Family-oriented dignity therapy for patients with lung cancer undergoing chemotherapy: How does it work better?

OBJECTIVE: This study aimed to examine the fidelity of intervention delivery and identify precursory factors contributing to the successful delivery and beneficial effects of family-oriented dignity therapy. METHODS: This was a process evaluation with quantitative and qualitative methods alongside a randomized controlled trial from March to May 2019. Nonparametric statistics were used to analyze how participants’ demographics (n ​= ​45 dyads) and process variables influenced the intervention effects. Fourteen patients, 11 family caregivers, and 11 nurses were interviewed to explore their perception of the intervention. Conventional content analysis was adopted to analyze the qualitative data. RESULTS: The fidelity was achieved with minor deviations from the protocol. Higher educational level and higher income were significantly correlated with lower levels of existential distress (H ​= ​12.20, P ​= ​0.030) and higher spiritual well-being (H ​= ​−16.310, P ​= ​0.031), respectively. Higher levels of interest were significantly correlated with lower levels of existential distress (H ​= ​10.396, P ​= ​0.035) and peace of mind distress (H ​= ​−16.778, P ​= ​0.006) and higher levels of life meaning (H ​= ​−12.808, P ​= ​0.047). Patients who had higher response levels to the question were significantly correlated with lower levels of symptom distress (H ​= ​−13.879, P ​= ​0.035). Four major categories were identified from the interview data: (1) benefits of the intervention, (2) risks of the intervention, (3) factors that enhance successful dignity-conserving care, and (4) difficulties and barriers to the delivery of dignity-conserving care. CONCLUSIONS: Fidelity and precursory factors that enhance the beneficial effects of family-oriented dignity therapy were identified. Reinforcement strategies, such as using supplementary video, audio, and reading materials; developing a flexible approach to expressing feelings; and exploring lessons and achievements from various perspectives, are recommended for future research to enhance intervention effects. TRIAL REGISTRATION: The study was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1900020806).