Background: Enhancing patients' sense of dignity is the core element of high-quality palliative care. In Western countries, dignity therapy has shown promising positive effects on the sense of dignity and end-of-life experience. To apply this therapy in Chinese patients, a theory-driven, culturally relevant family-oriented dignity therapy was developed, guided by the Medical Research Council framework for complex intervention development.
Objectives: This study examined the effectiveness of family-oriented dignity therapy in improving dignity-related distress, depression, and spiritual well-being in Chinese patients with lung cancer undergoing chemotherapy.
Design: A randomised controlled trial.
Settings and methods: Patients who were diagnosed with lung cancer and undergoing chemotherapy were recruited using convenience sampling from a cancer hospital in Changsha, China. A significant family caregiver of each patient was invited to participate. Patients who met the inclusion criteria and agreed to participate (N = 120) were randomly assigned to receive family-oriented dignity therapy (intervention group, n = 60) or attention (control group, n = 60). The Patient Dignity Inventory, Patient Health Questionnaire-9, and Functional Assessment of Chronic Illness Therapy - Spiritual Well-being Scale were used to assess dignity-related distress, depression, and spiritual well-being, respectively, at baseline and 1- and 4-week follow-up. A generalised estimating equation was used to analyse the intervention effects across the time points.
Results: Compared with the control group, the patients in the intervention group showed significantly greater reduction in existential distress (β: -1.372, 95% CI: -2.269, -0.472; p = 0.003) and depression (β: -3.430, 95% CI: -5.032, -1.829; p < 0.001) at week one, as well as significantly greater improvement in spiritual well-being at both week one (β: 3.705, 95% CI: 0.599, 6.811; p = 0.019) and week four (β: 4.939, 95% CI: 0.476, 9.401; p = 0.030).
Conclusions: Family-oriented dignity therapy has the potential to relieve existential distress and depressive symptoms and improve spiritual well-being. We expect our finding to impact research on family-oriented dignity therapy and enhance its effectiveness. We may also have an impact on nursing practice by providing a means to initiate conversations between nurses and the patients and family caregivers to relieve the psychosocial distress of patients during treatment. This study has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1900020806).
Keywords: Cancer; Chemotherapy; Depression; Dignity; Family; Spiritual well-being.
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