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The Effects of Dignity Therapy on Dignity at the End-of-Life

10 August 2019

Abstract

Background: Terminally ill patients face tremendous distress including physical pain, mental agony, and existential uncertainty. Dignity Therapy is a psychotherapy technique that aims to improve the quality of life of patients at the end-of-life. It incorporates a series of reflective questions transcribed into a legacy document which is then given to the patient for their dispersal. The purpose of this review is to determine if studies show an impact on dignity at the end-of-life with the utilization of Dignity Therapy.

Methods: An exhaustive search of available medical literature search using MEDLINE, CINHAL, Web of Science, and Google Scholar using the search words dignity therapy, randomized, end-of-life, terminally ill, demoralization syndrome, desire for death, palliative, and existential distress. Studies were assessed for quality using GRADE criteria.

Results: Twelve studies were evaluated for relevancy. Four randomized controlled trials met all the eligibility criteria and were chosen to be included in this systematic review. One 3-arm randomized controlled trial looked at 441 terminally ill patients. This study measured the effects of Dignity Therapy on various measurements of distress. Significant findings were not found in the primary outcome measurements of dignity, but significant findings were reported in self-reported secondary outcomes. Similarly, a second RCT looked at 45 terminally ill patients with advanced cancer and did not find significant differences between the intervention and control groups. A third RCT looked at 80 terminally ill patients with higher baseline levels of depression. In this study, Dignity Therapy was associated with a significant increase in dignity and a significant decrease in demoralization syndrome and a desire for death. A fourth study provided a reanalysis of the seminal 3-arm RCT using a different outcome measurement aimed at the spiritual domain of dignity. This trial found significant improvements of dignity in the intervention group.

Conclusion: Dignity Therapy is a relatively new psychotherapy that has shown mixed results in the various outcome measurements used in previous studies. Initially, Dignity Therapy did not prove any concrete benefits, but rather was found to have subjective advantages. When studies began to use more explicit measurements of distress, proven benefits emerged. It is clear that the therapy is an easy and cost-effective tool that improves low morale of those with terminal illnesses. However, further research with consistent, clear, and validated measures is needed to confirm the specific impacts of Dignity Therapy on the sense of dignity.

Keywords: Dignity Therapy, randomized, end-of-life, terminally ill, dignity, demoralization syndrome, desire for death, and palliative

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