JMIR Publications

ABSTRACT

Background:

Our goal is to improve psychosocial and spiritual care outcomes for elderly patients with cancer by optimizing an intervention focused on dignity conservation tasks such as settling relationships, sharing words of love, and preparing a legacy document. These tasks are central needs for elderly patients with cancer. Dignity Therapy (DT) has proven efficacy and can be led by nurses or chaplains, the two disciplines within palliative care that may be most available to provide DT. DT is well accepted by patients in studies, but not widely used; it remains unclear how best it can work in real life settings.

Objective:

We propose a randomized clinical trial whose aims are to: (1) compare usual palliative care for elderly patients with cancer and usual palliative care with DT groups for effects on: a) patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness); and b) processes of delivering palliative spiritual care services (satisfaction and unmet spiritual needs); and (2) explore the influence of physical symptoms and spiritual distress on the dignity impact and existential tasks effects of usual palliative care and nurse- or chaplain-led DT. We hypothesize that, controlling for pretest scores, each of the DT groups will have higher scores on the dignity impact and existential tasks measures than the usual care group; each of the DT groups will have better peaceful awareness and treatment preference more consistent with their cancer prognosis than the usual care group. We also hypothesize that physical symptoms and spiritual distress will significantly affect intervention effects.

Methods:

We are conducting a 3-arm, pre/posttest, randomized, controlled 4-step, stepped-wedge design to compare the effects of usual outpatient palliative care and usual outpatient palliative care along with either nurse or chaplain led DT on patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness). We will include 560 elderly patients with cancer from 6 outpatient palliative care services across the U.S. Using multilevel analysis with site, provider (nurse, chaplain), and time (step) included in the model, we will compare usual care and DT groups for effects on patient outcomes and spiritual care processes and determine the moderating effects of physical symptoms and spiritual distress

Results:

Results are expected in 4 years.

Conclusions:

This rigorous trial of DT will constitute a landmark step in palliative care and spiritual health services research. Clinical Trial: NCT03209440