University of Florida College of Nursing, Gainesville, Florida, USA.
Center for Palliative Care Research & Education, Gainesville, Florida, USA.
BMC Palliat Care. 2022 Jan 11;21(1):8. doi: 10.1186/s12904-021-00888-y.
Intervention fidelity is imperative to ensure confidence in study results and intervention replication in research and clinical settings. Like many brief protocol psychotherapies, Dignity Therapy lacks sufficient evidence of intervention fidelity. To overcome this gap, our study purpose was to examine intervention fidelity among therapists trained with a systematized training protocol.
For preliminary fidelity evaluation in a large multi-site stepped wedge randomized controlled trial, we analyzed 46 early transcripts of interviews from 10 therapists (7 female; 7 White, 3 Black). Each transcript was evaluated with the Revised Dignity Therapy Adherence Checklist for consistency with the Dignity Therapy protocol in terms of its Process (15 dichotomous items) and Core Principles (6 Likert-type items). A second rater independently coded 26% of the transcripts to assess interrater reliability.
Each therapist conducted 2 to 10 interviews. For the 46 scored transcripts, the mean Process score was 12.4/15 (SD = 1.2), and the mean Core Principles score was 9.9/12 (SD = 1.8) with 70% of the transcripts at or above the 80% fidelity criterion. Interrater reliability (Cohen's kappa and weighted kappa) for all Adherence Checklist items ranged between .75 and 1.0. For the Core Principles items, Cronbach's alpha was .92.
Preliminary findings indicate that fidelity to Dignity Therapy delivery was acceptable for most transcripts and provide insights for improving consistency of intervention delivery. The systematized training protocol and ongoing monitoring with the fidelity audit tool will facilitate consistent intervention delivery and add to the literature about fidelity monitoring for brief protocol psychotherapeutic interventions.
干预保真度对于确保研究结果的可信度以及在研究和临床环境中重复干预措施至关重要。与许多简短的协议心理疗法一样，尊严疗法缺乏足够的干预保真度证据。为了克服这一差距，我们的研究目的是检查经过系统培训协议培训的治疗师的干预保真度。
在一项大型多站点阶梯式随机对照试验中，为了进行初步保真度评估，我们分析了 10 名治疗师的 46 份早期访谈记录（7 名女性；7 名白人，3 名黑人）。每个转录本都根据尊严疗法协议的过程（15 个二分法项目）和核心原则（6 个李克特量表项目）用修订后的尊严疗法依从性检查表进行评估，以评估其一致性。第二位评分员独立对 26%的转录本进行编码，以评估评分者间的可靠性。
每位治疗师进行了 2 到 10 次访谈。对于 46 个评分的转录本，过程评分的平均值为 12.4/15（SD=1.2），核心原则评分为 9.9/12（SD=1.8），70%的转录本达到或高于 80%的保真度标准。所有依从性检查表项目的评分者间可靠性（Cohen's kappa 和加权 kappa）在.75 到 1.0 之间。对于核心原则项目，克朗巴赫的 alpha 值为.92。
初步研究结果表明，大多数转录本的尊严疗法交付保真度是可以接受的，并为提高干预措施一致性提供了参考。系统培训协议和使用保真度审计工具进行的持续监测将有助于实现干预措施的一致性，并为简短协议心理治疗干预措施的保真度监测增加文献资料。
