• George Fitchett, Yingwei Yao, Linda L Emanuel, Marvin O Delgado Guay, George Handzo, Joshua Hauser, Sheri Kittelson, Sean O'Mahony, Tammie Quest, Michael Rabow, Tasha M Schoppee, Sheldon Solomon, Diana J Wilkie, and Harvey Max Chochinov.
• Department of Religion, Health and Human Values (G.F.), Rush University Medical Center, Chicago, Illinois, USA. Electronic address: george_fitchett@rush.edu.
• J Pain Symptom Manage. 2024 Apr 1; 67 (4): e333e340e333-e340.

ContextDignity therapy (DT) is a well-researched psychotherapeutic intervention but it remains unclear whether symptom burden or religious/spiritual (R/S) struggles moderate DT outcomes.ObjectiveTo explore the effects of symptom burden and R/S struggles on DT outcomes.MethodsThis analysis was the secondary aim of a randomized controlled trial that employed a stepped-wedge design and included 579 participants with cancer, recruited from six sites across the United States. Participants were ages 55 years and older, 59% female, 22% race other than White, and receiving outpatient specialty palliative care. Outcome measures included the seven-item dignity impact scale (DIS), and QUAL-E subscales (preparation for death; life completion); distress measures were the Edmonton Symptom Assessment Scale (ESAS-r) (symptom burden), and the Religious Spiritual Struggle Scale (RSS-14; R/S).ResultsDT effects on DIS were significant for patients with both low (P = 0.03) and moderate/high symptom burden (P = 0.001). They were significant for patients with low (P = 0.004) but not high R/S struggle (P = 0.10). Moderation effects of symptom burden (P = 0.054) and R/S struggle (P = 0.52) on DIS were not significant. DT effects on preparation and completion were not significant, neither were the moderation effects of the two distress measures.ConclusionNeither baseline symptom burden nor R/S struggle significantly moderated the effect of DT on DIS in this sample. Further study is warranted including exploration of other moderation models and development of measures sensitive to effects of DT and other end-of-life psychotherapeutic interventions.Copyright © 2024 American Academy of Hospice and Palliative Medicine. All rights reserved.

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