Dignity Therapy and Life Review for Palliative Care Patients: A Randomized Controlled Trial. The Meaning-Making intervention (MMi) appears to increase meaning in life in advanced ovarian cancer: a randomized controlled pilot study. The impact of life review on depression in older adults: a randomized controlled trial. A Palliative Care Intervention in Forgiveness Therapy for Elderly Terminally Ill Cancer Patients Do preparation and life completion discussions improve functioning and quality of life in seriously ill patients? Pilot randomized control trial. Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. Evaluation of the effect of a life review group program on self-esteem and life satisfaction in the elderly. Efficacy of short-term life-review interviews on the spiritual well-being of terminally ill cancer patients. A novel approach to enhancing hope in patients with advanced cancer: a randomised phase II trial of dignity therapy Efficacy of dignity therapy for depression and anxiety in terminally ill patients: early results of a randomized controlled trial. The meaning of life intervention for patients with advanced-stage cancer: development and pilot study. Seriously ill patients' discussions of preparation and life completion: an intervention to assist with transition at the end of life. Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Legacy activities as interventions approaching the end of life. [Effects of a short-term life review on spiritual well-being, depression, and anxiety in terminally ill cancer patients]. Study on Effects of Life Review Activities on the Quality of Life of the Elderly: A Randomized Controlled Trial Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. A prospective evaluation of Dignity Therapy in advanced cancer patients admitted to palliative care Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Might Massage Or Guided Meditation Provide “Means to A Better End”? Primary Outcomes from An Efficacy Trial with Patientsatthe end of Life Nurse-Facilitated Preparation and Life Completion Interventions Are Acceptable and Feasible in the Australian Palliative Care Setting: Results From a Phase 2 Trial Feasibility, acceptability and potential effectiveness of Dignity Therapy for older people in care homes: A phase II randomized controlled trial of a brief palliative care psychotherapy Meaning-centered group psychotherapy: an effective intervention for improving psychological well-being in patients with advanced cancer. Effect of dignity therapy on end-of-life psychological distress in terminally ill Portuguese patients: A randomized controlled trial. Effect of a life review program for Chinese patients with advanced cancer: a randomized controlled trial.
CONTEXT Dignity therapy ( DT ) is a psychotherapeutic intervention with increasing evidence of acceptability and utility in palliative care setting s. OBJECTIVES The aim of this study was to evaluate the legacy creation component of DT by comparing this intervention with life review ( LR ) and waitlist control ( WC ) groups . METHODS Seventy adults with advanced terminal disease were r and omly allocated to DT , LR , or WC followed by DT , of which 56 completed the study protocol . LR followed an identical protocol to DT except that no legacy document was created in LR . Primary outcome measures were the Brief Generativity and Ego-Integrity Question naire , Patient Dignity Inventory , Functional Assessment of Cancer Therapy-General , version 4 , and treatment evaluation question naires . RESULTS Unlike LR and WC groups , DT recipients demonstrated significantly increased generativity and ego-integrity scores at study completion . There were no significant changes for dignity-related distress or physical , social , emotional , and functional well-being among the three groups . There were also no significant changes in primary outcomes after the provision of DT after the waiting period in the WC group . High acceptability and satisfaction with interventions were noted for recipients of both DT and LR and family/carers of DT participants . CONCLUSION This study provides initial evidence that the specific process of legacy creation is able to positively affect sense of generativity , meaning , and acceptance near end of life . High acceptability and satisfaction rates for both DT and LR and positive impacts on families/carers of DT participants provide additional support for clinical utility of these interventions . Further evaluation of specific mechanisms of change post-intervention is required given DT 's uncertain efficacy on other primary outcomes OBJECTIVE This pilot study aim ed to provide supportive evidence for the acceptability and usefulness of the Meaning-Making intervention ( MMi ) in patients newly diagnosed with Stage III or IV ovarian cancer , and to provide estimates of parameters needed to design a full-scale study . METHODS A r and omized controlled trial with 24 patients ( 12 experimental and 12 control ) was conducted . Existential well-being ( primary outcome ) , overall quality of life , distress , anxiety , depression and self-efficacy were measured . RESULTS Compared to the control group , patients in the experimental group had a better sense of meaning in life at one and three months post-intervention . CONCLUSION The MMi seems a promising intervention for advanced cancer patients , and a full r and omized controlled trial is warranted to further investigate its efficacy BACKGROUND We developed an indicated preventive life- review course , " Looking for