Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-23T10:24:09.003Z Has data issue: false hasContentIssue false

Dignity therapy in Mexican lung cancer patients with emotional distress: Impact on psychological symptoms and quality of life

Published online by Cambridge University Press:  04 May 2021

Ana Gonzalez-Ling*
Affiliation:
Unidad para la Investigación y Desarrollo de la Psicooncología, Instituto Nacional de Cancerología, Mexico, Mexico
Oscar Galindo Vázquez
Affiliation:
Unidad para la Investigación y Desarrollo de la Psicooncología, Instituto Nacional de Cancerología, Mexico, Mexico
María Luisa Rascón-Gasca
Affiliation:
Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico, Mexico
Rebeca Robles
Affiliation:
Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico, Mexico
Harvey Max Chochinov
Affiliation:
Department of Psychiatry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
*
Author for correspondence: Ana Gonzalez-Ling, Servicio de Psicooncología, Instituto Nacional de Cancerología, Calle Av. San Fernando No. 22, Colonia. Sección XVI Ciudad de México, C.P. 14080, Mexico. E-mail: ana.marcela.gzz@gmail.com

Abstract

Lung cancer (LC) is the most frequent and deadly neoplasm in the world, and patients have shown a tendency to have more emotional distress than other cancer populations. Dignity Therapy (DT) is a brief intervention aimed to improve emotional well-being in patients facing life-threatening illness.

Objective

To analyze the effect of DT on anxiety, depression, hopelessness, emotional distress, dignity-related distress, and quality of life (QoL) in a group of Mexican patients with stage IV LC undergoing active medical treatment with baseline emotional distress.

Method

In this preliminary pretest–posttest study, patients received three sessions of DT and were evaluated with the HADS, Distress Thermometer, Patient Dignity Inventory, single-item questions, and QLQ-30.

Results

In total, 24 out of 29 patients completed the intervention. Statistically significant improvements were found in anxiety, depression, emotional distress, hopelessness, and dignity-related distress with large effect sizes. Patients reported that DT helped them, increased their meaning and purpose in life, their sense of dignity, and their will to live, while it decreased their suffering. No changes were found in QoL.

Significance of results

DT was well accepted and effective in improving the emotional symptoms of LC patients with distress that were undergoing medical treatment. Although more research is warranted to confirm these results, this suggests that DT can be used in the context of Latin-American patients.

