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Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial
Open accessAbstract
Background Dignity therapy is a unique, individualised, short-term psychotherapy that was developed for patients (and their families) living with life-threatening or life-limiting illness. We investigated whether dignity therapy could mitigate distress or bolster the experience in patients nearing the end of their lives.Methods Patients (aged ≥18 years) with a terminal prognosis (life expectancy ≤6 months) who were receiving palliative care in a hospital or community setting (hospice or home) in Canada, USA, and Australia were randomly assigned to dignity therapy, client-centred care, or standard palliative care in a 1:1:1 ratio. Randomisation was by use of a computer-generated table of random numbers in blocks of 30. Allocation concealment was by use of opaque sealed envelopes. The primary outcomes--reductions in various dimensions of distress before and after completion of the study--were measured with the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale, Patient Dignity Inventory, Hospital Anxiety and Depression Scale, items from the Structured Interview for Symptoms and Concerns, Quality of Life Scale, and modified Edmonton Symptom Assessment Scale. Secondary outcomes of self-reported end-of-life experiences were assessed in a survey that was undertaken after the completion of the study. Outcomes were assessed by research staff with whom the participant had no previous contact to avoid any possible response bias or contamination. Analyses were done on all patients with available data at baseline and at the end of the study intervention. This study is registered with ClinicalTrials.gov, number NCT00133965.Findings 165 of 441 patients were assigned to dignity therapy, 140 standard palliative care, and 136 client-centred care. 108, 111, and 107 patients, respectively, were analysed. No significant differences were noted in the distress levels before and after completion of the study in the three groups. For the secondary outcomes, patients reported that dignity therapy was significantly more likely than the other two interventions to have been helpful (χ(2)=35·50, df=2; p<0·0001), improve quality of life (χ(2)=14·52; p=0·001), increase sense of dignity (χ(2)=12·66; p=0·002), change how their family saw and appreciated them (χ(2)=33·81; p<0·0001), and be helpful to their family (χ(2)=33·86; p<0·0001). Dignity therapy was significantly better than client-centred care in improving spiritual wellbeing (χ(2)=10·35; p=0·006), and was significantly better than standard palliative care in terms of lessening sadness or depression (χ(2)=9·38; p=0·009); significantly more patients who had received dignity therapy reported that the study group had been satisfactory, compared with those who received standard palliative care (χ(2)=29·58; p<0·0001).Interpretation Although the ability of dignity therapy to mitigate outright distress, such as depression, desire for death or suicidality, has yet to be proven, its benefits in terms of self-reported end-of-life experiences support its clinical application for patients nearing death.Funding National Cancer Institute, National Institutes of Health.
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“The intervention was administered by the first author as part of her PhD studies, who was trained in dignity therapy by Harvey Max Chochinov who developed dignity therapy [1,4].”
From Feasibility, acceptability and potential effectiveness of dignity therapy for family carers of people with motor neurone disease (2014) · cites this paper as [1]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Further, many interventions for adults with metastatic cancer (e.g., [14, 23]) are disconnected from the scientific evidence base on how to effectively reduce distress or change behavior.”
From A randomized controlled trial of a multi-modal palliative care intervention to promote advance care planning and psychological well-being among adults with advanced cancer: study protocol. (2022) · cites this paper as [14]
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“Many palliative care interventions address a single dimension of palliative care – e.g., ACP directive completion or sense of life meaning – or focus on patients in general rather than the anxious and depressed patients most in need of support [5, 13–15].”
From A randomized controlled trial of a multi-modal palliative care intervention to promote advance care planning and psychological well-being among adults with advanced cancer: study protocol. (2022) · cites this paper as [14]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Though notable meaning-focused interventions for metastatic cancer patients exist (e.g., [14, 15]), none directly target avoidance of internal experience [25]”
From A randomized controlled trial of a multi-modal palliative care intervention to promote advance care planning and psychological well-being among adults with advanced cancer: study protocol. (2022) · cites this paper as [14]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Dignity therapy was significantly better than client-centered care (but not standard palliative care) in improving spiritual well-being”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Chochinov et al. 2011
Experimental — accuracy not yet measured
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“it was significantly better than standard palliative care in terms of lessening sadness or depression”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Chochinov et al. 2011
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“Dignity therapy is a brief psychotherapeutic intervention which has been shown to enhance the end of life experience in people with life-limiting conditions [1].”
