Palliative and Supportive Care

Original Articles

Efficacy of dignity therapy for depression and anxiety in terminally ill patients: Early results of a randomized controlled trial

Miguel Juliãoa1a2a3 c1, António Barbosaa1a4, Fátima Oliveiraa3, Baltazar Nunesa5 and António Vaz Carneiroa2

a1 Center of Bioethics, Faculty of Medicine of the University of Lisbon, Lisbon, Portugal

a2 Center for Evidence Based Medicine, Faculty of Medicine of the University of Lisbon, Lisbon, Portugal

a3 Department of Palliative Medicine, Instituto das Irmãs Hospitaleiras do Sagrado Coração de Jesus, Casa de Saúde da Idanha, Belas, Portugal

a4 Department of Psychiatry, Hospital de Santa Maria, Lisbon, Portugal

a5 Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal

Abstract

Objective: Dignity therapy (DT) is a short-term psychotherapy developed for patients living with a life-limiting illness. Our aim was to determine the influence of DT on symptoms of depression and anxiety in people with a life-threatening disease with high level of distress, referred to an inpatient palliative care unit.

Method: This was an open-label randomized controlled trial. Sixty terminally ill patients were randomly assigned to one of two groups: intervention group (DT+ standard palliative care [SPC]) or control group (SPC alone). The main outcomes were symptoms of depression and anxiety, measured with the Hospital Anxiety and Depression Scale, assessed at baseline, day 4, day 15, and day 30 of follow-up.

Results: Of the 60 participants, 29 were randomized to DT and 31 to SPC. Baseline characteristics were similar between the two groups. DT was associated with a significant decrease in depressive symptoms at day 4 and day 15 (mean = −4.46, 95% CI, −6.91–2.02, p = 0.001; mean= −3.96, 95% CI, −7.33 to −0.61; p = 0.022, respectively), but not at day 30 (mean = −3.33, 95% CI, −7.32–0.65, p = 0.097). DT was also associated with a significant decrease in anxiety symptoms at each follow-up (mean= −3.96, 95% CI, −6.66 to −1.25, p = 0.005; mean= −6.19, 95% CI, −10.49 to −1.88, p = 0.006; mean = −5.07, 95% CI, −10.22 to −0.09, p = 0.054, respectively).

Significance of results: DT appears to have a short-term beneficial effect on the depression and anxiety symptoms that often accompany patients at the end of their lives. Future research with larger samples compared with other treatments is needed to better understand the potential benefits of this psychotherapy.

(Received June 09 2012)

(Accepted July 07 2012)

Keywords

  • DT;
  • Depression and anxiety symptoms;
  • Randomized controlled trial

Correspondence

c1 Address correspondence to: Miguel Julião, Center of Bioethics, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal. E-mail: migueljuliao@gmail.com