Iani Luca, De Vincenzo Francesco, Maruelli Alice, Chochinov Harvey Max, Ragghianti Matilde, Durante Sieva, Lombardo Luigi
Department of Human Sciences, European University of Rome, Rome, Italy.
Psychology Unit, LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy.
Front Psychol. 2020 Jun 25;11:1468. doi: 10.3389/fpsyg.2020.01468. eCollection 2020.
Dignity Therapy (DT) is a brief, individualized, narrative psychotherapy developed to reduce psychosocial and existential distress, and promote dignity, meaning, and hope in end of life patients. Previous studies have shown that DT was effective in reducing anxiety and depression, and improving dignity-related distress. However, less is known about its efficacy on spiritual well-being. The aim of this study is to contribute to the existing literature by investigating the effects of DT on specific dimensions of spiritual well-being, demoralization and dignity-related distress in a sample of terminally ill patients. A randomized, controlled trial was conducted with 64 terminally ill patients who were randomly assigned to the intervention group (DT + standard palliative care) or the control group (standard palliative care alone). The primary outcome measures were Meaning, Peace, and Faith whereas the secondary outcome measures were (loss of) Meaning and purpose, Distress and coping ability, Existential distress, Psychological distress, and Physical distress. All measures were assessed at baseline (before the intervention), 7-10 and 15-20 days after the baseline assessment. The trial was registered with ClinicalTrials.gov (Protocol Record NCT04256239). The MANOVA yielded a significant effect for the Group X Time interaction. ANOVA with repeated measures showed a significant effect of time on peace and a significant Group X Time interaction effect on peace. comparisons revealed that, while there was a decrease in peace from pre-treatment to follow-up and from post-treatment to follow-up in the control group, there was no such trend in the intervention group. This study provides initial evidence that patients in the DT intervention maintained similar levels of peace from pre-test to follow-up, whereas patients in the control group showed a decrease in peace during the same time period. We did not find significant longitudinal changes in measures of meaning, faith, loss of meaning and purpose, distress and coping ability, existential, psychological and physical distress. The findings of our study are of relevance in palliative care and suggest the potential clinical utility of DT, since they offer evidence for the importance of this intervention in maintaining peace of mind for terminally ill patients.
尊严疗法（DT）是一种简短的、个性化的叙事心理治疗方法，旨在减轻临终患者的心理社会和存在性痛苦，并促进其尊严、意义和希望。先前的研究表明，尊严疗法在减轻焦虑和抑郁以及改善与尊严相关的痛苦方面是有效的。然而，关于其对精神健康的疗效知之甚少。本研究的目的是通过调查尊严疗法对一组晚期患者精神健康的特定维度、士气低落和与尊严相关的痛苦的影响，为现有文献做出贡献。对64名晚期患者进行了一项随机对照试验，这些患者被随机分配到干预组（尊严疗法+标准姑息治疗）或对照组（仅标准姑息治疗）。主要结局指标是意义、安宁和信仰，而次要结局指标是（意义和目的的）丧失、痛苦和应对能力、存在性痛苦、心理痛苦和身体痛苦。所有指标在基线（干预前）、基线评估后7 - 10天和15 - 20天进行评估。该试验已在ClinicalTrials.gov注册（方案记录NCT04256239）。多变量方差分析显示组×时间交互作用有显著效应。重复测量方差分析显示时间对安宁有显著效应，组×时间交互作用对安宁有显著效应。比较结果显示，对照组从治疗前到随访以及从治疗后到随访安宁水平均有下降，而干预组没有这种趋势。本研究提供了初步证据，表明接受尊严疗法干预的患者从测试前到随访期间保持了相似的安宁水平，而对照组患者在同一时期安宁水平有所下降。我们没有发现意义、信仰、意义和目的丧失、痛苦和应对能力、存在性、心理和身体痛苦等指标有显著的纵向变化。我们研究的结果在姑息治疗中具有相关性，并表明尊严疗法具有潜在的临床效用，因为它们为这种干预措施对维持晚期患者心理安宁的重要性提供了证据。
