Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA.
Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, Illinois, USA.
J Palliat Med. 2024 Feb;27(2):176-184. doi: 10.1089/jpm.2023.0336. Epub 2023 Sep 7.
Patients consider the life review intervention, Dignity Therapy (DT), beneficial to themselves and their families. However, DT has inconsistent effects on symptoms and lacks evidence of effects on spiritual/existential outcomes. To compare usual outpatient palliative care and chaplain-led or nurse-led DT for effects on a quality-of-life outcome, dignity impact. In a stepped-wedge trial, six sites in the United States transitioned from usual care to either chaplain-led or nurse-led DT in a random order. Of 638 eligible cancer patients (age ≥55 years), 579 (59% female, mean age 66.4 ± 7.4 years, 78% White, 61% stage 4 cancer) provided data for analysis. Over six weeks, patients completed pretest/posttest measures, including the Dignity Impact Scale (DIS, ranges 7-35, low-high impact) and engaged in DT+usual care or usual care. They completed procedures in person (steps 1-3) or via Zoom (step 4 during pandemic). We used multiple imputation and regression analysis adjusting for pretest DIS, study site, and step. At pretest, mean DIS scores were 24.3 ± 4.3 and 25.9 ± 4.3 for the DT ( = 317) and usual care ( = 262) groups, respectively. Adjusting for pretest DIS scores, site, and step, the chaplain-led ( = 1.7, = 0.02) and nurse-led ( = 2.1, = 0.005) groups reported significantly higher posttest DIS scores than usual care. Adjusting for age, sex, race, education, and income, the effect on DIS scores remained significant for both DT groups. Whether led by chaplains or nurses, DT improved dignity for outpatient palliative care patients with cancer. This rigorous trial of DT is a milestone in palliative care and spiritual health services research. clinicaltrials.gov: NCT03209440.
患者认为生命回顾干预（尊严疗法，DT）对他们自己和家人都有益。然而，DT 对症状的影响并不一致，并且缺乏对精神/存在结果影响的证据。 比较常规门诊姑息治疗和牧师主导或护士主导的 DT 对生活质量结果（尊严影响）的影响。 在一项阶梯式试验中，美国的六个地点随机按顺序从常规护理过渡到牧师主导或护士主导的 DT。在 638 名符合条件的癌症患者（年龄≥55 岁）中，有 579 名（59%为女性，平均年龄 66.4±7.4 岁，78%为白人，61%为 4 期癌症）提供了分析数据。 在六周内，患者完成了预测试/后测试测量，包括尊严影响量表（DIS，范围 7-35，低-高影响）和 DT+常规护理或常规护理。他们亲自（步骤 1-3）或通过 Zoom（大流行期间的步骤 4）完成了程序。我们使用多重插补和回归分析调整了预测试 DIS、研究地点和步骤。 在预测试时，DT 组（ = 317）和常规护理组（ = 262）的平均 DIS 分数分别为 24.3±4.3 和 25.9±4.3。在调整了预测试 DIS 评分、地点和步骤后，牧师主导的组（ = 1.7， = 0.02）和护士主导的组（ = 2.1， = 0.005）报告的后测试 DIS 分数明显高于常规护理组。在调整了年龄、性别、种族、教育程度和收入后，DT 对两组的 DIS 评分的影响仍然显著。 无论是由牧师还是护士主导，DT 都改善了癌症门诊姑息治疗患者的尊严。这项针对 DT 的严格试验是姑息治疗和精神健康服务研究的一个里程碑。clinicaltrials.gov：NCT03209440。
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