Chochinov Harvey Max, Hack Thomas, Hassard Thomas, Kristjanson Linda J, McClement Susan, Harlos Mike
Department of Psychiatry, Family Medicine, Community Health Sciences, and Faculty of Nursing, University of Manitoba, Canada.
J Clin Oncol. 2005 Aug 20;23(24):5520-5. doi: 10.1200/JCO.2005.08.391.
This study examined a novel intervention, dignity therapy, designed to address psychosocial and existential distress among terminally ill patients. Dignity therapy invites patients to discuss issues that matter most or that they would most want remembered. Sessions are transcribed and edited, with a returned final version that they can bequeath to a friend or family member. The objective of this study was to establish the feasibility of dignity therapy and determine its impact on various measures of psychosocial and existential distress.
Terminally ill inpatients and those receiving home-based palliative care services in Winnipeg, Canada, and Perth, Australia, were asked to complete pre- and post-intervention measures of sense of dignity, depression, suffering, and hopelessness; sense of purpose, sense of meaning, desire for death, will to live, and suicidality; and a post-intervention satisfaction survey.
Ninety-one percent of participants reported being satisfied with dignity therapy; 76% reported a heightened sense of dignity; 68% reported an increased sense of purpose; 67% reported a heightened sense of meaning; 47% reported an increased will to live; and 81% reported that it had been or would be of help to their family. Post-intervention measures of suffering showed significant improvement (P = .023) and reduced depressive symptoms (P = .05). Finding dignity therapy helpful to their family correlated with life feeling more meaningful (r = 0.480; P = .000) and having a sense of purpose (r = 0.562; P = .000), accompanied by a lessened sense of suffering (r = 0.327; P = .001) and increased will to live (r = 0.387; P = .000).
Dignity therapy shows promise as a novel therapeutic intervention for suffering and distress at the end of life.
本研究考察了一种新型干预措施——尊严疗法，旨在解决晚期患者的心理社会和存在性困扰。尊严疗法邀请患者讨论最重要的问题或他们最希望被铭记的事情。治疗过程会被转录和编辑，最终版本会返还给患者，以便他们遗赠给朋友或家人。本研究的目的是确定尊严疗法的可行性，并确定其对心理社会和存在性困扰的各项指标的影响。
加拿大温尼伯市和澳大利亚珀斯市的晚期住院患者以及接受居家姑息治疗服务的患者，被要求在干预前后完成尊严感、抑郁、痛苦和绝望感的测量；目的感、意义感、死亡欲望、生存意志和自杀倾向的测量；以及干预后的满意度调查。
91%的参与者表示对尊严疗法满意；76%的人表示尊严感增强；68%的人表示目的感增强；67%的人表示意义感增强；47%的人表示生存意志增强；81%的人表示该疗法对他们的家人已经或将会有帮助。干预后痛苦的测量结果显示有显著改善（P = 0.023），抑郁症状减轻（P = 0.05）。认为尊严疗法对家人有帮助与生活感觉更有意义（r = 0.480；P = 0.000）和有目的感（r = 0.562；P = 0.000）相关，同时痛苦感减轻（r = 0.327；P = 0.001），生存意志增强（r = 0.387；P = 0.000）。
尊严疗法有望成为一种针对生命末期痛苦和困扰的新型治疗干预措施。
