4.6 Article

Effects of family-oriented dignity therapy on dignity, depression and spiritual well-being of patients with lung cancer undergoing chemotherapy: A randomised controlled trial

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PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.ijnurstu.2022.104217

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Dignity; Depression; Spiritual well-being; Family; Cancer; Chemotherapy

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This study confirms the positive effects of family-oriented dignity therapy in alleviating existential distress and depression symptoms, as well as improving spiritual well-being in lung cancer patients.
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 endof-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 (beta: - 1.372, 95% CI: - 2.269, - 0.472; p = 0.003) and depression (beta: -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 (beta: 3.705, 95% CI: 0.599, 6.811; p = 0.019) and week four (beta: 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. (C) 2022 Elsevier Ltd. All rights reserved.

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