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Home > A Randomized Control Trial of English-Speaking Advanced Cancer Patients at Akus Medical and Surgical Clinics and the Impact on Qol of One Session of Dignity Therapy

A Randomized Control Trial of English-Speaking Advanced Cancer Patients at Akus Medical and Surgical Clinics and the Impact on Qol of One Session of Dignity Therapy

Thesis Info

Author

Gatehi-Muriithi, Miriam

Department

Internal Medicine (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2018

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728033618

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Background: Palliative care is a modality of treatment that addresses physical, psychological and spiritual symptoms. Dignity therapy, a form of psychotherapy, was developed by Professor Harvey Chochinov, MD in 2005. Methods: This was a randomized control trial of 144 patients (72 in each arm) randomized into group 1 (intervention arm) and group 2 (control arm). Baseline ESAS scores were determined in both arms following which group 1 received Dignity therapy while Group 2 received usual care only. Data collected was presented as Legacy documents to group 1 participants. Post intervention ESAS scores were obtained in both groups after 6 weeks. Analysis was based on the intention to treat principle and descriptive statistics computed. The main outcome was symptom distress scores on the ESAS (summated out of 100 and symptom specific scores out of 10). The student T-test was used to test for difference in ESAS scores at follow up and graphs computed for common cancers and comorbidities. Results: Of the 144 (72 patients in each arm) patients randomized, 70%were female while 30% were male with a mean age of 50 years. At 6 weeks, 11 patients were lost to follow up, seven died and 126 completed the study. The commonly encountered cancers were gastrointestinal cancers (43%, p=0.29), breast cancer (27.27% p=0.71) and gynaecologic cancers (23% p=0.35).Majority of the patients i.e. 64.3% had no comorbidities. After adjusting for baseline scores, the mean (summated) symptom distress score was not significant (GLM p=0.78). Dignity therapy group showed a trend towards statistical improvement in anxiety (p=0.059). The largest effects seen were in improvement of appetite, lower anxiety and improved wellbeing (Cohen effect size 0.3, 0.5 and 0.31 respectively). Conclusion: Dignity therapy showed no statistical improvement in overall quality of life. Symptom improvement was seen in anxiety and this was a trend towards statistical significance (p=0.059).
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