Type
Original Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Aaronson, NK, Ahmedzai, S, Bergman, B, et al. (1993) The European organization for research and treatment of cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute 85(5), 365376.CrossRefGoogle ScholarPubMed
Almanza, J, Rosario, I and Pérez, S (2008) Traducción, adaptación y validación del termómetro de distrés en una muestra de pacientes mexicanos con cáncer. Revista de Sanidad Militar Mexicana 62(5), 209217.Google Scholar
Arrieta, Ó, Angulo, LP, Núñez-Valencia, C, et al. (2013) Association of depression and anxiety on quality of life, treatment adherence, and prognosis in patients with advanced non-small cell lung cancer. Annals of Surgical Oncology 20(6), 19411948. doi:10.1245/s10434-012-2793-5.CrossRefGoogle ScholarPubMed
Aukst Margetic, B, Kukulj, S, Santic, Z, et al. (2013) Predicting depression with temperament and character in lung cancer patients. European Journal of Cancer Care 22(6), 807814. doi:10.1111/ecc.12080.CrossRefGoogle ScholarPubMed
Carlsen, K, Jensen, AB, Jacobsen, E, et al. (2005) Psychosocial aspects of lung cancer. Lung Cancer 47(3), 293300. doi:10.1016/j.lungcan.2004.08.002.CrossRefGoogle ScholarPubMed
Cataldo, JK, Jahan, TM and Pongquan, VL (2012) Lung cancer stigma, depression, and quality of life among ever and never smokers. European Journal of Oncology Nursing 16(3), 264269. doi:10.1016/j.ejon.2011.06.008.CrossRefGoogle ScholarPubMed
Chochinov, HM (2012) Dignity Therapy: Final Words for Final Days. New York, NY: Oxford University Press.CrossRefGoogle Scholar
Chochinov, HM, Hack, T, McClement, S, et al. (2002) Dignity in the terminally ill: An empirical model. Social Science and Medicine 54(June), 433443.CrossRefGoogle ScholarPubMed
Chochinov, HM, Hack, T, Hassard, T, et al. (2005) Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. Journal of Clinical Oncology 23(24), 55205525. doi:10.1200/JCO.2005.08.391.CrossRefGoogle ScholarPubMed
Chochinov, HM, Hassard, T, McClement, S, et al. (2008) The patient dignity inventory: A novel Way of measuring dignity-related distress in palliative care. Journal of Pain and Symptom Management 36(6), 559571. doi:10.1016/j.jpainsymman.2007.12.018.CrossRefGoogle ScholarPubMed
Chochinov, HM, Kristjanson, LJ, Breitbart, W, et al. (2011) Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomised controlled trial. The Lancet Oncology 12(8), 753762. doi:10.1016/S1470-2045(11)70153-X.CrossRefGoogle ScholarPubMed
Diaz-Frutos, D, Baca-Garcia, E, García-Foncillas, J, et al. (2016) Predictors of psychological distress in advanced cancer patients under palliative treatments. European Journal of Cancer Care 25(4), 608615. doi:10.1111/ecc.12521.CrossRefGoogle ScholarPubMed
Donato, SCT, Matuoka, JY, Yamashita, CC, et al. (2016) Effects of dignity therapy on terminally ill patients: A systematic review. Revista da Escola de Enfermagem da USP 50(6), 10141024. doi:10.1590/s0080-623420160000700019.CrossRefGoogle ScholarPubMed
Dose, A, Hubbard, J, Sloan, J, et al. (2016) Dignity therapy feasibility for cancer patients undergoing chemotherapy (S734). Journal of Pain and Symptom Management 51(2), 425426. doi:10.1016/j.jpainsymman.2015.12.037.CrossRefGoogle Scholar
Ferlay, J, Colombet, M, Soerjomataram, I, et al. (2018) Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. International Journal of Cancer. doi:10.1002/ijc.31937.Google ScholarPubMed
Fitchett, G, Emanuel, L, Handzo, G, et al. (2015) Care of the human spirit and the role of dignity therapy: A systematic review of dignity therapy research. BMC Palliative Care 14(1), 8. doi:10.1186/s12904-015-0007-1.CrossRefGoogle ScholarPubMed
Galindo Vázquez, O, Benjet, C, Juárez García, F, et al. (2015) Propiedades psicométricas de la Escala Hospitalaria de Ansiedad y Depresión (HADS) en una población de pacientes oncológicos mexicanos. Salud Mental 38(4), 253258. doi:10.17711/SM.0185-3325.2015.035.CrossRefGoogle Scholar
Gonzalez, BD and Jacobsen, PB (2012) Depression in lung cancer patients: The role of perceived stigma. Psycho-Oncology 21(3), 239246. doi:10.1002/pon.1882.CrossRefGoogle ScholarPubMed
Gonzalez-Ling, A, De La Torre-Vallejo, M, Luvian-Morales, J, et al. (2017) P3.05-003 Anxiety and depression in patients with EGFR+ NSCLC receiving treatment with TKIs. Journal of Thoracic Oncology 12(1), S1414. doi:10.1016/j.jtho.2016.11.2165.CrossRefGoogle Scholar
Hall, S, Goddard, C, Opio, D, et al. (2011) A novel approach to enhancing hope in patients with advanced cancer: A randomised phase II trial of dignity therapy. BMJ Supportive & Palliative Care 1(3), 315321. doi:10.1136/bmjspcare-2011-000054.CrossRefGoogle ScholarPubMed
