The effectiveness of dignity therapy on hope, quality of life, anxiety, and depression in cancer patients: A meta-analysis of randomized controlled trials

https://doi.org/10.1016/j.ijnurstu.2022.104273Get rights and content

Abstract

Background

Cancer presents a progressively deteriorating illness that not only causes significant physical, social and economic burdens in patients but also impacts an individual's psychological well-being and quality of life. Dignity therapy is a well-accepted psychosocial intervention but the effectiveness on hope, quality of life, anxiety, and depression in cancer patients remains inconsistent.

Objective

The purpose of this meta-analysis was to identify the effectiveness of dignity therapy on hope, quality of life, anxiety, and depression in cancer patients.

Design

A meta-analysis of randomized controlled trials was performed.

Methods

Relevant studies published from inception to February 2022 were retrieved from PubMed, Embase (Ovid), the Cochrane Central Register of Controlled Trials, Web of Science, PsycINFO, CINAHL, CBM, CNKI, VIP and Wanfang. The literature search and data extraction processes were conducted by two independent authors. The methodological quality of the included studies was assessed by the Cochrane Risk-of-Bias Assessment Tool, version 2 and the GRADE approach. The data analysis was performed using Review Manager (Version 5.4).

Results

Fourteen randomized controlled trials published between 2011 and 2021 were included. Most of the studies were assessed as having some concerns. The certainty of the evidence in this review varied from low to high across outcomes. The meta-analysis showed statistically significant effects of dignity therapy on hope (mean difference (MD) = 3.41, 95% CI: 2.82 to 4.00, P < 0.001), anxiety (standardized mean difference (SMD) = − 0.75, 95% confidence interval (CI): − 1.32 to − 0.18, P = 0.01), and depression (SMD = − 1.01, 95% CI: − 1.60 to − 0.43, P = 0.0007) at postintervention, and the separate analysis revealed that dignity therapy had a sustainable effect on anxiety (MD = − 2.96, 95% CI: − 3.85 to − 2.07, P < 0.001) and depression (MD = − 3.44, 95% CI: − 6.20 to − 0.68, P = 0.0003) at one month after the intervention. However, no statistically significant effect on quality of life were found in our study.

Conclusion

Dignity therapy may be effective for improving hope, anxiety, and depression among adult cancer patients, but the effect on quality of life is nonsignificant. Culture-tailored dignity therapy should be further focused and explored. More randomized controlled trials with larger sample sizes, multiple follow-up times, and strict study designs should be further conducted to identify the effect of dignity therapy on cancer patients.

Registration number

CDR42021275142.

Section snippets

What is already known

  • Cancer presents a progressively deteriorating illness that not only causes significant physical, social and economic burdens in patients but also impacts an individual's psychological well-being and quality of life.

  • Dignity therapy can help patients enhance their dignity, address psychological problems and facilitate their overall quality of life.

  • Current evidence suggests that dignity therapy is well accepted, but its effectiveness on hope, quality of life, anxiety, and depression in cancer

What this paper adds

  • Dignity therapy is effective for enhancing hope and decreasing anxiety and depression in adult cancer patients, while the evidence for quality of life is not significant.

  • Dignity therapy presented a sustainable effect on anxiety and depression at one-month after the intervention.

Methods

This review was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (Page et al., 2021). We registered the study protocol in International Prospective Register of Systematic Reviews, CDR42021275142.

Study selection

Two authors conducted the study selection process independently, and the kappa coefficients of title/abstract screening and full-text reading were 0.89 (P < 0.001) and 0.93 (P < 0.001), respectively, indicating that the consistency in this part was almost perfect. From the databases, a total of 2394 records were retrieved. A total of 2019 records remained after removing duplicates of 375 articles. Of these remaining records, 1914 studies were excluded after preliminary selection by reading the

Methodological quality of included studies

The methodological quality of the included studies was assessed by the Cochrane risk-of-bias tool, version 2 and the GRADE approach. Most of the included studies were assessed as having some concerns or high-risk bias, and the summarized evidence across outcomes ranged from low to high. Specifically, five studies didn't provide a description of allocation concealment, which could introduce selection bias. Due to the nature of psychological interventions, it was difficult to use blind method

