A novel approach to enhancing hope in patients with advanced cancer: a randomised phase II trial of dignity therapy.
A novel approach to enhancing hope in patients with advanced cancer: a randomised phase II trial of dignity therapy.
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DOI：
10.1136/bmjspcare-2011-000054
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发表时间：
2011-12-01
影响因子：
2.7
通讯作者：
Higginson, Irene J
中科院分区：
文献类型：
--
作者：
Hall, Sue;Goddard, Cassie;Higginson, Irene J
主要目的：评估尊严治疗减轻晚期癌症患者痛苦的能力。设计：一项II期开放试验。设置：两家英国国民健康服务信托基金。对象：45名晚期癌症患者。干预：尊严治疗：一种短暂的姑息护理心理疗法。方法：随机分配参与者接受干预加标准护理或仅接受标准护理(对照组)。在基线以及1周和4周的随访中收集结果。主要结果测量：主要结果是与尊严相关的痛苦(缓解性尊严问卷)。次要结果是希望、焦虑和抑郁、生活质量、与姑息相关的结果和自我报告的研究益处。结果：45/188(24%)患者有反应。27/45(60%)的患者保持1周的随访，20/45(44%)的患者保持4周的随访。痛苦的基线水平很低。在任何时候，群体在与尊严相关的痛苦方面都没有不同。只发现了一个对次要结果的影响：在两次随访中，干预组报告了比对照组更多的希望。有效大小为中等(部分ETA(2)=0.20和0.15)，在1周随访时差异有统计学意义(调整后平均值差异为2.55；95%CI-4.73至0.36；p=0.02)。干预组在所有自我报告的福利评级上都比对照组更积极。效应大小(Cohen‘s d)从1.34(感觉尊严疗法已起作用)到0.31(增强生存意愿)不等。结论：尊严疗法对晚期癌症患者的治疗效果令人鼓舞。有必要进行进一步的调查，重点放在痛苦的患者和那些在姑息治疗轨迹早期的患者。TRIAL注册号：ISRCTN29868352。
MAIN OBJECTIVE: To assess the ability of dignity therapy to reduce distress in advanced cancer patients.DESIGN: A phase II open-label trial.SETTING: Two UK National Health Service trusts.PARTICIPANTS: 45 adults with advanced cancer.INTERVENTION: Dignity therapy: a brief palliative care psychotherapy.METHODS: Participants were randomly allocated to receive the intervention plus standard care or standard care only (control group). Outcomes were collected at baseline and at 1- and 4-week follow-up.MAIN OUTCOME MEASURES: The primary outcome was dignity-related distress (Palliative Dignity Inventory). Secondary outcomes were hope, anxiety and depression, quality of life, palliative-related outcomes, and self-reported study benefits.RESULTS: 45/188 (24%) patients responded. 27/45 (60%) participants remained at 1-week and 20/45 (44%) at 4-week follow-up. Baseline levels of distress were low. Groups did not differ in dignity-related distress at any time. An effect on only one secondary outcome was found: the intervention group reported more hope than the control group at both follow-ups. Effect sizes were medium (partial eta(2)=0.20 and 0.15) and the difference was statistically significant at 1-week follow-up (difference in adjusted means 2.55; 95% CI -4.73 to 0.36; p=0.02). The intervention group was more positive than the control group on all the self-reported benefits ratings. Effect sizes (Cohen's d) ranged from 1.34 for feeling that dignity therapy had helped to 0.31 for increasing will to live.CONCLUSIONS: The effects of dignity therapy on people with advanced cancer are encouraging. Further investigation is warranted focusing on distressed patients and those earlier in the palliative care trajectory.TRIAL REGISTER NUMBER: ISRCTN29868352.