Meaning " , based on the assumption that reminiscence styles influence coping with depressive symptoms . This study describes the impact of this course in a pragmatic r and omized controlled trial . METHODS Inclusion criteria were > 50 years , a score of 5 or higher on the Center for Epidemiological Studies Depression Scale ( CES-D ) , and no depressive disorder or psychotropic or psychological treatment . Participants were r and omized and stratified by gender : the experimental group ( N = 83 ) was offered the course and the comparison group ( N = 88 ) a movie . There were three measurements : pre-treatment , post-treatment and 6 months after post-treatment . Depressive symptoms constituted the primary outcome . Secondary outcomes were anxiety symptoms , satisfaction with life , mastery and reminiscence styles . All analyses were conducted according to the intention-to-treat principle . Missing values were replaced by regression imputation . RESULTS The course reduced depressive symptoms , a decrease that was retained during follow-up . A significant between-group effect size was found ( d = 0.58 ) . There was also a reduction in symptoms of anxiety ; however , the comparison group showed the same reduction , result ing in a small between-group effect size . Gender and level of depressive symptoms were found to be prognostic factors for the change in depressive symptoms ; age was not . Post hoc analyses showed significant between-group effect sizes for females and those with a score above the cut-off of the CES-D. CONCLUSION The course " Looking for Meaning " can be recommended for people aged over 50 years , females and older adults with a clinical ly relevant level of depressive symptoms ( above cut-off ) in particular Palliative care is now considered an essential part of end-of-life care , yet little research examines the efficacy of interventions addressing the psychological treatment of dying patients . Forgiveness therapy has been shown to be effective in improving psychological well-being and may provide a valuable addition to a terminal cancer patient 's overall treatment plan . This study experimentally tested the effectiveness of a four-week forgiveness therapy in improving the quality of life of elderly terminally ill cancer patients . Participants ( n=20 ) were r and omly assigned to a forgiveness therapy group or to a  wait-list control group , which received forgiveness therapy in the second four-week period . All participants completed instruments measuring forgiveness , hope , quality of life , and anger at pre-test , post-test 1 , and post-test 2 . The forgiveness therapy group showed greater improvement than the control group , with one-tailed t-tests , on all measures . After receiving forgiveness therapy , participants in both forgiveness treatment conditions demonstrated significant improvements on all measures . The aggregated effect size was large . The four-week forgiveness therapy demonstrated psychological benefits for elderly terminally ill cancer patients and thus may be an appropriate addition to the treatment plan for terminal cancer patients BACKGROUND Significant palliative care intervention has focused on physical pain and symptom control ; yet less empirical evidence supports efforts to address the psychosocial and spiritual dimensions of experience . OBJECTIVE To evaluate the impact of an intervention ( Outlook ) that promotes discussion s of end-of-life preparation and completion on health outcomes in dying persons , including pain and symptoms , physical function , emotional function ( anxiety and depression ) , spiritual well-being , and quality of life at the end of life . DESIGN A three-arm pilot r and omized control trial . Subjects were recruited from inpatient and outpatient hospital , palliative care , and hospice setting s. Intervention subjects met with a facilitator three times and discussed issues related to life review , forgiveness , and heritage and legacy . Attention control subjects met with a facilitator three times and listened to a nonguided relaxation CD . True control subjects received no intervention . MEASUREMENTS Pre outcomes and post outcomes included the Memorial Symptom Assessment Scale , QUAL-E , Rosow-Breslau ADL Scale , Profile of Mood States anxiety sub-scale , the CESD short version , and the Daily Spiritual Experience Scale . RESULTS Eighty-two hospice eligible patients enrolled in the study ; 38 were women , 35 were African American . Participants ' primary diagnoses included cancer ( 48 ) , heart disease ( 5 ) lung disease ( 10 ) , and other ( 19 ) Ages ranged from 28 - 96 . Participants in the active discussion intervention showed improvements in functional status , anxiety , depression , and preparation for end of life . CONCLUSIONS The Outlook intervention was acceptable to patients from a variety of educational and ethnic background s and offers a brief , manualized , intervention for emotional and spiritual concerns PURPOSE Spiritual well-being and sense of meaning are important concerns for clinicians who care for patients with cancer . We developed Individual Meaning-Centered Psychotherapy ( IMCP ) to address the need for brief interventions targeting spiritual well-being and meaning for patients with advanced cancer . PATIENTS AND METHODS Patients with stage III or IV cancer ( N = 120 ) were r and omly assigned to seven sessions of either IMCP or therapeutic massage ( TM ) . Patients were assessed before and after completing the intervention and 2 months postintervention . Primary outcome