Abstract
Background: Patients consider the life review intervention, Dignity Therapy (DT), beneficial to themselves and their families. However, DT has inconsistent effects on symptoms and lacks evidence of effects on spiritual/ existential outcomes. Objective: To compare usual outpatient palliative care and chaplain-led or nurse-led DT for effects on a quality-of-life outcome, dignity impact. Design/Setting/Subjects: In a stepped-wedge trial, six sites in the United States transitioned from usual care to either chaplain-led or nurse-led DT in a random order. Of 638 eligible cancer patients (age ‡55 years), 579 (59% female, mean age 66.4 – 7.4 years, 78% White, 61% stage 4 cancer) provided data for analysis. Methods: Over six weeks, patients completed pretest/posttest measures, including the Dignity Impact Scale (DIS, ranges 7–35, low-high impact) and engaged in DT+usual care or usual care. They completed procedures in person (steps 1–3) or via Zoom (step 4 during pandemic). We used multiple imputation and regression analysis adjusting for pretest DIS, study site, and step. Results: At pretest, mean DIS scores were 24.3 – 4.3 and 25.9 – 4.3 for the DT (n = 317) and usual care (n = 262) groups, respectively. Adjusting for pretest DIS scores, site, and step, the chaplain-led (b = 1.7, p = 0.02) and nurse-led (b = 2.1, p = 0.005) groups reported significantly higher posttest DIS scores than usual care. Adjusting for age, sex, race, education, and income, the effect on DIS scores remained significant for both DT groups. Conclusion: Whether led by chaplains or nurses, DT improved dignity for outpatient palliative care patients with cancer. This rigorous trial of DT is a milestone in palliative care and spiritual health services research. Clinicaltrials.gov: NCT03209440.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 176-184 |
| Number of pages | 9 |
| Journal | Journal of palliative medicine |
| Volume | 27 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 1 2024 |
Funding
This research was made possible by Grant Number 1R01CA200867 from the National Institutes of Health (NIH), National Cancer Institute (NCI), and the National Institute of Nursing Research (NINR). Also, support for the health equity analyses was made possible by Grant Numbers U54CA233396, U54CA233444, U54CA233465 from the NIH, NCI. The authors thank the patients, clinicians, and the many research staff members for giving their time to advance science. Special thanks go to Mrs. Amelia Greenlee for her untiring support of this study. This research was presented, in part, at the following scientific meetings: 15th American Association for Cancer Research Health Disparities Conference, Philadelphia, Pennsylvania, September 16–19, 2022 (https://aacrjournals.org/cebp/article/32/1_Supplement/A032/712202/AbstractA032-Dignity-therapy-effects-by-race). 23rd International Congress on Palliative Care, Montréal, Canada, October 18–21, 2022 (https://event.fourwaves.com/pal2022/abstracts/ a17c0033-e2f1-40e1-b6b8-663919461a0f). University of Florida Cancer Center Research Day 2023, Gainesville, FL, January 11, 2023. 20th Annual APOS Conference, Portland, Oregon, March 15–17, 2023. 12th Annual Collective Soul Symposium, Houston, TX, March 31–April 1, 2023. This research was made possible by Grant Number 1R01CA200867 from the National Institutes of Health (NIH), National Cancer Institute (NCI), and the National Institute of Nursing Research (NINR). Also, support for the health equity analyses was made possible by Grant Numbers U54CA233396, U54CA233444, U54CA233465 from the NIH, NCI.
ASJC Scopus subject areas
- General Nursing
- Anesthesiology and Pain Medicine
