Examining Moderation of Dignity Therapy Effects by Symptom Burden or Religious/Spiritual Struggles

George Fitchett*, Yingwei Yao, Linda L Emanuel, Marvin O.Delgado Guay, George Handzo, Joshua Hauser, Sheri Kittelson, Sean O'Mahony, Tammie Quest, Michael Rabow, Tasha M. Schoppee, Sheldon Solomon, Diana J. Wilkie, Harvey Max Chochinov

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Context: Dignity therapy (DT) is a well-researched psychotherapeutic intervention but it remains unclear whether symptom burden or religious/spiritual (R/S) struggles moderate DT outcomes. Objective: To explore the effects of symptom burden and R/S struggles on DT outcomes. Methods: This analysis was the secondary aim of a randomized controlled trial that employed a stepped-wedge design and included 579 participants with cancer, recruited from six sites across the United States. Participants were ages 55 years and older, 59% female, 22% race other than White, and receiving outpatient specialty palliative care. Outcome measures included the seven-item dignity impact scale (DIS), and QUAL-E subscales (preparation for death; life completion); distress measures were the Edmonton Symptom Assessment Scale (ESAS-r) (symptom burden), and the Religious Spiritual Struggle Scale (RSS-14; R/S). Results: DT effects on DIS were significant for patients with both low (P = 0.03) and moderate/high symptom burden (P = 0.001). They were significant for patients with low (P = 0.004) but not high R/S struggle (P = 0.10). Moderation effects of symptom burden (P = 0.054) and R/S struggle (P = 0.52) on DIS were not significant. DT effects on preparation and completion were not significant, neither were the moderation effects of the two distress measures. Conclusion: Neither baseline symptom burden nor R/S struggle significantly moderated the effect of DT on DIS in this sample. Further study is warranted including exploration of other moderation models and development of measures sensitive to effects of DT and other end-of-life psychotherapeutic interventions.

Original languageEnglish (US)
Pages (from-to)e333-e340
JournalJournal of Pain and Symptom Management
Volume67
Issue number4
DOIs
StatePublished - Apr 2024

Keywords

  • cancer
  • Dignity therapy
  • palliative care
  • religious/spiritual struggle
  • symptom burden

ASJC Scopus subject areas

  • General Nursing
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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