measures assessed spiritual well-being and quality of life ; secondary outcomes included anxiety , depression , hopelessness , symptom burden , and symptom-related distress . RESULTS Of the 120 participants r and omly assigned , 78 ( 65 % ) completed the post-treatment assessment and 67 ( 56 % ) completed the 2-month follow-up . At the post-treatment assessment , IMCP participants demonstrated significantly greater improvement than the control condition for the primary outcomes of spiritual well-being ( b = 0.39 ; P < .001 , including both components of spiritual well-being ( sense of meaning : b = 0.34 ; P = .003 and faith : b = 0.42 ; P = .03 ) , and quality of life ( b = 0.76 ; P = .013 ) . Significantly greater improvements for IMCP patients were also observed for the secondary outcomes of symptom burden ( b = -6.56 ; P < .001 ) and symptom-related distress ( b = -0.47 ; P < .001 ) but not for anxiety , depression , or hopelessness . At the 2-month follow-up assessment , the improvements observed for the IMCP group were no longer significantly greater than those observed for the TM group . CONCLUSION IMCP has clear short-term benefits for spiritual suffering and quality of life in patients with advanced cancer . Clinicians working with patients who have advanced cancer should consider IMCP as an approach to enhance quality of life and spiritual well-being OBJECTIVE This study was aim ed at evaluating whether a Life Review Group Program ( LRGP ) improved the self-esteem and life satisfaction in the elderly . METHODS This r and omized , controlled trial consisted of 75 elderly males from a Veterans ' Home in Northern Taiwan , 36 of whom were in the experimental group and 39 of whom were in the control group . The subjects in the experimental group participated in an 8-week LRGP . Data were collected before and after the LRGP and again 1 month after the end of the program . RESULTS The study subjects had a mean age of 78.13 years . The generalized estimating equation was used to compare alterations in the self-esteem and life satisfaction of the elderly before and after the intervention . The alterations in self-esteem and life satisfaction in the experimental group after the LRGP were significantly improved compared to the control group . One month after the LRGP was completed , the self-esteem and life satisfaction of the experimental group continued to improve when compared with pre-intervention levels . CONCLUSIONS Based on these results , the LRGP can potentially improve the self-affirmation , confidence , and self-esteem of the elderly and promote short-term life satisfaction . The results of this study provide a model for clinical evidence -based therapy , serving as a reference for related studies and evaluation of health-promoting programs , as well as improving the health and quality of care of the elderly CONTEXT There is a little information about effective psychotherapies to enhance the spiritual well-being of terminally ill cancer patients . OBJECTIVES The primary aim of the study was to examine the efficacy of a one-week Short-Term Life Review for the enhancement of spiritual well-being , using a r and omized controlled trial . The secondary aim was to assess the effect of this therapy on anxiety and depression , suffering , and elements of a good death . METHODS The subjects were 68 terminally ill cancer patients r and omly allocated to a Short-Term Life- Review interview group or a control group . The patients completed question naires pre- and post-treatment , including the meaning of life domain from the Functional Assessment of Chronic Illness Therapy-Spiritual ( FACIT-Sp ) scale , the Hospital Anxiety and Depression Scale ( HADS ) , a numeric scale for psychological suffering , and items from the Good Death Inventory ( Hope , Burden , Life Completion , and Preparation ) . RESULTS The FACIT-Sp , Hope , Life Completion , and Preparation scores in the intervention group showed significantly greater improvement compared with those of the control group ( FACIT-Sp , P<0.001 ; Hope , P<0.001 ; Life Completion , P<0.001 ; and Preparation , P<0.001 ) . HADS , Burden , and Suffering scores in the intervention group also had suggested greater alleviation of suffering compared with the control group ( HADS , P<0.001 ; Burden , P<0.007 ; Suffering , P<0.001 ) . CONCLUSION We conclude that the Short-Term Life Review is effective in improving the spiritual well-being of terminally ill cancer patients , and alleviating psychosocial distress and promoting a good death 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 r and omly allocated to receive the intervention plus st and ard care or st and ard 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 η2=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 IS RCT N29868352 OBJECTIVE Dignity therapy ( DT ) is a short-term psychotherapy developed for patients living with a life-limiting illness . Our aim was to determine the influence of DT on symptoms of depression and anxiety in people with a life-threatening disease with high level of distress , referred to an inpatient palliative care unit . METHOD This was an open-label r and omized controlled trial . Sixty terminally ill patients were r and omly assigned to one of two groups : intervention group ( DT+ st and ard palliative care [ SPC ] ) or control group ( SPC alone ) . The main outcomes were symptoms of depression and anxiety , measured with the Hospital Anxiety and Depression Scale , assessed at baseline , day 4 , day 15 , and day 30 of follow-up . RESULTS Of the 60 participants , 29 were r and omized to DT and 31 to SPC . Baseline characteristics were similar between the two groups . DT was associated with a significant decrease in depressive symptoms at day 4 and day 15 ( mean = -4.46 , 95 % CI , -6.91 - 2.02 , p = 0.001 ; mean= -3.96 , 95 % CI , -7.33 to -0.61 ; p = 0.022 , respectively ) , but not at day 30 ( mean = -3.33 , 95 % CI , -7.32 - 0.65 , p = 0.097 ) . DT was also associated with a significant decrease in anxiety symptoms at each follow-up ( mean= -3.96 , 95 % CI , -6.66 to -1.25 , p = 0.005 ; mean= -6.19 , 95 % CI , -10.49 to -1.88 , p = 0.006 ; mean = -5.07 , 95 % CI , -10.22 to -0.09 , p = 0.054 , respectively ) . SIGNIFICANCE OF RESULTS DT appears to have a short-term beneficial effect on the depression and anxiety symptoms that often accompany patients at the end of their lives . Future research with larger sample s compared with other treatments is needed to better underst and the potential benefits of this psychotherapy PURPOSE / OBJECTIVES To develop the Meaning of Life Intervention in response to the need for brief and meaning-focused interventions in palliative care and to establish potential effect sizes for future full-scale r and omized , controlled trials . DESIGN A r and omized , controlled trial conducted to pilot test the Meaning of Life Intervention . SETTING A 68-bed oncology inpatient ward in an urban acute general hospital in Hong Kong . SAMPLE 84 patients with advanced-stage cancer . Fifty-eight completed the study . METHODS Assessment s of outcome variables were conducted at baseline and one day and two weeks after the intervention . Patients were r and omly allocated to the intervention group or the control group . Repeated measures analysis of covariance were conducted to assess the impact of the Meaning of Life Intervention on participants ' quality of life . MAIN RESEARCH VARIABLES The primary outcome was quality of life and was measured by the Quality -of-Life Concerns in the End-of-Life ( QOLC-E ) question naire and with a single-item scale on global quality of life . The eight subscales of the QOLC-E served as secondary outcomes . FINDINGS Statistically significant main effects were noted for the group in the QOLC-E question naire total score , the single-item scale on global quality of life , and the existential distress subscale of the QOLC-E question naire . The effects represented a medium effect size . CONCLUSIONS The results of this pilot study show that the Meaning of Life Intervention can improve quality of life , particularly existential distress . IMPLICATION S FOR NURSING The Meaning of Life Intervention represents a potentially effective and efficient intervention that is feasible for implementation by nursing staff for patients with advanced-stage cancer in a palliative care setting OBJECTIVE Patients approaching the end of life not only face challenges to physical well-being but also threats to emotional and spiritual integrity . Yet , identifying appropriate , effective , and brief interventions to address those concerns has proven elusive . We developed an intervention based on life review and emotional disclosure literature s and conducted a pilot study to determine feasibility and acceptability . This article presents qualitative intervention responses . METHOD We conducted a three-armed r and omized control trial to evaluate the effects of preparation and life completion discussion on health outcomes in patients with advanced serious illness . Hospice-eligible subjects were r and omly assigned to one of three groups : ( 1 ) intervention ( life completion discussion intervention ) , ( 2 ) attention control ( relaxation meditation ) , and control ( no intervention ) . Subjects in the intervention arm met with a facilitator three times . Session 1 focused on life story , Session 2 on forgiveness , and Session 3 , on heritage and legacy . RESULTS Eighteen subjects participated in the pilot intervention interviews . Subjects from a range of socioeconomic background s completed the intervention with equal facility . Results from Session 1 demonstrate narrative responses participants gave as they reconnected with previous life roles , values , and accomplishments . The second session illustrated reflections of choices one might have made differently and exploration of forgiveness offered and sought . Content from the first and second sessions laid the foundation for discussing Session 3 's lessons learned and heritage and legacy . Responses are summarized to assist clinicians in anticipating life review content that may improve overall quality of life at the end of life . SIGNIFICANCE OF RESULTS Discussion s of life completion may improve important health outcomes for patients at the end of life . This intervention may provide a brief , st and ardized , and transportable means for improving the quality of life of patients with advanced serious illness Existential issues often accompany a diagnosis of cancer and remain one aspect of psychosocial oncology care for which there is a need for focused , empirically tested interventions . This study examined the efficacy of a novel psychological intervention specifically design ed to address existential issues through the use of meaning-making coping strategies on psychological adjustment to cancer . Eighty-two breast or colorectal cancer patients were r and omly chosen to receive routine care ( control group ) or up to four sessions that explored the meaning of the emotional responses and cognitive appraisal s