Title

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

Date of Award

5-30-2018

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. John Weru

Second Supervisor/Advisor

Dr. Alice Musibi

Department

Internal Medicine (East Africa)

Abstract

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).

This document is available in the relevant AKU library

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