An exploratory study of Dignity Therapy for people with advanced cancer

ISRCTN ISRCTN29868352
DOI https://doi.org/10.1186/ISRCTN29868352
Secondary identifying numbers N/A
Submission date
05/02/2009
Registration date
12/02/2009
Last edited
02/03/2016
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Cancer
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Not provided at time of registration

Contact information

Dr Sue Hall
Scientific

Department of Palliative Care, Policy & Rehabilitation
Weston Education Centre
Cutcombe Road
London
SE5 9RJ
United Kingdom

Study information

Study designPhase II randomised controlled open-label trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details below to request a patient information sheet
Scientific titleA phase II randomised controlled trial assessing the feasibility, acceptability and potential effectiveness of Dignity Therapy for people with advanced cancer
Study objectivesThe broad aims of this phase II randomised controlled trial (RCT) are to assess the feasibility, acceptability and potential effectiveness of Dignity Therapy to reduce psychological and spiritual distress in people with advanced cancer who have been referred to a hospital based palliative care team. The specific objectives are to:
1. Determine whether Dignity Therapy is likely to increase peoples’ sense of dignity and reduce psychological or spiritual distress
2. Determine whether it is feasible to provide Dignity Therapy to people with advanced cancer in this setting
3. Determine whether Dignity Therapy is acceptable to patients and their families
4. Pilot methods for a larger RCT (e.g. recruitment, randomisation, follow-up, suitability of measures)
Ethics approval(s)King’s College Hospital Research Ethics Committee gave approval on the 10th November 2008 (ref: 08/H0808/155)
Health condition(s) or problem(s) studiedAdvanced cancer
InterventionDignity Therapy: this is a brief psychotherapy to foster a sense of dignity and reduce psychological and spiritual distress in people with advanced cancer. The therapy involves a therapist conducting an interview with the patient using a standard framework of questions. This is given to patients at least a day before the therapy session to give them the opportunity to think about their responses beforehand. The question framework provides a flexible guide for the therapist to shape the interview, based on patients' level of interest and responses. The therapist follows the patients' cues, helping them to structure and organise their thoughts, for example, by asking questions about time sequences, how events are causally related to each other and facilitating the disclosure of thoughts, feelings and memories. These interviews are tape-recorded, quickly transcribed verbatim then shaped into a narrative using a formatted editing process. This includes clarifications (eliminating colloquialisms, non-starters and sections not related to the "generativity" material, such an interruptions), chronological corrections, tagging and editing any content that might inflict significant harm on recipients of the document (after discussion with the patient) and finding a suitable ending for the document which is appropriate to the patient's overall message. Another session is arranged for the therapist to read the edited transcript to the patient, who is invited to make any editorial suggestions, including identifying errors of omission or commission. Once the patient is satisfied with the document, they can give it, or bequeath it, to people of their choosing. Dignity Therapy is given in addition to standard palliative care (patients are assessed by a multi-professional palliative care team, including nurses, a psychosocial worker and doctors trained in providing psychosocial support). Patients in this group will also have at least three interviews with the research assistant to assess outcomes.

In addition to standard palliative care, the control group will have at least three interviews with the research assistant. Completing the measures and taking part in the interview gives them an opportunity to talk about their feelings. The extent to which they feel that this is therapeutic is explored in qualitative interviews.

The initial Dignity Therapy interview lasts for approximately one hour. This is followed approximately 3 - 4 days later with a review interview, also lasting about an hour. However, if patients become fatigued these can take longer, be split over more than one session, or be delayed.

Duration of follow-up: interviews last about 1 hour, however, if patients become fatigued these can take longer, or be split over more than one session.
Intervention typeOther
Primary outcome measurePatients' sense of dignity, assessed using the Patient Dignity Inventory at baseline, as soon as possible after the intervention has been completed and 1 month post-intervention, and the equivalent in the control group. Themes covered by this questionnaire include physical, psychosocial, existential and spiritual domains of concern or distress.
Secondary outcome measures1. Potential effectiveness, assessed at baseline, as soon as possible after the intervention has been completed and 1 month post-intervention, and the equivalent in the control group, by the following:
1.1. Hospital Anxiety and Depression Scale
1.2. Herth Hope Index
1.3. Euroqol EQ-5D
1.4. A two-item measure of quality of life specifically designed to assess the effectiveness of the Dignity Therapy
1.5. The Distress Thermometer
2. Acceptability of Dignity Therapy (intervention group only). Patients views on the intervention assessed as soon as possible after the intervention has been completed and 1 month post-intervention using semi-structured face-to-face qualitative interviews
3. Outcomes for family, friends and recipients of "generativity" documents; potential effectiveness, assessed at three months post- bereavement for patients who die during the study period using the following:
3.1. Hospital Anxiety and Depression Scale
3.2. Complicated Grief Assessment Scale
3.3. Palliative Care Outcome Scale
4. Acceptability of Dignity Therapy (intervention group only). Views of patients' family, friends and recipients of "generativity" documents on the intervention, assessed as soon as possible after the intervention has been completed and 3 months post- bereavement (for patients who die in the study period) using semi-structured qualitative telephone interviews
5. Feasibility of delivering Dignity Therapy in this setting will be assessed by recording:
5.1. Time taken to organise and conduct the Dignity Therapy sessions, transcribe and edit narratives
5.2. Deviations from the therapy protocol and the reasons for this
5.3. The therapist’s perceptions of competence as a result of training
6. Methods for a phase III trial; to assess the feasibility our methodology, the following will be recorded:
6.1. Exclusions
6.2. Recruitment rates (patients and their family, friends and recipients of the “generativity” documents)
6.3. Loss to follow-up
6.4. Time taken to obtain informed consent
6.5. Time taken to collect outcomes
6.6. Missing data and the reasons for this
7. Acceptability. To assess the acceptability of our methodology to patients and their family, friends and recipients of the “generativity” documents we will obtain their views on taking part in the study and completing the measures at each follow-up using semi-structured qualitative interviews.
Overall study start date05/01/2009
Completion date31/12/2009

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participants40
Key inclusion criteriaAdults aged greater than or equal to 18 years, either sex, with advanced cancer who have been referred to a hospital-based palliative care team. In one hospital trust only patients being cared for in the community will be included. In the other hospital only in-patients and those visiting out-patient clinics will be included. Participants will not be screened for spiritual or psychological distress, or loss of dignity, however, they will be assessed at baseline, to explore the potential moderating effects of these on the impact of the intervention.
Key exclusion criteria1. Patients who are considered by the palliative care team to be too ill to take part in a protocol lasting two weeks
2. Unable to provide informed consent either due to cognitive problems, or to the severity of their illness, or because they are unable to understand English
Date of first enrolment05/01/2009
Date of final enrolment31/12/2009

Locations

Countries of recruitment

  • England
  • United Kingdom

Study participating centre

Weston Education Centre
London
SE5 9RJ
United Kingdom

Sponsor information

King's College London (UK)
University/education

c/o Professor Robert Lechler
King’s College School of Medicine
James Clerk Maxwell Building
London
SE1 8WA
England
United Kingdom

Website http://www.kcl.ac.uk/
ROR logo "ROR" https://ror.org/0220mzb33

Funders

Funder type

Charity

Dimbleby Cancer Care (UK)

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Protocol article protocol 16/05/2009 Yes No
Results article results 01/12/2011 Yes No

Editorial Notes

02/03/2016: Publication reference added.