of each individual 's cancer experience within the context of past life events and future goals ( experimental group ) . This paper reports the results from 74 patients who completed and returned pre- and post-test measures for self-esteem , optimism , and self-efficacy . After controlling for baseline scores , the experimental group participants demonstrated significantly higher levels of self-esteem , optimism , and self-efficacy compared to the control group . The results are discussed in light of the theoretical and clinical implication s of meaning-making coping in the context of stress and illness We examined the efficacy of an innovative family-based intervention design ed to decrease caregiving stress and increase family communication among individuals with chronic , life-limiting illnesses and their family caregivers in a r and omized , contact control group design . The intervention group received three home visits in which the interventionist actively worked with the family to construct a personal Legacy , usually a scrapbook with photographs or audiotaped stories .  Control group families received three supportive telephone calls . Of the 42 families that entered the project , 31 families completed follow-up assessment s within 9 to 10 weeks ( 14 control ; 17 intervention ; 72 % African American ) for a retention rate of 74 % . Intervention caregivers showed reduced caregiving stress in comparison with control group caregivers , who showed increases in stress . Intervention patients reported decreased breathing difficulty and increased religious meaning . Caregivers and patients reported greater social interaction on the part of the patient . All participants in the intervention group initiated a Legacy activity and reported that Legacy improved family communication .  Legacy interventions hold promise and are simple to implement PURPOSE This study was done to evaluate the effects of a short-term life review on spiritual well-being , depression , and anxiety in patients with terminal cancer . METHODS The study used a pre posttest quasi experimental design with a nonequivalent control group . Measurement instruments included the Functional Assessment of Chronic Illness Therapy-Spiritual scale ( FACIT-Sp12 ) and the Hospital Anxiety and Depression Scale ( HADS ) .  Participants were 32 patients with terminal cancer who were receiving chemotherapy or palliative care at hospitals or at home . Eighteen patients were assigned to the experimental group and 14 to the control group .  A sixty minute short-term life review session was held twice a week as the intervention with the experimental group . RESULTS There was a statistically significant increase in spiritual well-being in the experimental group compared to the control group . There were also significant decreases in depression and anxiety in the experimental group compared to the control group . CONCLUSION The results indicate that a short-term life review can be used as a nursing intervention for enhancing the spiritual well-being of patients with terminal cancer Background : The objective of this study was to evaluate the mid-term efficacy of life review activities on the quality of life ( QOL ) of the elderly by conducting a r and omized controlled trial , and to identify the factors that should be taken into consideration when conducting life review activities . Methods : Written consent was obtained from 80 of the 97 eligible elderly persons . After r and omly assigning them to two groups , an intervention group and a control group , group life review activities were conducted in the intervention group and discussion activities about health were conducted in the control group . In both the intervention group and the control group , life satisfaction , self-esteem , depression , and hopelessness were evaluated using self-rating scales at three points : at baseline , immediately after completion of the 8 weeks of sessions , and 3 months after completion of the intervention . Results : Repeated measures analysis of covariance showed significant differences between the two groups in the changes in scores for depression ( p = 0.04 ) and hopelessness ( p = 0.04 ) . Regarding the factors that were associated with depression and hopelessness , 3 months after completion of the intervention , depression and hopelessness of a more severe nature at baseline and having greater unresolved conflicts in the past were extracted by multiple regression analysis . Conclusions : The results suggested that group life review activities have a role in assisting the developmental stage of old age and supporting mental health , and have mid- to long-term effectiveness in maintaining and improving the QOL of the elderly OBJECTIVES An increasingly important concern for clinicians who care for patients at the end of life is their spiritual well-being and sense of meaning and purpose in life . In response to the need for short-term interventions to address spiritual well-being , we developed Meaning Centered Group Psychotherapy ( MCGP ) to help patients with advanced cancer sustain or enhance a sense of meaning , peace and purpose in their lives , even as they approach the end of life . METHODS Patients with advanced ( stage III or IV ) solid tumor cancers ( N=90 ) were r and omly assigned to either MCGP or a supportive group psychotherapy ( SGP ) . Patients were assessed before and after completing the 8-week intervention , and again 2 months after completion . Outcome assessment included measures of spiritual well-being , meaning , hopelessness , desire for death , optimism/pessimism , anxiety , depression and overall quality of life . RESULTS MCGP result ed in significantly greater improvements in spiritual well-being and a sense of meaning . Treatment gains were even more substantial ( based on effect size estimates ) at the second follow-up assessment . Improvements in anxiety and desire for death were also significant ( and increased over time ) . There was no significant improvement on any of these variables for patients participating in SGP . CONCLUSIONS MCGP appears to be a potentially beneficial intervention for patients ' emotional and spiritual suffering at the end of life . Further research , with larger sample s , is clearly needed to better underst and the potential benefits of this novel intervention Background : Dignity Therapy is a brief , psychosocial intervention for patients with incurable disease . Aim : To investigate participation in and evaluation of Dignity Therapy and longitudinal changes in patient-rated outcomes . Design : A prospect i ve ( pre/post ) evaluation design was employed . Evaluation question naires were completed when patients received the generativity document ( T1 ) and 2 weeks later ( T2 ) . Changes from baseline ( T0 ) were measured in sense of dignity , Structured Interview for Symptoms and Concerns items , Patient Dignity Inventory , Hospital Anxiety and Depression Scale and European Organisation for Research and Treatment of Cancer QLQ-C15-PAL ( Clinical Trials.gov number : NCT01507571 ) . Setting / participants : Consecutive patients with incurable cancer , ≥18 years , informed of prognosis and not having cognitive impairment/physical limitations precluding participation were included at a hospice and a hospital palliative medicine unit . Results : Over 2 years , 80 of 341 eligible patients  completed Dignity Therapy . At T1 , 55 patients completed evaluations , of whom 73%–89 % found Dignity Therapy  helpful , satisfactory and of help to relatives ; 47%–56 % reported that it heightened their sense of purpose , dignity and will to live . Quality of life decreased ( mean = −9 ( 95 % confidence interval : −14.54 ; −2.49 ) ) and depression increased ( mean = 0.31 ( 0.06 ; 0.57 ) ) on one of several depression measures . At T2 ( n = 31 ) , sense of dignity ( mean = −0.52 ( −1.01 ; −0.02 ) ) and sense of being a burden to others ( mean = −0.26 ( −0.49 ; −0.02 ) ) improved . Patients with children and lower performance status , emotional functioning and quality of life  were more likely to report benefit . Conclusions : This study adds to the growing body of evidence supporting Dignity Therapy as a valuable intervention in palliative care ; a substantial subset of patients facing end of life found it manageable , relevant and beneficial BACKGROUND Dignity therapy is a unique , individualised , short-term psychotherapy that was developed for patients ( and their families ) living with life-threatening or life-limiting illness . We investigated whether dignity therapy could mitigate distress or bolster the experience in patients nearing the end of their lives . METHODS Patients ( aged ≥18 years ) with a terminal prognosis ( life expectancy ≤6 months ) who were receiving palliative care in a hospital or community setting ( hospice or home ) in Canada , USA , and Australia were r and omly assigned to dignity therapy , client-centred care , or st and ard palliative care in a 1:1:1 ratio . R and omisation was by use of a computer-generated table of r and om numbers in blocks of 30 . Allocation concealment was by use of opaque sealed envelopes . The primary outcomes --reductions in various dimensions of distress before and after completion of the study --were measured with the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale , Patient Dignity Inventory , Hospital Anxiety and Depression Scale , items from the Structured Interview for Symptoms and Concerns , Quality of Life Scale , and modified Edmonton Symptom Assessment Scale . Secondary outcomes of self-reported end-of-life experiences were assessed in a survey that was undertaken after the completion of the study . Outcomes were assessed by research staff with whom the participant had no previous contact to avoid any possible response bias or contamination . Analyses were done on all patients with available data at baseline and at the end of the study intervention . This study is registered with Clinical Trials.gov , number NCT00133965 . FINDINGS 165 of 441 patients were assigned  to dignity therapy , 140 st and ard palliative care , and 136 client-centred care . 108 , 111 , and 107 patients , respectively , were analysed . No significant differences were noted in the distress levels before and after completion of the study in the three groups . For the secondary outcomes , patients reported that dignity therapy was significantly more likely than the other two interventions to have been helpful ( χ(2)=35·50 , df=2 ; p<0·0001 ) , improve quality of life ( χ(2)=14·52 ; p=0·001 ) , increase sense of dignity ( χ(2)=12·66 ; p=0·002 ) , change how their family saw and appreciated them ( χ(2)=33·81 ; p<0·0001 ) , and be helpful to their family ( χ(2)=33·86 ; p<0·0001 ) . Dignity therapy was significantly better than client-centred care  in improving spiritual wellbeing ( χ(2)=10·35 ; p=0·006 ) , and was significantly better than st and ard palliative care in terms of lessening sadness or depression ( χ(2)=9·38 ; p=0·009 ) ; significantly more patients who had received dignity therapy reported that the