From Feasibility, acceptability and potential effectiveness of dignity therapy for family carers of people with motor neurone disease (2014) · cites this paper as [1]
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“This is similar to the findings for terminally ill cancer patients, where distressed individuals had a decrease in anxiety and depression scores [2], but those with low baseline levels of distress showed no change [1].”
From Feasibility, acceptability and potential effectiveness of dignity therapy for family carers of people with motor neurone disease (2014) · cites this paper as [1]
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“Palliative care research has developed personally tailored, individually delivered interventions requiring significant resources (e.g., [14, 23, 38])”
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“Postintervention, the participants reported that dignity therapy was significantly more likely than the other two interventions to be helpful, improve QL, increase sense of dignity, change how their families saw and appreciated them, and help their families.”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Chochinov et al. 2011
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“Postintervention, the participants reported that dignity therapy was significantly more likely than the other two interventions to be helpful, improve QL, increase sense of dignity, change how their families saw and appreciated them, and help their families.”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Chochinov et al. 2011
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“Postintervention, the participants reported that dignity therapy was significantly more likely than the other two interventions to be helpful, improve QL, increase sense of dignity, change how their families saw and appreciated them, and help their families.”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Chochinov et al. 2011
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“Postintervention, the participants reported that dignity therapy was significantly more likely than the other two interventions to be helpful, improve QL, increase sense of dignity, change how their families saw and appreciated them, and help their families.”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Chochinov et al. 2011
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“Postintervention, the participants reported that dignity therapy was significantly more likely than the other two interventions to be helpful, improve QL, increase sense of dignity, change how their families saw and appreciated them, and help their families.”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Chochinov et al. 2011
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“9 환자들에게 가장 문제되는 것을 생각하고 반추해 볼 기회를 제공하고, 그들이 가장 기억하고 싶어 하는 것을 정리하도록 도와준다(2,4,17).”
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Metadata
- Authors
- Chochinov, H. M., Kristjanson, L. J., Breitbart, W., McClement, S., Hack, T. F., Hassard, T., & Harlos, M.
- Affiliations
- CancerCare Manitoba (CA)
- Edith Cowan University (AU)
- Memorial Sloan Kettering Cancer Center (US)
- University of Manitoba (CA)
- Winnipeg Regional Health Authority (CA)
- Corresponding author
- Chochinov, Harvey Max
- Venue
- The Lancet Oncology
- Publisher
- Elsevier BV
- Published
- 2011-08
- Volume
- 12
- Issue
- 8
- Pages
- 753-762
- ISSN
- 1470-2045 (ISSN-L)
- PMC
- PMC3185066
- OpenAlex
- W2041265397
- Cited by
- 775
- References
- 35
- Citations by year
- 2026: 40 · 2025: 46 · 2024: 60 · 2023: 51 · 2022: 52 · 2021: 49 · 2020: 112 · 2019: 46 · 2018: 41 · 2017: 60 · 2016: 46 · 2015: 47 · 2014: 45 · 2013: 43 · 2012: 32
- FWCI
- 38.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Lancet Oncology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Edith Cowan University Research Online (Edith Cowan University) (submittedVersion)
- eSpace (Curtin University) (submittedVersion)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion)
- Funders
- Memorial Sloan-Kettering Cancer Center
- Canada Research Chairs
- Canadian Institutes of Health Research
- National Cancer Institute (R01CA102201)
- Topics
- Health Sciences › Nursing › Issues, ethics and legal aspects › Patient Dignity and Privacy
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- dignity therapy, terminal illness, end-of-life care, palliative care, distress, quality of life, sense of dignity, spiritual well-being, client-centred care, patient experience, symptom burden, anxiety and depression, patient-centered care
- MeSH terms
- Aged, Australia, Canada, Counseling, Female, Humans, Male, Middle Aged, Neoplasms, Palliative Care, Psychotherapy, Brief, Quality of Life, Surveys and Questionnaires, Stress, Psychological, United States, Treatment Outcome, Terminally Ill
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