Dignity therapy led by nurses or chaplains for elderly cancer palliative care outpatients

Protocol for a randomized controlled trial

Sheri Kittelson*, Lisa Scarton, Paige Barker, Joshua M Hauser, Sean O'Mahony, Michael Rabow, Marvin Delgado Guay, Tammie E. Quest, Linda L Emanuel, George Fitchett, George Handzo, Yingewi Yao, Harvey Max Chochinov, Diana Wilkie

*Corresponding author for this work

Research output: Contribution to journalArticle

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 languageEnglish (US)
Article numbere12213
JournalJournal of medical Internet research
Volume21
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Clergy
Palliative Care
Outpatients
Randomized Controlled Trials
Nurses
Neoplasms
Ambulatory Care
Group Psychotherapy
Therapeutics
Health Services for the Aged
Multilevel Analysis
Love
Health Services Research

Keywords

  • Cancer
  • Elderly
  • Palliative care
  • Religion
  • Therapy

ASJC Scopus subject areas

  • Health Informatics

Cite this

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. / Dignity therapy led by nurses or chaplains for elderly cancer palliative care outpatients : Protocol for a randomized controlled trial. In: Journal of medical Internet research. 2019 ; Vol. 21, No. 4.
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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.",
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Kittelson, S, Scarton, L, Barker, P, Hauser, JM, O'Mahony, S, Rabow, M, Guay, MD, Quest, TE, Emanuel, LL, Fitchett, G, Handzo, G, Yao, Y, Chochinov, HM & Wilkie, D 2019, 'Dignity therapy led by nurses or chaplains for elderly cancer palliative care outpatients: Protocol for a randomized controlled trial', Journal of medical Internet research, vol. 21, no. 4, e12213. https://doi.org/10.2196/12213

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 journalArticle

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

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