دانلود رایگان ترجمه مقاله اثربخشی کرامت درمانی روی افسردگی و اضطراب در بیماران لاعلاج (نشریه Liebertpub 2014)

بازده کرامت درمانی روی افسردگی و اضطراب در بیماران لاعلاج پرتغالی: یک کارآزمایی کنترل شده تصادفی فاز 2

Efficacy of Dignity Therapy on Depression and Anxiety in Portuguese Terminally Ill Patients: A Phase II Randomized Controlled Trial

Abstract

Background: Dignity therapy is a brief psychotherapy developed for patients living with a life-limiting illness.

Objective: To determine the influence of dignity therapy on depression and anxiety in inpatients with a terminal illness and experiencing a high level of distress in a palliative care unit.

Methods: A nonblinded phase II randomized controlled trial of 80 patients who were randomly assigned to one of two groups: intervention group (dignity therapy + standard palliative care [SPC]) or control group (SPC alone). The main outcomes were depression and anxiety scores, as measured with the Hospital Anxiety and Depression Scale, and assessed at baseline (T1), day 4 (T2), day 15 (T3), and day 30 (T4) of follow-up. This study is registered with www.controlled-trials.com/ISRCTN34354086.

Results: Of the final 80 participants, 41 were randomly assigned to SPC and 39 to dignity therapy. Baseline characteristics were similar between the two groups. Dignity therapy was associated with a decrease in depression scores (median, 95% confidence interval [CI]: – 4.00, – 6.00 to – 2.00, p < 0.0001; – 4.00, – 7.00 to – 1.00, p = 0.010; – 5.00, – 8.00 to – 1.00, p = 0.043, for T2, T3, and T4, respectively). Dignity therapy was similarly associated with a decrease in anxiety scores (median, 95% CI: – 3.00, – 5.00 to – 1.00, p < 0.0001; – 4.00, – 7.00 to – 2.00, p = 0.001; – 4.00, – 7.00 to – 1.00, p = 0.013, for T2, T3, and T4, respectively).

Conclusion: Dignity therapy resulted in a beneficial effect on depression and anxiety symptoms in end-of-life care. The therapeutic benefit of dignity therapy was sustained over a 30-day period. Having established its efficacy, future trials of dignity therapy may now begin, comparing it with other psychotherapeutic approaches within the context of terminal illness.

1 Introduction

In addition to physical suffering, psychological distress is a major problem for many terminally ill patients. Psychological distress contributes to a decreased quality of life, adds to patient and family suffering, and presents a huge challenge for health care professionals in the provision of end-of-life care.1,2 Depression and anxiety are two of the most common psychological problems in the terminally ill, with prevalence ranging from 15% to 48%, respectively.3–6 The clinical consequences of both depression and anxiety are well known. Depression, for example, is a recognized risk factor for suicide and requests to hasten death,7 disrupting social connections and diminishing individual’s capacity to overcome loss and difficulties associated with incurable diseases.2 Anxiety can markedly interfere with patients’ lives as an independent psychiatric disorder or as an amplifier in association with certain physical symptoms, such as pain or dyspnea, thus rendering their control more difficult.

Psychological suffering for terminally ill patients is also often framed in terms of loss of dignity.8 The empirical work by Chochinov and colleagues9 regarding the concept of dignity in terminally ill patients created the Model of Dignity offering important insights as to how patients face terminal illness in terms of their dignity. This model provides the theoretical basis for a brief, individualized intervention designed to address psychosocial and existential distress among terminally ill patients (dignity therapy).10

The most recent trial by Chochinov and coworkers,11 designed to compare dignity therapy with standard palliative care and client-centered care, showed that although dignity therapy did not significantly reduce distress, those assigned to dignity therapy were significantly more likely than other study groups to find this approach helpful, to improve quality of life, increase sense of dignity, change how their family saw and appreciated them, and be helpful to their family. In this study, dignity therapy did not show any effect on patients’ symptoms of depression and anxiety, but the authors stated that this apparent lack of effect might have been due to the low initial base rates of distress. For this reason, future investigation using dignity therapy should target more distressed patients, with symptoms of depression and anxiety. Portuguese cancer populations have been shown to have high levels of depression and anxiety.12 For this reason, we conducted a randomized controlled trial (RCT) of Portuguese terminally ill patients hospitalized within an inpatient palliative medicine unit, with high levels of psychological suffering at baseline, to study the efficacy of dignity therapy on symptoms of depression and anxiety. The preliminary results of this RCT (interim analysis, n = 60 patients) have been published elsewhere.13

This article reports the efficacy data for dignity therapy on symptoms of depression and anxiety within a cohort of 80 patients with end-stage cancer.