Hall Sue, Goddard Cassie, Opio Diana, Speck Peter W, Martin Pauline, Higginson Irene J
King's College London, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, UK.
BMJ Support Palliat Care. 2011 Dec;1(3):315-21. doi: 10.1136/bmjspcare-2011-000054. Epub 2011 Oct 9.
To assess the ability of dignity therapy to reduce distress in advanced cancer patients.
A phase II open-label trial.
Two UK National Health Service trusts.
45 adults with advanced cancer.
Dignity therapy: a brief palliative care psychotherapy.
Participants were randomly allocated to receive the intervention plus standard care or standard care only (control group). Outcomes were collected at baseline and at 1- and 4-week follow-up.
The primary outcome was dignity-related distress (Palliative Dignity Inventory). Secondary outcomes were hope, anxiety and depression, quality of life, palliative-related outcomes, and self-reported study benefits.
45/188 (24%) patients responded. 27/45 (60%) participants remained at 1-week and 20/45 (44%) at 4-week follow-up. Baseline levels of distress were low. Groups did not differ in dignity-related distress at any time. An effect on only one secondary outcome was found: the intervention group reported more hope than the control group at both follow-ups. Effect sizes were medium (partial η(2)=0.20 and 0.15) and the difference was statistically significant at 1-week follow-up (difference in adjusted means 2.55; 95% CI -4.73 to 0.36; p=0.02). The intervention group was more positive than the control group on all the self-reported benefits ratings. Effect sizes (Cohen's d) ranged from 1.34 for feeling that dignity therapy had helped to 0.31 for increasing will to live.
The effects of dignity therapy on people with advanced cancer are encouraging. Further investigation is warranted focusing on distressed patients and those earlier in the palliative care trajectory.
ISRCTN29868352.
评估尊严疗法减轻晚期癌症患者痛苦的能力。
一项II期开放标签试验。
英国两个国民医疗服务信托机构。
45名晚期癌症成年患者。
尊严疗法：一种简短的姑息治疗心理疗法。
参与者被随机分配接受干预措施加标准护理或仅接受标准护理（对照组）。在基线以及1周和4周随访时收集结果。
主要结局为与尊严相关的痛苦（姑息尊严量表）。次要结局包括希望、焦虑和抑郁、生活质量、与姑息治疗相关的结局以及自我报告的研究益处。
45/188（24%）名患者有反应。27/45（60%）名参与者在1周随访时仍参与研究，20/45（44%）名在4周随访时仍参与研究。基线时的痛苦水平较低。两组在任何时间的与尊严相关的痛苦方面均无差异。仅在一个次要结局上发现有效果：干预组在两次随访时报告的希望均多于对照组。效应量为中等（偏η² = 0.20和0.15），且差异在1周随访时具有统计学意义（调整后均值差异为2.55；95%置信区间为 -4.73至0.36；p = 0.02）。干预组在所有自我报告的益处评分方面均比对照组更积极。效应量（科恩d值）范围从尊严疗法有帮助的感觉的1.34到增加生存意愿的0.31。
尊严疗法对晚期癌症患者的效果令人鼓舞。有必要针对痛苦的患者以及处于姑息治疗进程早期的患者进行进一步研究。
ISRCTN29868352。
