• Diana J Wilkie, George Fitchett, Yingwei Yao, Tasha Schoppee, Delgado GuayMarvin OMODepartment of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Institute, Houston, Texas, USA., Joshua Hauser, Sheri Kittelson, Sean O'Mahony, Michael Rabow, Tammie Quest, Sheldon Solomon, George Handzo, Harvey Max Chochinov, and Linda L Emanuel.
• Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA.
• J Palliat Med. 2024 Feb 1; 27 (2): 176184176-184.

AbstractBackground: Patients consider the life review intervention, Dignity Therapy (DT), beneficial to themselves and their families. However, DT has inconsistent effects on symptoms and lacks evidence of effects on spiritual/existential outcomes. Objective: To compare usual outpatient palliative care and chaplain-led or nurse-led DT for effects on a quality-of-life outcome, dignity impact. Design/Setting/Subjects: In a stepped-wedge trial, six sites in the United States transitioned from usual care to either chaplain-led or nurse-led DT in a random order. Of 638 eligible cancer patients (age ≥55 years), 579 (59% female, mean age 66.4 ± 7.4 years, 78% White, 61% stage 4 cancer) provided data for analysis. Methods: Over six weeks, patients completed pretest/posttest measures, including the Dignity Impact Scale (DIS, ranges 7-35, low-high impact) and engaged in DT+usual care or usual care. They completed procedures in person (steps 1-3) or via Zoom (step 4 during pandemic). We used multiple imputation and regression analysis adjusting for pretest DIS, study site, and step. Results: At pretest, mean DIS scores were 24.3 ± 4.3 and 25.9 ± 4.3 for the DT (n = 317) and usual care (n = 262) groups, respectively. Adjusting for pretest DIS scores, site, and step, the chaplain-led (β = 1.7, p = 0.02) and nurse-led (β = 2.1, p = 0.005) groups reported significantly higher posttest DIS scores than usual care. Adjusting for age, sex, race, education, and income, the effect on DIS scores remained significant for both DT groups. Conclusion: Whether led by chaplains or nurses, DT improved dignity for outpatient palliative care patients with cancer. This rigorous trial of DT is a milestone in palliative care and spiritual health services research. clinicaltrials.gov: NCT03209440.

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