Hall Sue, Chochinov Harvey, Harding Richard, Murray Scott, Richardson Alison, Higginson Irene J
Department of Palliative Care, Policy & Rehabilitation, King's College London, Weston Education Centre, London, UK.
BMC Geriatr. 2009 Mar 24;9:9. doi: 10.1186/1471-2318-9-9.
Although most older people living in nursing homes die there, there is a dearth of robust evaluations of interventions to improve their end-of-life care. Residents usually have multiple health problems making them heavily reliant on staff for their care, which can erode their sense of dignity. Dignity Therapy has been developed to help promote dignity and reduce distress. It comprises a recorded interview, which is transcribed, edited then returned to the patient, who can bequeath it to people of their choosing. Piloting has suggested that Dignity Therapy is beneficial to people dying of cancer and their families. The aims of this study are to assess the feasibility, acceptability and potential effectiveness of Dignity Therapy to reduce psychological and spiritual distress in older people reaching the end of life in care homes, and to pilot the methods for a Phase III RCT.
METHODS/DESIGN: A randomised controlled open-label trial. Sixty-four residents of care homes for older people are randomly allocated to one of two groups: (i) Intervention (Dignity Therapy offered in addition to any standard care), and (ii) Control group (standard care). Recipients of the "generativity" documents are asked their views on taking part in the study and the therapy. Both quantitative and qualitative outcomes are assessed in face-to-face interviews at baseline and at approximately one and eight weeks after the intervention (equivalent in the control group). The primary outcome is residents' sense of dignity (potential effectiveness) assessed by the Patient Dignity Inventory. Secondary outcomes for residents include depression, hopefulness and quality of life. In view of the relatively small sample size, quantitative analysis is mainly descriptive. The qualitative analysis uses the Framework method.
Dignity Therapy is brief, can be done at the bedside and could help both patients and their families. This detailed exploratory research shows if it is feasible to offer Dignity Therapy to residents of care homes, whether it is acceptable to them, their families and care home staff, if it is likely to be effective, and determine whether a Phase III RCT is desirable.
Current Controlled Clinical Trials: ISRCTN37589515.
尽管大多数住在养老院的老年人在那里去世，但对于改善他们临终关怀的干预措施，缺乏有力的评估。养老院居民通常有多种健康问题，这使得他们在生活护理上严重依赖工作人员，而这可能会削弱他们的尊严感。尊严疗法旨在帮助提升尊严并减轻痛苦。它包括一次录音访谈，访谈内容会被转录、编辑，然后返还给患者，患者可以将其遗赠给他们选择的人。初步试验表明，尊严疗法对癌症临终患者及其家人有益。本研究的目的是评估尊严疗法在减少养老院中临终老年人的心理和精神痛苦方面的可行性、可接受性和潜在效果，并为三期随机对照试验试行相关方法。
方法/设计：一项随机对照开放标签试验。64名养老院老年居民被随机分配到两个组之一：（i）干预组（除任何标准护理外还提供尊严疗法），以及（ii）对照组（标准护理）。收到“繁衍性”文件的人会被询问他们对参与研究和治疗的看法。在基线时以及干预后大约1周和8周（对照组同等时间）进行面对面访谈，评估定量和定性结果。主要结果是通过患者尊严量表评估的居民尊严感（潜在效果）。居民的次要结果包括抑郁、希望感和生活质量。鉴于样本量相对较小，定量分析主要是描述性的。定性分析采用框架法。
尊严疗法简短，可以在床边进行，可能对患者及其家人都有帮助。这项详细的探索性研究表明，向养老院居民提供尊严疗法是否可行，他们、他们的家人以及养老院工作人员是否接受，该疗法是否可能有效，并确定是否需要进行三期随机对照试验。
当前受控临床试验：ISRCTN37589515
Zotero 插件