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Table 1 Dignity therapy studies

From: Care of the human spirit and the role of dignity therapy: a systematic review of dignity therapy research

Study Sample Design Measures Findings
Feasibility studies
Passik et al., 2004 [23] US sample; 8 pts with cancer in hospice care Single group pre-post trial of DT via telemedicine • ZSDS DT is feasible by telemedicine/ videoconference.
• PUBs
• Single item scale for depression
Assessments: Baseline & immediate post DT
Satisfaction survey
Chochinov et al., 2005 [17] Canada and Australia sample Single group, pre-post trial of DT Single item screening measures for: Significant improvement in: suffering (p = .023), depressive symptoms (p = .05).
• Depression
100 terminally ill pts in hospital, NH or home Assessments: Baseline & immediate post DT • Dignity
• Anxiety High proportions gave positive evaluation for benefits of DT: 91% reported feeling satisfied/ highly satisfied with DT.
• Suffering
• Hopefulness
• Desire for death
86% reported DT was helpful or very helpful.
• Suicide
• Sense of well-being 81% indicated DT had already helped, or would help, their family.
QoL – 2 items
ESAS (revised) 76% indicated DT heightened their sense of dignity.
DTPFQ 47% indicated DT increased their will to live.
Akechi et al., 2012 [24] Japanese sample; Two trials of DT feasibility, no control Evaluation Major problems with recruitment in Study 1 but not Study 2. The authors raise concern about acceptability of DT in Japanese culture.
DTPFQ– 9 items
11 pts with advanced cancer in hospice and hospital pall care unit Assessment: No schedule of assessment reported
Overall positive evaluation of DT: 67% indicated DT heightened their sense of dignity, 56% indicated DT was beneficial, 78% indicated DT had already helped, or would help, their family.
Chochinov et al., 2012 [25] Canadian sample; Single group trial of DT Evaluation Cognitively intact: reports helpful and satisfactory, but no specification of benefits around meaning, purpose, dignity.
DTPFQ– 9 items
Assessment: 2–3 days post DT
12 cognitively intact and 11 cognitively impaired frail elderly in long-term care
Cognitively impaired: proxy participants (family members) indicated DT is helpful to them and their families.
Johns 2013 [26] US sample; 10 pts with metastatic cancer from community or outpatient oncology unit Single group trial of DT • 7-item cancer distress measure 4 completers (3 declined to finish, 3 deaths); sample size too small for statistical analyses.
Assessment: Baseline & f/u 1 shortly post DT, f/u 2 within 1 month • FACIT-PAL
Evaluation Feasibility and acceptability reported from surviving participants.
Bentley et al., 2014 [27,28] Australian sample; Single group pre-post trial of DT • PDI Feasibility and acceptability established.
• FACIT-SP High rating of satisfaction (93%) and helpfulness (89%) for DT.
29 pts diagnosed with motor neurone disease living in community Assessment: Evaluation
Baseline, f/u • DTPFQ
1 wk post DT
• 3 additional single-item measures of hopefulness & family support. No significant changes in hope, spirituality or dignity.
Houmann et al., 2014 [29,30] Danish sample; 80 pts w incurable ca from hospice and hospital pall care unit Single group pre-post trial of DT • SISC - 6 items No change on any measure at f/u 1 or f/u 2 except QoL decreased baseline to f/u 1.
• Quality of life: EORTC QLQ-C15-
Assessment: At f/u 1 and f/u 2 positive responses on DTPFQ.
Baseline, f/u 1 immediately after receiving generativity document (median 36 days post DT), f/u 2 1 mo after DT (median 60 days) • PAL
• HADS Issues w recruitment (~50%)
• Palliative Issues w retention f/u 1 69%, f/u 2 39%.
• Performance scale ver2 (PPSv2)
Evaluation Issues with floor effects (30%-70% no sx on SISC/PDI).
DTPFQ– 9 items
Subgroup analysis for each SISC/PDI item using those with some sx found some improvement for selected items.
Vergo et al., 2014 [19] US sample; Single group pre-post trial of DT • TIA DTPFQ indicates DT very acceptable; increase in death acceptance over time (11% at baseline vs. 57% at f/u 2).
15 pts with stage-IV colorectal cancer receiving palliative chemotherapy • Distress Thermometer
Baseline, f/u 1 • 2-item QOL
2–3 weeks post-DT, f/u 2
1 month post-DT
DTPFQ – 5 items
Efficacy studies
Chochinov et al., 2011 [31] Canada, Australian, & US sample 3 arm RCT: DT vs client-centered care vs standard care Outcomes No significant differences on any of the outcomes.
• Structured Interview for Symptoms and Concerns (SISC): 7 items
Pts in the DT group had higher scores than the other grps on 8 of 22 evaluation items.
441 pts receiving palliative care in hospital, hospice or home
• Edmonton Sx – 8 items Issues with recruitment, retention, floor effects.
• Quality of life: 2 items
Baseline & f/u immediately post receiving generativity document • HADS
DTPFQ– 22 items
Intervention: psychiatrist, psychologist, palliative care nurses
Hall et al., 2011 [32,33,36] UK sample Design RCT (Phase II trial for acceptability, estimates of effect sizes): Tx = DT plus usual care; Control = usual care Primary: No differences on PDI.
No differences for any secondary outcomes, except higher hope in DT grp at f/u 1 (p = .02).
45 pts with advanced cancer Secondary:
• Hope
• EQ-5D Patients in the DT group had higher scores on DTPFQ, some significant.
Assessment: • palliative-related outcomes (Hearn)
Baseline, f/u 1 1 week post DT, f/u 2 4 wks post-DT.
Intervention: oncologist
Hall et al., 2012 [35,36] UK sample Design RCT (Phase II trial for potential effectiveness, feasibility): Tx = DT plus usual care; Control = usual care Primary: No significant differences on effectiveness measures at any point; reduced dignity-related distress as measured by DTPFQ across both groups (p = 0.026).
64 pts in older care homes • PDI
• EQ-5D
Acceptability: Patients in the DT group significantly more likely to feel DT had made life more meaningful at f/u 1 (p = 0.04).
Baseline, f/u 1 7 days post-DT, f/u 2 8 wks post-DT
Intervention: palliative care nurse
Juliao et al., 2014 [37,38] Portuguese sample Design RCT: Tx = DT+ usual care; Control = usual care HADS DT associated with lower depression at f/u 1 and 2 (p < 0.0001) and lower anxiety at f/u 1, 2 and 3 (p < 0.0001).
60 terminally ill pts  
Baseline, f/u 1 4 days post-DT, f/u 2 15 days post-DT, f/u 3 30 days post-DT
Intervention: palliative care physician
  1. BDI = Beck Depression Index; DTPFQ = DT Patient Feedback Questionnaire; EORTCQLQ-C15-PAL = European Organization for Research in Cancer Quality of Life Questionnaire; EQ-5D = EuroQol; ESAS = Edmonton System Assessment Scale; FACIT-SP = Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being; FACIT-PAL = Functional Assessment of Chronic Illness Therapy – Palliative Care; GDS = Geriatric Depression Scale; HADS = Hospital Anxiety Depression Scale; H-CAP-S = Hypothetical Advanced Care Planning Scenario; HHI = Herth Hope Index; NH = nursing home; PDI = Personal Dignity Inventory; PPSv2 = Palliative Performance Scale; PUBs = Purposelessness, Understimulation and Boredom scale; QoL – 2 = Quality of Life; SISC = Structured Interview for Symptoms and Concerns; TIA = Terminal Illness Acknowledgement; ZSDS = Zung Self-Rating Depression Scale.