Department of Religion, Health and Human Values (G.F.), Rush University Medical Center, Chicago, Illinois, USA.
Department of Biobehavioral Nursing Science, College of Nursing (Y.Y., T.M.S., D.J.W.), University of Florida, Gainesville, Florida, USA.
J Pain Symptom Manage. 2024 Apr;67(4):e333-e340. doi: 10.1016/j.jpainsymman.2024.01.003. Epub 2024 Jan 11.
Dignity therapy (DT) is a well-researched psychotherapeutic intervention but it remains unclear whether symptom burden or religious/spiritual (R/S) struggles moderate DT outcomes.
To explore the effects of symptom burden and R/S struggles on DT outcomes.
This analysis was the secondary aim of a randomized controlled trial that employed a stepped-wedge design and included 579 participants with cancer, recruited from six sites across the United States. Participants were ages 55 years and older, 59% female, 22% race other than White, and receiving outpatient specialty palliative care. Outcome measures included the seven-item dignity impact scale (DIS), and QUAL-E subscales (preparation for death; life completion); distress measures were the Edmonton Symptom Assessment Scale (ESAS-r) (symptom burden), and the Religious Spiritual Struggle Scale (RSS-14; R/S).
DT effects on DIS were significant for patients with both low (P = 0.03) and moderate/high symptom burden (P = 0.001). They were significant for patients with low (P = 0.004) but not high R/S struggle (P = 0.10). Moderation effects of symptom burden (P = 0.054) and R/S struggle (P = 0.52) on DIS were not significant. DT effects on preparation and completion were not significant, neither were the moderation effects of the two distress measures.
Neither baseline symptom burden nor R/S struggle significantly moderated the effect of DT on DIS in this sample. Further study is warranted including exploration of other moderation models and development of measures sensitive to effects of DT and other end-of-life psychotherapeutic interventions.
尊严疗法（DT）是一种经过充分研究的心理治疗干预措施，但目前尚不清楚症状负担或宗教/精神（R/S）困扰是否会调节 DT 的结果。
探讨症状负担和 R/S 困扰对 DT 结果的影响。
这是一项随机对照试验的次要目的分析，该试验采用了逐步楔形设计，纳入了来自美国六个地点的 579 名患有癌症的参与者。参与者年龄在 55 岁及以上，59%为女性，22%为非白种人，正在接受门诊专科姑息治疗。结局指标包括尊严影响量表（DIS）的七个项目，以及 QUAL-E 子量表（死亡准备；生命完成）；痛苦指标包括埃德蒙顿症状评估量表（ESAS-r）（症状负担）和宗教/精神困扰量表（RSS-14；R/S）。
对于症状负担低（P = 0.03）和中/高（P = 0.001）的患者，DT 对 DIS 的影响均有统计学意义。对于 R/S 困扰低（P = 0.004）但不高（P = 0.10）的患者，DT 对 DIS 的影响有统计学意义。症状负担（P = 0.054）和 R/S 困扰（P = 0.52）对 DIS 的调节作用不显著。DT 对准备和完成的影响均无统计学意义，两个痛苦指标的调节作用也不显著。
在本样本中，基线症状负担和 R/S 困扰均不能显著调节 DT 对 DIS 的影响。需要进一步研究，包括探索其他调节模型和开发对 DT 和其他生命末期心理治疗干预措施的效果敏感的测量工具。
