Assessing the feasibility, acceptability and potential effectiveness of dignity therapy for people with advanced cancer referred to a hospital-based palliative care team: Study protocol

被引：25

作者：

Hall S. ^{[1
]}

Edmonds P. ^{[2
]}

Harding R. ^{[1
]}

Chochinov H. ^{[3
]}

Higginson I.J. ^{[1
]}

机构：

[1] Department of Palliative Care, Weston Education Centre, King's College London, London SE5 9RJ, Cutcombe Road

[2] Palliative Care Team, King's College Hospital NHS Foundation Trust, London SE5 9PJ, Denmark Hill

[3] Department of Psychiatry, Manitoba Palliative Care Research Unit, University of Manitoba, Winnipeg, MB R3E 0V9

来源：

BMC Palliative Care | / 8卷 / 1期

关键词：

Palliative Care; Advanced Cancer; Distress Thermometer; Palliative Care Team; Clinical Nurse Specialist;

D O I：

10.1186/1472-684X-8-5

中图分类号：

学科分类号：

摘要：

Background. Loss of dignity for people with advanced cancer is associated with high levels of psychological and spiritual distress and the loss of the will to live. Dignity Therapy is a brief psychotherapy, which has been developed to help promote dignity and reduce distress. It comprises a recorded interview, which is transcribed, edited then returned to the patient, who can bequeath it to people of their choosing. Piloting in Canada, Australia and the USA, has suggested that Dignity Therapy is beneficial to people with advanced cancer and their families. The aims of this study are to assess the feasibility, acceptability and potential effectiveness of Dignity Therapy to reduce psychological and spiritual distress in people with advanced cancer who have been referred to hospital-based palliative care teams in the UK, and to pilot the methods for a Phase III RCT. Design. A randomised controlled open-label trial. Forty patients with advanced cancer are randomly allocated to one of two groups: (i) Intervention (Dignity Therapy offered in addition to any standard care), and (ii) Control group (standard care). Recipients of the 'generativity' documents are asked their views on taking part in the study and the therapy. Both quantitative and qualitative outcomes are assessed in face-to-face interviews at baseline and at approximately one and four weeks after the intervention (equivalent in the control group). The primary outcome is patients' sense of dignity (potential effectiveness) assessed by the Patient Dignity Inventory. Secondary outcomes for patients include distress, hopefulness and quality of life. In view of the relatively small sample size, quantitative analyses are mainly descriptive. The qualitative analysis uses the Framework method. Discussion. Dignity Therapy is brief, can be delivered at the bedside and may help both patients and their families. This detailed exploratory research shows if it is feasible to offer Dignity Therapy to patients with advanced cancer, many of whom are likely to be in the terminal stage of their illness, whether it is acceptable to them and their families, if it is likely to be effective, and determine whether a Phase III RCT is desirable. Trial registration. Current Controlled Clinical Trials: ISRCTN29868352. © 2009 Hall et al; licensee BioMed Central Ltd.

引用

共 22 条

[1]

Chochinov H.M., Hack T., Hassard T., Kristjanson L.J., McClement S., Harlos M., Dignity in the terminally ill: A cross-sectional, cohort study, Lancet, 360, pp. 2026-2030, (2002)

[2]

Chochinov H.M., Hack T., McClement S., Kristjanson L., Harlos M., Dignity in the terminally ill: A developing empirical model, Soc Sci Med, 54, pp. 433-443, (2002)

[3]

Hack T.F., Chochinov H.M., Hassard T., Kristjanson L.J., McClement S., Harlos M., Defining dignity in terminally ill cancer patients: A factor-analytic approach, Psycho-Oncology, 13, pp. 700-708, (2004)

[4]

Chochinov H.M., Hack T., Hassard T., Kristjanson L.J., McClement S., Harlos M., Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life, J Clin Oncol, 23, pp. 5520-5525, (2005)

[5]

McClement S., Chochinov H.M., Hack T., Hassard T., Kristjanson L.J., Harlos M., Dignity therapy: Family member perspectives, Journal of Palliative Medicine, 10, pp. 1076-1082, (2007)

[6]

Kaasa S., Hjermstad M., Loge H., Methodological and structural challenges in palliative care research: How have we fared in the last decades?, Palliative Medicine, 20, pp. 727-734, (2006)

[7]

Craig P., Dieppe P., MacIntyre S., Michie S., Nazareth I., Petticrew M., Developing and evaluating complex interventions: The new Medical Research Council guidance, BMJ, 337, (2008)

[8]

Katzman R., Brown T., Fuld P., Peck A., Schechter R., Schimmel H., Validation of a short Orientation-Memory-Concentration Test of cognitive impairment, Am J Psychiatry, 140, pp. 734-739, (1983)

[9]

Hall S., Longhurst S.L., Higginson I.J., Living and dying with dignity: The views of older people in care homes, Age & Ageing, (2009)

[10]

Chochinov H.M., Hassard T., McClement S., Hack T., Kristjanson L.J., Harlos M., The patient dignity inventory: A novel way of measuring dignity-related distress in palliative care, J Pain Symptom Manage, 36, pp. 559-571, (2008)

← 1 2 3 →