Providing dignity therapy to patients with advanced cancer: a feasibility study within the setting of a hospital palliative care unit

Abstract

Background: Dignity is a basic principle of palliative care and is intrinsic in the daily practice of professionals assisting individuals with incurable diseases. Dignity Therapy (DT) is a short-term intervention aimed at improving the sense of purpose, meaning and self-worth and at reducing the existential distress of patients facing advanced illness. Few studies have examined how DT works in countries of non-Anglo Saxon culture and in different real-life settings. Moreover, most studies do not provide detailed information on how DT is conducted, limiting a reliable assessment of DT protocol application and of its evaluation procedure. The aim of this study was to assess the feasibility and acceptability of a nurse-led DT intervention in advanced cancer patients receiving palliative care.

Method: This is a mixed-method study using before and after evaluation and semistructured interviews. Cancer patients referred to a hospital palliative care unit were recruited and provided with DT. The duration of sessions, and timeframes concerning each step of the study, were recorded, and descriptive statistical analyses were performed. The patients' dignity-related distress and feedback toward the intervention were assessed through the Patient Dignity Inventory and the Dignity Therapy Patient Feedback Questionnaire, respectively. Three nurses were interviewed on their experience in delivering the intervention, and the data were analyzed qualitatively.

Results: A total of 37/50 patients were enrolled (74.0%), of whom 28 (75.7%) completed the assessment. In 76.7% of cases, patients completed the intervention in the time limit scheduled in the study. No statistically significant reduction in the Patient Dignity Inventory scores was observed at the end of the intervention; most patients found DT to be helpful and satisfactory. Building opportunities for personal growth and providing holistic care emerged among the facilitators to DT implementation. Nurses also highlighted too great of a time commitment and a difficult collaboration with ward colleagues among the barriers.

Conclusions: Our findings strongly support the acceptability, but only partially support the feasibility, of nurse-led DT in advanced cancer patients in a hospital setting. Further research is needed on how to transfer the potential benefits of DT into clinical practice.

Trial registration: Retrospectively registered on ClinicalTrial.gov NCT04738305 .

Keywords: Cancer; Dignity Therapy; Dignity-related distress; Feasibility studies; Mixed-method study; Nurses; Palliative care.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1

Dignity Therapy intervention procedures. Patients who gave their written informed consent to participate went through the pre-intervention assessment by means of a self-administered questionnaire. Within the following 5 days, they were phoned by a DT-trained nurse to schedule a vis-a-vis encounter, which took place 3 to 7 days later. During this encounter, they were provided with further information about the intervention, and the DT interview was administered. In contrast to the original protocol, DT questions were not delivered in advanced to subjects. DT interviews were audio-recorded and transcribed verbatim within 4 days. In the next 3 weeks, the transcription was read and discussed together with the subject, who could suggest any modification or integration. The implementation process, which could include subsequent encounters, ended when the final version of the Generativity Document was finalized and delivered to the patient. Finally, 2 or 3 weeks later, subjects were phoned by another nurse to perform the post-intervention evaluation by means of two self-administered questionnaires

Fig. 2

Patient’s flow in the study