Table 1 Dignity therapy 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

Evaluation

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.

Evaluation

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.

• BDI

Assessment: Baseline & f/u 1 shortly post DT, f/u 2 within 1 month

• FACIT-PAL

Evaluation

Feasibility and acceptability reported from surviving participants.

DTPFQ

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.

• PDI

• 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

Assessment:

• ESAS

Baseline, f/u 1

• 2-item QOL

2–3 weeks post-DT, f/u 2

1 month post-DT

• H-CAP-S

Evaluation

DTPFQ – 5 items

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

Assessment:

• Edmonton Sx – 8 items

Issues with recruitment, retention, floor effects.

• Quality of life: 2 items

Baseline & f/u immediately post receiving generativity document

• HADS

• FACIT-Sp

PDI

Evaluation

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.

• 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

• HADS

• EQ-5D

Patients in the DT group had higher scores on DTPFQ, some significant.

Assessment:

• palliative-related outcomes (Hearn)

DTPFQ

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

Secondary:

• GDS

• HHI

• 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).

• DTPFQ

Assessment:

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

Assessment:

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