Hostname: page-component-7c8c6479df-94d59 Total loading time: 0 Render date: 2024-03-27T07:06:48.023Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  19 March 2013

Miguel Julião*
Affiliation:
Center of Bioethics, Faculty of Medicine of the University of Lisbon, Lisbon, Portugal Center for Evidence Based Medicine, Faculty of Medicine of the University of Lisbon, Lisbon, Portugal Department of Palliative Medicine, Instituto das Irmãs Hospitaleiras do Sagrado Coração de Jesus, Casa de Saúde da Idanha, Belas, Portugal
António Barbosa
Affiliation:
Center of Bioethics, Faculty of Medicine of the University of Lisbon, Lisbon, Portugal Department of Psychiatry, Hospital de Santa Maria, Lisbon, Portugal
Fátima Oliveira
Affiliation:
Department of Palliative Medicine, Instituto das Irmãs Hospitaleiras do Sagrado Coração de Jesus, Casa de Saúde da Idanha, Belas, Portugal
Baltazar Nunes
Affiliation:
Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
António Vaz Carneiro
Affiliation:
Center for Evidence Based Medicine, Faculty of Medicine of the University of Lisbon, Lisbon, Portugal
*
Address correspondence to: Miguel Julião, Center of Bioethics, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal. E-mail: migueljuliao@gmail.com

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Block, S.D. (2000). Assessing and managing depression in the terminally ill patient. ACP-ASIM End-of-Life Care Consensus Panel. American College of Physicians American Society of Internal Medicine. Annals of Internal Medicine, 132, 209218.CrossRefGoogle ScholarPubMed
Boston, P., Bruce, A. & Schreiber, R. (2011). Existential suffering in the palliative care setting: An integrated literature review. Journal of Pain and Symptom Management, 41, 604618.Google Scholar
Chochinov, H.M. (2007). Dignity and the essence of medicine: The A, B, C, and D of dignity conserving care. British Medical Journal, 335, 184187.Google Scholar
Chochinov, H.M. (2011). Dignity Therapy: Final Words for Final Days. New York: Oxford University Press.Google Scholar
Chochinov, H.M., Hack, T., Hassard, T., et al. (2005). Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. Journal of Clinical Oncology, 23, 55205525.Google Scholar
Chochinov, H.M., Hack, T., McClement, S., et al. (2002). Dignity in the terminally ill: A developing empirical model. Social Science in Medicine, 54, 433443.Google Scholar
Chochinov, H.M., Kristjanson, L.J., Breitbart, W., et al. (2011). Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomised controlled trial. Lancet Oncology, 12, 753762.CrossRefGoogle ScholarPubMed
Chochinov, H.M., Wilson, K.G., Enns, M., et al. (1995). Desire for death in the terminally ill. American Journal of Psychiatry, 152, 11851191.Google Scholar
Pais-Ribeiro, J., Silva, I., Ferreira, T., et al. (2007). Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychology, Health & Medicine, 12, 225235.Google Scholar