Dignity Therapy for Older Cancer Patients: Identifying Mechanisms and Moderators

项目总结 每年有近60万美国老年人死于癌症相关的死亡。维护人类尊严是 严重疾病患者的生活质量。我们的长期目标是培养最佳的人文模式 以患者为中心的临床沟通。我们将重点放在拟议的尊严疗法(DT)研究中，该研究 旨在维护癌症患者的尊严，尽管他们的健康状况有所下降。理论上植根于 老年学生命回顾研究，DT涉及治疗师指导患者产生他们自己独特的， 结构化的生活叙事。患者报告了DT的益处，但到目前为止，DT的作用机制尚未得到 经验性调查。随着这种疗法在国际上的推广，因此迫切需要 勾勒出精确的机制。这项拟议的研究是第一个可靠地分析老年癌症内容的研究。 患者在接受治疗期间与治疗师的互动情况(N=280名接受治疗的老年人)。我们的设计 允许研究通过DT提高患者尊严的两种理论上的核心机制。这些 建议的机制、DT期间同理心的提供者与患者的沟通以及患者生活的丰富性 在DT期间产生的叙事将被分析性地用作治疗前后尊严变化的预测因子 冲击力。我们建议的研究使用创新的方法工具：它将使用互动和叙事两种方法 根据患者自己的经验进行分析，以建立治疗影响的机制 耐心的尊严。过去的研究由于对接受DT的概念性远期结局的评估而受到影响。 作为回应，建议的结果被选为DT密切指导的近端结构 概念基础。我们感兴趣的主要结果是患者的自尊感有多大 从测试前到测试后的增长(即，尊严影响)。拟议研究的另一个方面是调查 当患者最有能力进行DT的时候。这将通过评估以下方面来实现： DT后对尊严的影响受患者症状严重程度的影响。共同描述机制和 确定患者参与DT的最佳时机将在将DT作为一种 为老年癌症患者提供心理社会护理的形式。我们的跨学科团队确保研究结果将 实施以改进DT培训和交付。这包括我们创新的主办传播计划 与全国舆论领袖举行的关爱科学峰会。我们的具体目标如下：SA1：划定 移情沟通与较高患者尊严影响(主要结局)治疗前后的关系 心理治疗。SA2：调查患者被引导产生的生活叙事的丰富性与 在DT期间，和治疗前后的尊严影响(主要结果)。SA3：确定最适合的模型 患者与提供者的共情沟通与治疗后对患者尊严的影响 作为中介的丰富度和作为调节变量的患者的症状严重程度(即，调节中介分析)。

PROJECT SUMMARY Nearly 600,000 older Americans die a cancer-related death each year. Maintaining human dignity is central to quality of life for patients with serious illness. Our long-term goal is to foster optimal humanistic modes of patient-centered clinical communication. We focus in the proposed study on Dignity Therapy (DT) which was designed to preserve cancer patients’ dignity despite declines in their health. Theoretically grounded in gerontological life review research, DT involves a therapist guiding a patient to generate their own unique, structured life narrative. Patients report benefits of DT but to date the mechanisms of DT have not been empirically investigated. As the use of this therapy spreads internationally, there is thus a pressing need to delineate precise mechanisms. The proposed study is the first to reliably analyze the content of older cancer patients’ interactions with the therapist in DT sessions (N=280 older adults who received DT). Our design allows for investigation of two mechanisms theoretically central to improving patient dignity through DT. These proposed mechanisms, empathic provider-patient communication during DT and richness of the patient’s life narrative produced during DT, will be used analytically as predictors of pre-to-post-therapy change in dignity impact. Our proposed study uses innovative methodological tools: it will employ both interactional and narrative analysis, grounded in the patient’s own experience, to establish mechanisms through which the therapy affects patient dignity. Past research has suffered due to assessment of conceptually distal outcomes of receiving DT. In response, the proposed outcomes have been chosen as proximal constructs closely guided by DT’s conceptual underpinnings. Our primary outcome of interest is the extent to which the patients sense of dignity increases from pre-to-posttest (i.e., Dignity Impact). Another aspect of the proposed study is to investigate when patients are most able to engage in DT. This will be accomplished through assessing whether extent of dignity impact after DT is moderated by patients’ symptom severity. Together, delineating mechanisms and identifying best timing for patient engagement in DT will provide substantial progress in implementing DT as a form of psychosocial care for older cancer patients. Our interdisciplinary team ensures that study findings will be implemented to improve DT training and delivery. This includes our innovative dissemination plan of hosting a Science of Care Summit with national opinion leaders. Our specific aims are as follows: SA1: Delineate the relation between empathic communication and higher patient dignity impact (primary outcome) pre-to-post- therapy. SA2: Investigate the relation between richness of the life narrative the patient is guided to produce during DT, and dignity impact (primary outcome) pre-to-post therapy.SA3: Identify the best-fitting model of relation of patient-provider empathic communication to post-therapy impact on patients’ dignity, with narrative richness as a mediator and patients’ symptom severity as a moderator (i.e., moderated-mediation analyses).