title: A novel approach to enhancing hope in patients with advanced cancer: a randomised phase II trial of dignity therapy.
abstract: OBJECTIVE
  To assess the ability of dignity therapy to reduce distress in advanced cancer patients.
  
  
  METHODS
  A phase II open-label trial.
  
  
  METHODS
  Two UK National Health Service trusts.
  
  
  METHODS
  45 adults with advanced cancer.
  
  
  METHODS
  Dignity therapy: a brief palliative care psychotherapy.
  
  
  METHODS
  Participants were randomly allocated to receive the intervention plus standard care or standard care only (control group). Outcomes were collected at baseline and at 1- and 4-week follow-up.
  
  
  METHODS
  The primary outcome was dignity-related distress (Palliative Dignity Inventory). Secondary outcomes were hope, anxiety and depression, quality of life, palliative-related outcomes, and self-reported study benefits.
  
  
  RESULTS
  45/188 (24%) patients responded. 27/45 (60%) participants remained at 1-week and 20/45 (44%) at 4-week follow-up. Baseline levels of distress were low. Groups did not differ in dignity-related distress at any time. An effect on only one secondary outcome was found: the intervention group reported more hope than the control group at both follow-ups. Effect sizes were medium (partial η(2)=0.20 and 0.15) and the difference was statistically significant at 1-week follow-up (difference in adjusted means 2.55; 95% CI -4.73 to 0.36; p=0.02). The intervention group was more positive than the control group on all the self-reported benefits ratings. Effect sizes (Cohen's d) ranged from 1.34 for feeling that dignity therapy had helped to 0.31 for increasing will to live.
  
  
  CONCLUSIONS
  The effects of dignity therapy on people with advanced cancer are encouraging. Further investigation is warranted focusing on distressed patients and those earlier in the palliative care trajectory.
  ISRCTN29868352.
authors.affiliation: King's College London, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Hall
authors.forename: Cassie
authors.initials: C
authors.lastname: Goddard
authors.forename: Diana
authors.initials: D
authors.lastname: Opio
authors.forename: Peter W
authors.initials: PW
authors.lastname: Speck
authors.forename: Pauline
authors.initials: P
authors.lastname: Martin
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000150:complications / Q000523:psychology / Q000628:therapy*; D003863:Depression / Q000150:complications / Q000523:psychology / Q000628:therapy*; D005260:Female; D065026:Hope; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D028723:Personhood; D011614:Psychotherapy, Brief / Q000379:methods*; D011788:Quality of Life; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome