Effects of dignity therapy on palliative patients’ family members: A systematic review

Storytelling Through Music With Parents Whose Children Have Died From Cancer: A Randomized Controlled Feasibility Trial

BACKGROUND

Bereaved parents have significantly higher morbidity and mortality than non-bereaved parents. Despite national guidelines recommending bereavement care, resources for bereaved parents are scarce. Most intervention studies lack empirical evidence of effectiveness or alignment with key theoretical concepts.

AIMS

To evaluate the feasibility of a 6-week intervention with parents of children who have died from cancer. Storytelling Through Music (STM) combines multiple modalities of expression (storytelling, reflective writing, songwriting) and psychoeducation to facilitate loss- and restoration-oriented coping by creating a legacy piece (self-written story paired with a song) to help bereaved parents adapt to a life-long process of finding meaning after loss.

METHODS

Two-group, randomized controlled trial, utilizing multiple methods. Participants were randomized to STM or waitlist control. The intervention is delivered online and in a group setting. Descriptive statistics were used for feasibility data, content analysis to evaluate open-ended acceptability questions, and RM ANOVA to evaluate the differences between psychosocial, coping, and grief outcomes.

RESULTS

Twenty-three parents were enrolled. Average age was (range: 32-68) and the child's average age was 18.9 (range: 1.5-35). This study indicates that the online delivery of STM is feasible and acceptable and provides preliminary evidence of reducing prolonged grief and loneliness.

CONCLUSIONS

STM is a theoretically driven, innovative approach to addressing grief in a high-risk, underserved population. Findings suggest STM can be delivered online and is acceptable to participants. Adding music to storytelling and reflective writing provides a unique expression and preliminary data suggests improvements in psychosocial well-being, coping, and grief intensity.

"It seemed I was having a conversation with him": Posthumous Dignity Therapy case series

OBJECTIVES

Dignity Therapy (DT) is a brief psychotherapeutic intervention designed to address the psychosocial and spiritual needs of terminally ill patients. Research demonstrates DT's efficacy in reducing dignity-related distress and alleviating psychosocial symptoms like depression and anxiety in terminally ill patients. Its application has been extended to nonterminal patients with chronic conditions, mental health challenges, and children nearing the end of life, with promising results. DT also benefits families and caregivers, promoting emotional resilience and facilitating grieving. However, the potential for proxy applications, such as posthumous DT (p-DT) - conducted by relatives after a patient's death or on behalf of individuals unable to participate - remains underexplored.

METHODS

A case series report.

RESULTS

This case series examines 3 relatives who engaged in p-DT, highlighting its feasibility and potential benefits.

SIGNIFICANCE OF RESULTS

Findings suggest p-DT may serve as a valuable tool for bereavement support, warranting further research to expand its scope and accessibility.

Effectiveness of family dignity intervention for patients in palliative care and their family caregivers-a systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

This study explores the impact of family dignity interventions (FDI) on palliative patients and their family caregivers through a systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

A systematic search was conducted in PubMed, Embase, and Cochrane databases for RCTs related to family-centered dignity interventions, with the search period extending from the inception of the databases up to July 2024. Statistical analyses were conducted using standardized mean difference (SMD) as the effect size with Stata 17.0 software for analysis, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was employed to assess the certainty of evidence.

RESULTS

A total of 7 RCTs involving 556 pairs of palliative patients and their caregivers were included. Compared to the control group, palliative patients who received FDI demonstrated greater improvements in dignity (SMD, - 0.27; 95% confidence interval (CI), - 0.43; - 0.10), hope (SMD, 0.50; 95% CI, 0.24; 0.75), sense of meaning (SMD, 0.39; 95% CI, 0.18; 0.75), and spiritual well-being (SMD, 0.43; 95% CI, 0.24; 0.61). Concurrently, their family caregivers experienced more significant reductions in anxiety (SMD, - 0.61; 95% CI, - 0.92; - 0.30), depression (SMD, - 0.52; 95% CI, - 0.69; - 0.34), and anticipatory grief (SMD, - 0.71; 95% CI, - 1.12; - 0.31). Subgroup analysis indicated that the benefits gained by palliative patients disappeared 2 months after the intervention, whereas the benefits for their family caregivers persisted 2 months after the intervention.

CONCLUSION

Current low-quality evidence suggests that FDI may have short-term positive effects on the psycho-spiritual well-being of palliative care patients and reduce psychological distress in their family caregivers. Future research should focus on conducting high-quality RCTs to assess the dose-response effect of FDI on the families of palliative care patients, providing evidence to optimize intervention strategies.

The usage of family audiobooks as a legacy for grieving children - an exploratory quantitative analysis among terminally ill parents and close persons

BACKGROUND

Since 2017, terminally ill parents with dependent children under the age of 18 have been able to record an audiobook for their dependent children. This service allows them to narrate how they would like to be remembered in their voice. The family audiobook is a professionally supported, voluntary, free service that is unique in Germany. There is little research on digital memories for children. The study aims to understand how this service is used and its influence on children through responses of terminally ill parents and close persons.

METHODS

An anonymous online survey, accessible between September 2023 and November 2023, was conducted among terminally ill parents and their close persons with support from the Family Audiobook Association in Germany. Analyses were carried out using SPSS.

RESULTS

186 respondents, 95 terminally ill parents, and 91 close persons completed the online survey. Almost all terminally ill parents felt eased to have recorded a family audiobook. The two groups showed differences in how they used the family audiobook and how often they listened to it. While some children listen to the family audiobook with their bereaved parents or friends, other children are not yet ready for this, according to the open-ended responses of terminally ill parents and close persons.

CONCLUSIONS

The family audiobook provides a valuable opportunity for terminally ill parents with dependent children under the age of 18 to tell their own biographical story, offer support to the bereaved in remembering, and preserve the voice of the deceased for the children. In addition, this approach could help healthcare professionals to reduce the stress associated with providing end-of-life care for terminally ill parents.

Dignity in Medicine: Definition, Assessment and Therapy

PURPOSE OF REVIEW

Over the last 20 years, dignity and dignity-conserving care have become the center of investigation, in many areas of medicine, including palliative care, oncology, neurology, geriatrics, and psychiatry. We summarized peer-reviewed literature and examined the definition, conceptualization of dignity, potential problems, and suggested interventions.

RECENT FINDINGS

We performed a review utilizing several databases, including the most relevant studies in full journal articles, investigating the problems of dignity in medicine. It emerged that dignity is a multifactorial construct and that dignity-preserving care should be at the center of the health organization. Dignity should be also regularly assessed through the tools currently available in clinical practice. Among dignity intervention, besides dignity models of care, dignity intervention, such as dignity therapy (DT), life review and reminiscence therapy, have a role in maintaining both the extrinsic (preserved when health care professionals treat the patient with respect, meeting physical and emotional needs, honors the patient's wishes, and makes attempts to maintain privacy and confidentiality) and intrinsic dignity (preserved when the patient has appropriate self-esteem, is able to exercise autonomy and has a sense of hope and meaning). Unified trends across diverse medical contexts highlight the need for a holistic, patient-centered approach in healthcare settings. Challenges compromising dignity are pervasive, underscoring the importance of interventions and systematic efforts to address these issues. Future research and interventions should prioritize the multifaceted nature of dignity, striving to create healthcare environments that foster compassion, respect, and dignity across all medical settings.

Life beyond Loss: A Retrospective Analysis of the Impact of Meaning of Life Therapy on the Grieving Process of Cancer Patients' Family Caregivers

Oncological disease in the palliative stage is a huge challenge for patients and their family caregivers (FCs) due to the fact that it confronts them with death, as well as physical, psychological, and existential suffering. Meaning of Life Therapy (MLT) is a brief structured psycho-existential intervention aiming to help patients in a meaning-making life review process, promoting end-of-life adaptation. The Life Letter (LL) resulting from MLT is an element that facilitates communication between the patient and their caregivers. The goal of this study was to understand the impact of MLT on the grieving processes of eight FCs and to study their perceptions of the role of the LL on grief through semi-structured interviews. The results of our qualitative analysis indicate that MLT was perceived by the FCs as a positive experience despite the conspiracy of silence being identified as a drawback. The LL was interpreted as a communicational element, promoting emotional closeness with the cancer patients and serving as a valuable tool in the FCs' adaptation to loss. Our research findings show that the needs of FCs, especially after experiencing the loss of their relative, are dynamic and specific. This is why it is urgent to develop interventions that consider the idiosyncrasies of end-of-life cancer patients and their FCs in order to avoid frustrated farewells, lonely deaths, and maladaptive grieving processes. This is the direction in which MLT should evolve.

Dignity therapy, psycho-spiritual well-being and quality of life in the terminally ill: systematic review and meta-analysis

OBJECTIVES

Dignity therapy (DT) is a brief, individualised psychotherapy that aims to alleviate psychosocial and spiritual distress in the final stages of life. It is unknown yet whether DT can enhance sense of dignity and improve psychological and spiritual well-being as well as quality of life of terminally ill patients.

METHODS

We searched PubMed, EMBASE, CINAHL plus, ProQuest Health & Medical Complete, PsycINFO and the Cochrane Library, as well as Chinese databases including Weipu Data, Wanfang Data and China National Knowledge Infrastructure from inception to 30 April 2021, for randomised controlled trials (RCTs) assessing the effects of DT on dignity, psycho-spiritual well-being and quality of life of terminally ill patients receiving palliative care.

RESULTS

We identified 507 unique records, and included 9 RCTs (871 participants). Comparator was standard palliative care. DT did not improve terminally ill patients' sense of dignity (p=0.90), hope (p=0.15), spiritual well-being (p=0.99) and quality of life (p=0.23). However, DT reduced anxiety and depression after intervention (standardised mean difference, SMD=-1.13, 95% CI (-2.21 to -0.04), p=0.04; SMD=-1.22, 95% CI (-2.25 to -0.18), p=0.02, respectively) and at 4 weeks post-intervention (SMD=-0.89, 95% CI (-1.71 to -0.07), p=0.03; SMD=-1.26, 95% CI (-2.38 to -0.14), p=0.03, respectively).

CONCLUSION

DT can be offered as a psychological intervention for terminally ill patients to reduce their anxiety and depression. More studies are needed to further evaluate the effects of DT on terminally ill patients' dignity, spiritual well-being and quality of life.

The European Portuguese Posthumous Dignity Therapy Schedule of Questions: Initial development and validation

OBJECTIVE

Dignity therapy (DT) is a brief psychotherapeutic intervention with beneficial effects in the end-of-life experience. Since it provides a continuing bond between the bereaved and their loved ones, we speculated that it could be offered as a novel bereavement intervention following the patient's death. We aimed to develop, translate, and validate the Posthumous DT Schedule of Questions (p-DT-SQ), for administration with bereaved relatives or friends.

METHOD

The original DT-SQ was adapted for application with bereaved relatives or friends. It was translated and back-translated to European Portuguese and revised by an expert committee. Content validity was assessed by the Content Validity Coefficient (CVC). The instrument was tested in a sample of 50 individuals from a large Senior Residence in Lisbon (10 elderly people and 40 healthcare professionals), who assessed face validity.

RESULTS

The p-DT-SQ showed very good CVC (0.94) and face validity: it was considered clear, easy to understand, reasonable in length, and not difficult to answer. Participants felt comfortable answering the p-DT-SQ and felt it could positively affect the way themselves or others would remember their loved ones, allowing an understanding of the deceased's concerns, interests, and values.

SIGNIFICANCE OF RESULTS

We created and validated an adapted version of the DT-SQ to be used posthumously by bereaved family and friends. The European Portuguese version of the p-DT-SQ is clear, comprehensible, and aligned with the fundamentals of DT. While our data suggest its beneficial effects for those who are bereft, future research is needed to examine the impact of p-DT-SQ for those who are grieving.