Conclusions

The results of our meta-analysis indicated that dignity therapy is effective for improving hope, anxiety, and depression among adult cancer patients, and sustainable effects were also manifested on anxiety and depression. However, the evidence is not statistically significant for the quality of life. Dignity therapy should be culture-tailored to adapt patients in different regions, and it is necessary to adopt dignity therapy early for cancer patients in clinical practice. A multidisciplinary

Funding

The study is supported by the National Natural Sciences Foundation of China (82172842 and 81803104), Sichuan Science and Technology Program and TianFu Laboratory (2022YFSY0012 and 2021ZYCD011), the National Key Research and Development Program of China (2021YFE0206600), the Post-Doctor Research Project, West China Hospital, Sichuan University (2020HXBH119), and West China Nursing Discipline Development Special Fund Project, Sichuan University (HXHL21008).

CRediT authorship contribution statement

Yalin Zhang: Conceptualization, Methodology, Software, Data-curation, Formal-analysis, Validation, Writing-original-draft preparation, Writing-Reviewing and Editing. Juejin Li: Conceptualization, Methodology, Data-curation, Writing-Reviewing and Editing. Xiaolin Hu: Conceptualization, Methodology, Supervision, Validation, Writing-Reviewing and Editing.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

We would like to thank the Professor Mary for her support and guidance.

References (59)

  • B. Bentley et al.

    A narrative review of dignity therapy research

    Aust. Psychol.

    (2017)
  • Y.C. Chen

    Chinese values, health and nursing

    J. Adv. Nurs.

    (2001)
  • J. Chen et al.

    Effects and satisfaction of dignity therapy among patients with hematologic neoplasms in the Chinese cultural context: a randomized controlled trial

    Support. Care Cancer Off. J. Multinatl. Assoc. Support. Care Cancer

    (2021)
  • H.M. Chochinov et al.

    Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life

    J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol.

    (2005)
  • J. Cohen

    Statistical power analysis for the behavioral science

    Technometrics

    (1988)
  • M. Dempster et al.

    Psychological distress among survivors of esophageal cancer: the role of illness cognitions and coping

    Dis. Esophagus Off. J. Int. Soc. Dis. Esophagus

    (2012)
  • G. Fitchett et al.

    Care of the human spirit and the role of dignity therapy: a systematic review of dignity therapy research

    BMC Palliat. Care

    (2015)
  • S. Folkman

    Stress, coping, and hope

    Psycho-oncology

    (2010)
  • H. Ghafoor et al.

    A cross-cultural comparison of the roles of emotional intelligence, metacognition, and negative coping for health-related quality of life in German versus Pakistani patients with chronic heart failure

    Br. J. Health Psychol.

    (2019)
  • Y. Gong et al.

    Effect of dignity therapy on self-esteem status and hoping level for patients with pancreatic cancer

    Nurs. Rehabil. J.

    (2014)
  • M. Gras et al.

    Art therapy sessions for Cancer patients: a single-Centre experience

    Oncology

    (2020)
  • S. Hall et al.

    A novel approach to enhancing hope in patients with advanced cancer: a randomised phase II trial of dignity therapy

    BMJ Support. Palliat. Care

    (2011)
  • Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., Welch, V.A. (Eds.). Cochrane handbook for...
  • K. Holtmaat et al.

    Long-term efficacy of meaning-centered group psychotherapy for cancer survivors: 2-year follow-up results of a randomized controlled trial

    Psycho-oncology

    (2020)
  • L.J. Houmann et al.

    Testing the feasibility of the dignity therapy interview: adaptation for the Danish culture

    BMC Palliat. Care

    (2010)
  • C.Y. Hsu et al.

    Understandings of death and dying for people of Chinese origin

    Death Stud.

    (2009)
  • L. Iani et al.

    Dignity therapy helps terminally ill patients maintain a sense of peace: early results of a randomized controlled trial

    Front. Psychol.

    (2020)
  • L. Inhestern et al.

    Anxiety and depression in working-age cancer survivors: a register-based study

    BMC Cancer

    (2017)
  • A. Jeong et al.

    Avoidance of cancer communication, perceived social support, and anxiety and depression among patients with cancer

    Psycho-oncology

    (2016)
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