study group had been satisfactory , compared with those who received st and ard palliative care ( χ(2)=29·58 ; p<0·0001 ) . INTERPRETATION Although the ability of dignity therapy to mitigate outright distress , such as depression , desire for death or suicidality , has yet to be proven , its benefits in terms of self-reported end-of-life experiences support its clinical application for patients nearing death . FUNDING National Cancer Institute , National Institutes of Health This article reports findings from a r and omized controlled trial of massage and guided meditation with patients at the end of life . Using data from 167 r and omized patients , the authors considered patient outcomes through 10 weeks post-enrolment , as well as next-of-kin ratings of the quality of the final week of life for 106 patients who died during study participation . Multiple regression models demonstrated no significant treatment effects of either massage or guided meditation , delivered up to twice a week , when compared with outcomes of an active control group that received visits from hospice-trained volunteers on a schedule similar to that of the active treatment arms . The authors discuss the implication s of their findings for integration of these complementary and alternative medicine therapies into st and ard hospice care Background : Existential/spiritual needs of advanced cancer patients are not always met in healthcare . Potential barriers for health professionals exploring existential concerns include lack of time , training , tools , and confidence . Yet patients with life-threatening illnesses require holistic care , and interest in their existential/spiritual needs is growing . Preparation and life completion interventions have shown positive results in the existential/spiritual care of hospice-eligible patients in the United States . Nurses are in the ideal position to deliver such interventions , but have not been previously evaluated in this context . Objective : The objective of this study was to explore the acceptability and feasibility of a nurse-facilitated preparation and life completion intervention ( Outlook ) in an Australian palliative care patient population . Methods : Patients discussed their life story , forgiveness , and heritage and legacy over 3 audiotaped sessions . Preintervention/postintervention outcome measures included the Memorial Symptom Assessment Scale , Functional Assessment of Cancer Therapy – Spirituality Well-being , Profile of Mood States , Quality of Life at End of Life Scale , and Center for Epidemiological Depression Scale . Participant feedback was subjected to thematic analysis to underst and the patient experience of receiving the intervention . Results : Ten palliative care patients with advanced cancer completed the study . Patients reported the intervention and assessment s to be acceptable and feasible and to be overall positively received although with nonsignificant improvements in measures of “ meaning and peace ” and “ preparation for end of life . ” Conclusion : A nurse-facilitated preparation and life completion intervention is acceptable and feasible for palliative care patients with advanced cancer in Australia . Implication s for Practice : Outlook is a novel , portable , and feasible tool for use by nurses when addressing existential and spiritual domains of care with patients with advanced cancer Background : A pilot study of Dignity Therapy conducted with hospice patients reported high levels of self-reported benefits of the psychotherapy . Aim : To assess the feasibility , acceptability and potential effectiveness of Dignity Therapy to reduce distress in older people in care homes . Design : A r and omized controlled open-label trial ( IS RCT N37589515 ) . Setting and participants : 60 residents aged 65 + with no major cognitive impairment living in care homes in London , UK . Intervention : Dignity Therapy , a brief palliative care psychotherapy . Outcomes : Potential effectiveness ( dignity-related distress , depression , hopefulness , quality of life at baseline and 1 and 8-week follow-up ) ; acceptability ( residents ’ views on self-reported benefits of Dignity Therapy/the Dignity Therapy study ) ; and feasibility ( time taken to deliver the intervention ) . Results : We r and omized 60/755 ( 8 % ) residents : 29 – control , 31 – intervention . We found no significant differences between groups on measures of potential effectiveness at any time . There was a reduction in dignity-related distress across both groups ( p = 0.026 ) . The intervention group outperformed the control group on all the acceptability items at both follow-ups . Effect sizes ( Cohen ’s d ) ranged from small ( 0.25 ) to large ( 0.85 ) . These were significant for feeling that Dignity Therapy/the Dignity Therapy study had made their life more meaningful at 2-week follow-up ( p = 0.04 ) , and that it would help their families at both follow-ups ( p = 0.02 and p = 0.01 , respectively ) . Although it was feasible to deliver the intervention in this setting , it took longer to complete than anticipated . Conclusions : Although Dignity Therapy took longer to deliver than expected , this intervention may be a way of enhancing the end-of-life experiences of residents PURPOSE To test the efficacy of meaning-centered group psychotherapy ( MCGP ) to reduce psychological distress and improve spiritual well-being in patients with advanced or terminal cancer . PATIENTS AND METHODS Patients with advanced cancer ( N = 253 ) were r and omly assigned to manualized