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Randomized control trial of advanced cancer patients at a private hospital in Kenya and the impact of dignity therapy on quality of life

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.The aim of the study was to assess the effect of one session of dignity therapy on q...

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Autores principales: Weru, John, Gatehi, Miriam, Musibi, Alice
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379366/
https://www.ncbi.nlm.nih.gov/pubmed/32703307
http://dx.doi.org/10.1186/s12904-020-00614-0
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author Weru, John
Gatehi, Miriam
Musibi, Alice
author_facet Weru, John
Gatehi, Miriam
Musibi, Alice
author_sort Weru, John
collection PubMed
description 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.The aim of the study was to assess the effect of one session of dignity therapy on quality of life in advanced cancer patients. 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 printed (Legacy) documents to group 1 participants. These documents were a summary of previous discussions held. 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 were 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. The primary analysis results showed higher scores for the DT group (change in mean = 1.57) compared to the UC group (change in mean = − 0.74) yielding a non-statistically significant difference in change scores of 1.44 (p = 0.670; 95% CI − 5.20 to 8.06). 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). TRIAL REGISTRATION: Trial registration number PACTR201604001447244 retrospectively registered with Pan African Clinical trials on 28th January 2016.
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spelling pubmed-73793662020-08-04 Randomized control trial of advanced cancer patients at a private hospital in Kenya and the impact of dignity therapy on quality of life Weru, John Gatehi, Miriam Musibi, Alice BMC Palliat Care Research Article 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.The aim of the study was to assess the effect of one session of dignity therapy on quality of life in advanced cancer patients. 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 printed (Legacy) documents to group 1 participants. These documents were a summary of previous discussions held. 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 were 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. The primary analysis results showed higher scores for the DT group (change in mean = 1.57) compared to the UC group (change in mean = − 0.74) yielding a non-statistically significant difference in change scores of 1.44 (p = 0.670; 95% CI − 5.20 to 8.06). 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). TRIAL REGISTRATION: Trial registration number PACTR201604001447244 retrospectively registered with Pan African Clinical trials on 28th January 2016. BioMed Central 2020-07-23 /pmc/articles/PMC7379366/ /pubmed/32703307 http://dx.doi.org/10.1186/s12904-020-00614-0 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Weru, John
Gatehi, Miriam
Musibi, Alice
Randomized control trial of advanced cancer patients at a private hospital in Kenya and the impact of dignity therapy on quality of life
title Randomized control trial of advanced cancer patients at a private hospital in Kenya and the impact of dignity therapy on quality of life
title_full Randomized control trial of advanced cancer patients at a private hospital in Kenya and the impact of dignity therapy on quality of life
title_fullStr Randomized control trial of advanced cancer patients at a private hospital in Kenya and the impact of dignity therapy on quality of life
title_full_unstemmed Randomized control trial of advanced cancer patients at a private hospital in Kenya and the impact of dignity therapy on quality of life
title_short Randomized control trial of advanced cancer patients at a private hospital in Kenya and the impact of dignity therapy on quality of life
title_sort randomized control trial of advanced cancer patients at a private hospital in kenya and the impact of dignity therapy on quality of life
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379366/
https://www.ncbi.nlm.nih.gov/pubmed/32703307
http://dx.doi.org/10.1186/s12904-020-00614-0
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