Effect of dignity therapy on end-of-life psychological distress in terminally ill Portuguese patients: A randomized controlled trial.
Dignity therapy (DT) is a brief form of psychotherapy developed for patients living with a life-limiting illness that has demonstrated efficacy in treating several dimensions of end-of-life psychological distress. Our aim was to determine the influence of DT on demoralization syndrome (DS), the desire for death (DfD), and a sense of dignity (SoD) in terminally ill inpatients experiencing a high level of distress in a palliative care unit.



A nonblinded phase II randomized controlled trial was conducted with 80 patients who were randomly assigned to one of two groups: the intervention group (DT + standard palliative care [SPC]) or the control group (SPC alone). The main outcomes were DS, DfD, and SoD, as measured according to DS criteria, the Desire for Death Rating Scale, and the Patient Dignity Inventory (PDI), respectively. All scales were assessed at baseline (day 1) and at day 4 of follow-up. This study is registered with http://www.controlled-trials.com/ISRCTN34354086.



Of the 80 participants, 41 were randomized to DT and 39 to SPC. Baseline characteristics were similar between the two groups. DT was associated with a significant decrease in DS compared with SPC (DT DS prevalence = 12.1%; SPC DS prevalence = 60.0%; p < 0.001). Similarly, DT was associated with a significant decrease in DfD prevalence (DT DfD prevalence = 0%; SPC DfD prevalence = 14.3%; p = 0.054). Compared with participants allocated to the control group, those who received DT showed a statistically significant reduction in 19 of 25 PDI items.



Dignity therapy had a beneficial effect on the psychological distress encountered by patients near the end of life. Our research suggests that DT is an important psychotherapeutic approach that should be included in clinical care programs, and it could help more patients to cope with their end-of-life experiences.
Life and Health Sciences Research Institute,School of Medicine,University of Minho,Braga,Portugal.
Miguel
M
Julião
Department of Palliative Medicine,Instituto das Irmãs Hospitaleiras do Sagrado Coração de Jesus,Casa de Saúde da Idanha,Belas,Portugal.
Fátima
F
Oliveira
Department of Epidemiology,Instituto Dr. Ricardo Jorge,Lisbon,Portugal.
Baltazar
B
Nunes
Center for Evidence-Based Medicine,Faculty of Medicine of the University of Lisbon,Lisbon,Portugal.
António Vaz
AV
Carneiro
Center for Bioethics,Faculty of Medicine,University of Lisbon,Lisbon,Portugal.
António
A
Barbosa
D000223:Adaptation, Psychological; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D028723:Personhood; D011174:Portugal; D015995:Prevalence; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods; D011613:Psychotherapy / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D011788:Quality of Life / Q000523:psychology; D018709:Statistics, Nonparametric; D013315:Stress, Psychological / Q000150:complications / Q000628:therapy*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods / Q000592:standards*; D019452:Terminally Ill / Q000523:psychology
Dignity therapy; End-of-life psychological distress; Palliative care; Randomized controlled trial