task measures than the usual care group; each of the DT groups will have better peaceful awareness and treatment preference more consistent with their cancer prognosis than the usual care group. We also hypothesize that physical symptoms and spiritual distress will significantly affect intervention effects. Methods: We are conducting a 3-arm, pre- and posttest, randomized, controlled 4-step, stepped-wedge design to compare the effects of usual outpatient palliative care and usual outpatient palliative care along with either nurse- or chaplain-led DT on patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness). We will include 560 elderly patients with cancer from 6 outpatient palliative care services across the United States. Using multilevel analysis with site, provider (nurse, chaplain), and time (step) included in the model, we will compare usual care and DT groups for effects on patient outcomes and spiritual care processes and determine the moderating effects of physical symptoms and spiritual distress. Results: The funding was obtained in 2016, with participant enrollment starting in 2017. Results are expected in 2021. Conclusions: This rigorous trial of DT will constitute a landmark step in palliative care and spiritual health services research for elderly cancer patients.
KW - Cancer
KW - Elderly
KW - Palliative care
KW - Religion
KW - Therapy
UR - http://www.scopus.com/inward/record.url?scp=85067316115&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85067316115&partnerID=8YFLogxK
U2 - 10.2196/12213
DO - 10.2196/12213
M3 - Article
VL - 21
JO - Journal of Medical Internet Research
JF - Journal of Medical Internet Research
SN - 1439-4456
IS - 4
M1 - e12213
ER -