The purpose of the study is to investigate whether Danish patients with incurable cancer have a need of, interest in and benefit from Dignity Therapy.
Research in palliative care has primarily focused on physical and psychological symptoms. Research in other psychosocial and existential problems has been sparse. Loss of dignity as a consequence of serious illness may be an important cause of suffering. The research team of the Canadian psychiatrist and professor, Harvey Chochinov has investigated the concept of dignity and developed the psychosocial intervention 'Dignity Therapy' (DT). The preliminary research results were promising. Research questions: Do Danish cancer patients have a need of, interest in, and benefit from DT? Methods: DT consists of an interview revolving around the patient's life, values, and accomplishments and is also an opportunity to leave messages and words of hope and compassion for friends and family. The interview is audio taped, transcribed, and edited together with the patient, and made into a tangible document, which the patient can give to his/her relatives. The project consists of three parts: (1) a cross-sectional investigation of the prevalence of loss of dignity and related symptoms/problems among at least 200 incurable cancer patients. (2) A feasibility study, testing the intervention in terms of relevance and the need of any modifications in relation to Danish patients. (3) An evaluation study testing the effect of and satisfaction with DT. At least 80 patients are planned for the feasibility and evaluation studies. Questionnaires are used for detection of loss of dignity and as measures of effect. These will be administered before the intervention and, along with a semi-structured evaluation questionnaire, right after the intervention, when the document is received and again approximately two weeks later. The duration of the intervention (DT) varies markedly between patients. In some cases the process (interview, transcription, editing of document, and the final meeting where the document is given back to the patient) is completed urgently in a few days, whereas in other cases, the patient prefers a slower pace, and may want to sub-divide the interview into two or more parts. Also, when presented with the document, some patients want to have something changed or they want add material. This variation is seen as intentional, as it illustrates that the process is tailored to the patient's wishes. As stated, the effect of the DT intervention is evaluated at completion of the intervention, i.e. when the final document is given back to the patient, and about two weeks later. Due to process described above, the time from the first measurement (before intervention) to the second measurement (which takes places at completion of the intervention) therefore varies considerably (median 36 days after baseline, range 7-121 days). Perspective: If Danish patients have a need of, an interest in and benefit from DT, it can be offered to Danish patients admitted to palliative care.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
80
Dignity Therapy is a brief psychotherapeutic intervention consisting of: 1. a tape-recorded session with the patient using the DT question protocol 2. Transcription of the interview, which is then edited 3. A session where the edited transcript is returned to the patient who can give it to family members or friends. If needed, one or more sessions are added. Dt allows the patient to give voice to the matters of importance concerning himself and his loved ones. Its purpose is to enhance sense of meaning, purpose and worth. It also gives the opportunity to leave something behind to be remembered by.
Department of Palliative Medicine
Copenhagen, Denmark
Sankt Lukas Hospice
Hellerup, Denmark
Sense of dignity
Measured with the Structured Interview for Symptoms and Concerns (SISC)
Time frame: Pre-post intervention (when the document was recieved by the patient), and again two weeks later.
Hopelessness
Measured with the Structured Interview for Symptoms and Concerns (SISC)
Time frame: Pre-post intervention (when the document was recieved by the patient), and again two weeks later.
Anxiety
Measured on the Hospital anxiety and depression scale
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Depression
Measured on the Hospital Anxiety and Depression scale
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Not able to perform tasks of daily living
Measured on the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Suffering
Measured with the Structured Interview for Symptoms and Concerns
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
performance status
Measured on the Palliative Performance Scale v2
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
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Communication
Measured on the Structured Interview for Symptoms and Concerns
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Social Contact
Measured on the Structured Interview for Symptoms and Concerns
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Depression
Measured with the Structured Interview for Symptoms and Concerns
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Not able to attend to bodily functions
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Physically distressing symptoms
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Feeling how I look has changed
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Feeling depressed
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Feeling anxious
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Feeling uncertain
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Worried about future
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Not able to think clearly
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Not able to continue usual routines
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Feeling no longer who I was
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Not feeling worthwhile or valued
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Not able to carry out important roles
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Feeling life no longer has meaning or purpose
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Feeling of not having made a meaningful contribution
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Feeling of unfinished business
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Concerns regarding spiritual life
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Feeling like a burden to others
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Feeling of not having control
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Feeling of reduced privacy
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Not feeling supported by friends or family
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Not feeling supported by health care providers
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Not feeling able to mentally fight illness
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Not being able to accept things as they are
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Not being treated with respect
Item from the Patient Dignity Inventory
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Physical function
Measured on the EORTC QLQ-C15-PAL
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Emotional function
Measured on the EORTC QLQ-C15-PAL
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Overall quality of life
Measured on the EORTC QLQ-C15-PAL
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Fatigue
Measured on the EORTC QLQ-C15-PAL
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Nausea / Vomiting
Measured on the EORTC QLQ-C15-PAL
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Pain
Measured on the EORTC QLQ-C15-PAL
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Dyspnoea
Measured on the EORTC QLQ-C15-PAL
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Insomnia
Measured on the EORTC QLQ-C15-PAL
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Appetite loss
Measured on the EORTC QLQ-C15-PAL
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.
Constipation
Measured on the EORTC QLQ-C15-PAL
Time frame: Pre-post intervention (when the document was received by the patient), and again two weeks later.