eight-session interventions of either MCGP or supportive group psychotherapy ( SGP ) . Patients were assessed before and after completing the treatment and 2 months after treatment . The primary outcome measures were spiritual well-being and overall quality of life , with secondary outcome measures assessing depression , hopelessness , desire for hastened death , anxiety , and physical symptom distress . RESULTS Hierarchical linear models that included a priori covariates and only participants who attended ≥ three sessions indicated a significant group × time interaction for most outcome variables . Specifically , patients receiving MCGP showed significantly greater improvement in spiritual well-being and quality of life and significantly greater reductions in depression , hopelessness , desire for hastened death , and physical symptom distress compared with those receiving SGP . No group differences were observed for changes in anxiety . Analyses that included all patients , regardless of whether they attended any treatment sessions ( ie , intent-to-treat analyses ) , and no covariates still showed significant treatment effects ( ie , greater benefit for patients receiving MCGP v SGP ) for quality of life , depression , and hopelessness but not for other outcome variables . CONCLUSION This large r and omized controlled study provides strong support for the efficacy of MCGP as a treatment for psychological and existential or spiritual distress in patients with advanced cancer OBJECTIVE Dignity therapy ( DT ) is a brief form of psychotherapy developed for patients living with a life-limiting illness that has demonstrated efficacy in treating several dimensions of end-of-life psychological distress . Our aim was to determine the influence of DT on demoralization syndrome ( DS ) , the desire for death ( DfD ) , and a sense of dignity ( SoD ) in terminally ill in patients experiencing a high level of distress in a palliative care unit . METHOD A nonblinded phase II r and omized controlled trial was conducted with 80 patients who were r and omly assigned to one of two groups : the intervention group ( DT + st and ard palliative care [ SPC ] ) or the control group ( SPC alone ) . The main outcomes were DS , DfD , and SoD , as measured according to DS criteria , the Desire for Death Rating Scale , and the Patient Dignity Inventory ( PDI ) , respectively . All scales were assessed at baseline ( day 1 ) and at day 4 of follow-up . This study is registered with http://www.controlled-trials.com/IS RCT N34354086 . RESULTS Of the 80 participants , 41 were r and omized to DT and 39 to SPC . Baseline characteristics were similar between the two groups . DT was associated with a significant decrease in DS compared with SPC ( DT DS prevalence = 12.1 % ; SPC DS prevalence = 60.0 % ; p < 0.001 ) . Similarly , DT was associated with a significant decrease in DfD prevalence ( DT DfD prevalence = 0 % ; SPC DfD prevalence = 14.3 % ; p = 0.054 ) . Compared with participants allocated to the control group , those who received DT showed a statistically significant reduction in 19 of 25 PDI items . SIGNIFICANCE OF RESULTS Dignity therapy had a beneficial effect on the psychological distress encountered by patients near the end of life . Our research suggests that DT is an important psychotherapeutic approach that should be included in clinical care programs , and it could help more patients to cope with their end-of-life experiences BACKGROUND Empirical data suggest that life review is an effective psychospiritual intervention . However , it has not been applied to Chinese patients with advanced cancer , and its effects on this population remain unknown . OBJECTIVE The aim of the study was to determine the effect of a life review program on quality of life among Chinese patients with advanced cancer . METHODS In this prospect i ve r and omized controlled trial , a total of 80 patients were r and omly assigned to the life review program group and the control group . The 3-weekly life review program included review ing a life and formulating a life review booklet . Outcome data were assessed by a collector who was blinded to group assignment before and immediately after the program and at a 3-week follow-up . RESULTS Significantly better scores in overall quality of life , support , negative emotions , sense of alienation , existential distress , and value of life were found in the life review group immediately after the program and at the 3-week follow-up . CONCLUSION This study provides additional data on the potential role of a life review in improving quality of life , particularly psychospiritual well being ; it also indicates that the life review program could enable Chinese patients with advanced cancer to express their views on life and death . IMPLICATION S FOR PRACTICE The life review program offers advanced cancer patients an opportunity to integrate their whole life experiences and discuss end-of-life issues , which lays the ground for further active intervention in their psychospiritual distress . The program could be integrated into daily home care to enhance the psychospiritual well-being of Chinese patients with advanced cancer
Background : Life review interventions have been used to alleviate psycho-spiritual distress in people near the end of life .
However , their effectiveness remains inconclusive .
Aim : To evaluate the effects of therapeutic life review on spiritual well-being , psychological distress , and quality of life in patients with terminal or advanced cancer .