Abstract
BackgroundDignity Therapy (DT) is a short-term intervention to reduce psychological suffering in end-of-life care. Its strength lies in evidenced-based development and investigation. The aim of the present study is to investigate the feasibility of DT at German palliative care units (PCU), as well as the acceptability and adaption of a German version of the DT question protocol (DTQP).MethodA clinical multicentre mixed methods study, whereby patients and relatives provided quantitative (feedback questionnaires) and qualitative (cognitive interviews) data on the DT intervention. Before using the DTQP on patients, healthcare professionals (HCP) were invited to participate in cognitive interviews to provide input on DT. Therefore 360° feedback was achieved. Finally, the conducted DT interviews were examined.The study took place at two German PCUs (Mainz and Würzburg). Participating HCPs were physicians, psychologists, nurses and chaplains. Patients admitted to the PCUs were eligible to participate if they had a terminal illness and a life expectancy ranging from 2 weeks to 12 months.Results: Out of 410 admitted patients, 72 were eligible and 30 (7.3% of all patients and 41.7% of eligible patients) participated. On average, 9 questions from the DTQP were used per DT interview. Subsequent cognitive interviews with patients produced four main categories of feedback (on the title, the question protocol, wording, and the questions actually asked). Finally, of the 30 participants, 19 completed the feedback questionnaire, as did 26 relatives. Of those, 18 patients and 24 relatives evaluated DT as helpful.ConclusionsDT is feasible for German PCUs. Our research yielded a validated German translation of the DTQP following EORTC guidelines and findings were reported according to the COREQ checklist for qualitative design.Trial registration.The study was registered retrospectively on the 22nd of December 2017 at the German Clinical Trials Register (DRKS00013627).
Highlights
Dignity Therapy (DT) is a short-term intervention to reduce psychological suffering in end-of-life care
Our research yielded a validated German translation of the DT question protocol (DTQP) following EORTC guidelines and findings were reported according to the criteria for reporting qualitative research (COREQ) checklist for qualitative design
healthcare professionals (HCP) views on the DTQP Besides general remarks on the interpretation of the word ‘dignity’, which some HCPs viewed in a religious way and others in a more philosophical way, we observed five main categories of comments on DT and the DTQP: (1) negative aspects of DT; (2) positive aspects of DT; (3) Dignity Therapist; (4) conducting DT; and (5) the DTQP (Table 2)
Summary
Dignity Therapy (DT) is a short-term intervention to reduce psychological suffering in end-of-life care. Findings regarding its efficacy have been contradictory in recent randomized controlled trials [8, 9], helpfulness and meaningfulness are proven benefits for patients and relatives, and DT is regarded as feasible in different clinical settings, healthcare systems and cultures. These findings were an encouraging starting point to evaluate the implementation of DT in palliative care units (PCU) in Germany
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