One of the greatest challenges facing palliative care today is how to address suffering of dying patients, particularly suffering that derives from psychosocial, spiritual or existential domains of the patients' experience. Patient distress associated with symptoms such as pain, nausea, dyspnea, and even to a degree depression and anxiety, have been the focus of some targeted research. Less is know about how to address sources of distress outside of these traditional domains. Over the past three years, our palliative care research group has developed, manualized and pilot tested and refined a novel individual, brief intervention called Dignity Psychotherapy. This intervention is based on an empirically derived theoretical model developed from our qualitative and quantitative work on dignity in the terminally ill. This therapeutic approach is unique, in that it is a brief practical bedside intervention, designed specifically to enhance a sense of purpose, meaning, and overall quality of life for patients nearing death. The proposed randomized clinical trial will test the efficacy of this innovative intervention for patients with advanced cancer. A multi-centered international randomized control trial will be launched in Winnipeg Canada (coordinating center), Perth Australia, and NYC, New York. Three hundred sixty patients will be randomized to one of three arms, comparing the efficacy of Dignity Psychotherapy, Client Centered Visits and standard care, in a cohort of dying patients. Patients will complete a number of baseline self-report measures, and will complete these same measures post intervention. One family member per patient will be invited to provide baseline self report data on their own psychosocial distress; standardized grief inventories and family satisfaction measures 6 to 9 months following the patients' death to obtain useful regarding this approach as a potential bereavement intervention. This study will provide essential data regarding the impact of this intervention for dying patients and their families. The Dignity Intervention holds great promise for improving suffering and distress for dying patients and their respective loved ones, thereby adding a much needed therapeutic option for those who provide care to this vulnerable population.
| Chochinov, Harvey Max; Kristjanson, Linda J; Breitbart, William et al. (2011) Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncol 12:753-62 |
| Breitbart, William; Alici, Yesne (2008) Agitation and delirium at the end of life: ""We couldn't manage him"". JAMA 300:2898-910, E1 |