Houmann, LJ, Chochinov, HM, Kristjanson, LJ, et al. (2014) A prospective evaluation of dignity therapy in advanced cancer patients admitted to palliative care. Palliative Medicine 28(5), 448458. doi:10.1177/0269216313514883.CrossRefGoogle ScholarPubMed
Javaloyes Bernácer, N, Botella Mira, L, Meléndez López, V, et al. (2014) Aplicación de la dignity therapy en pacientes oncológicos en situación avanzada. Psicooncología 11(2–3). doi:10.5209/rev_PSIC.2014.v11.n2-3.47393.CrossRefGoogle Scholar
Johns, SA (2013) Translating dignity therapy into practice: Effects and lessons learned. OMEGA - Journal of Death and Dying 67(1–2), 135145. doi:10.2190/om.67.1-2.p.CrossRefGoogle ScholarPubMed
Julião, M, Oliveira, F, Nunes, B, et al. (2014) Efficacy of dignity therapy on depression and anxiety in Portuguese terminally ill patients: A phase II randomized controlled trial. Journal of Palliative Medicine 17(6), 688695. doi:10.1089/jpm.2013.0567.CrossRefGoogle ScholarPubMed
Lung Cancer Key Findings (2020) American Lung Association. Available at: https://www.lung.org/research/state-of-lung-cancer/key-findings.Google Scholar
Martínez, M, Arantzamendi, M, Belar, A, et al. (2017) “Dignity therapy”, a promising intervention in palliative care: A comprehensive systematic literature review. Palliative Medicine 31(6), 492509. doi:10.1177/0269216316665562.CrossRefGoogle ScholarPubMed
McClement, S, Chochinov, HM, Hack, T, et al. (2007) Dignity therapy: Family member perspectives. Journal of Palliative Medicine 10(5), 10761082. doi:10.1089/jpm.2007.0002.CrossRefGoogle ScholarPubMed
Montross, L, Winters, KD and Irwin, SA (2011) Dignity therapy implementation in a community-based hospice setting. Journal of Palliative Medicine 14(6), 729734. doi:10.1089/jpm.2010.0449.CrossRefGoogle Scholar
Mosher, CE, Winger, JG, Hanna, N, et al. (2014) Barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients. Psycho-Oncology 23(7), 812819. doi:10.1002/pon.3488.CrossRefGoogle ScholarPubMed
NCCN (2003) Distress management clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network 1(3), 344. doi:10.6004/jnccn.2003.0031.CrossRefGoogle Scholar
Oñate-Ocaña, LF, Alcántara-Pilar, A, Vilar-Compte, D, et al. (2009) Validation of the Mexican Spanish version of the EORTC c30 and STO22 questionnaires for the evaluation of health-related quality of life in patients with gastric cancer. Annals of Surgical Oncology 16(1), 8895. doi:10.1245/s10434-008-0175-9.CrossRefGoogle ScholarPubMed
Rodríguez-Mayoral, O, Galindo-Vázquez, O, Allende-Pérez, S, et al. (2021). Validation of the patient dignity inventory in Mexican cancer patients. Journal of Palliative Medicine. Advance online publication. doi: 10.1089/jpm.2020.0572.CrossRefGoogle Scholar
Salminen, EK, Silvoniemi, M, Syrjänen, K, et al. (2013) Opioids in pain management of mesothelioma and lung cancer patients. Acta Oncologica 52(1), 3037. doi:10.3109/0284186X.2012.725944.CrossRefGoogle ScholarPubMed
Ugalde, A, Aranda, S, Krishnasamy, M, et al. (2012) Unmet needs and distress in people with inoperable lung cancer at the commencement of treatment. Supportive Care in Cancer 20(2), 419423. doi:10.1007/s00520-011-1296-4.CrossRefGoogle ScholarPubMed
Vergo, MT, Nimeiri, H, Mulcahy, MF, et al. (2012) Feasibility of dignity therapy in patients with stage IV colorectal cancer receiving chemotherapy. Journal of Clinical Oncology 30(4), 446453. doi:10.12788/jcso.0096.446.CrossRefGoogle Scholar
Vuksanovic, D, Green, HJ, Dyck, M, et al. (2017) Dignity therapy and life review for palliative care patients: A randomized controlled trial. Journal of Pain and Symptom Management 53(2), 162170.e1. doi:10.1016/j.jpainsymman.2016.09.005.CrossRefGoogle ScholarPubMed
Walker, J, Hansen, CH, Martin, P, et al. (2014) Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: A cross-sectional analysis of routinely collected clinical data. The Lancet Psychiatry 1(5), 343350. doi:10.1016/S2215-0366(14)70313-X.CrossRefGoogle ScholarPubMed
Wilson, KG, Scott, JF, Graham, ID, et al. (2000) Attitudes of terminally ill patients toward euthanasia and physician-assisted suicide. Archives of Internal Medicine 160(16), 24542460. doi:10.1001/archinte.160.16.2454.CrossRefGoogle ScholarPubMed
Xiao, J, Chow, KM, Liu, Y, et al. (2019) Effects of dignity therapy on dignity, psychological well-being, and quality of life among palliative care cancer patients: A systematic review and meta-analysis. Psycho-Oncology 28(9), 17911802. doi:10.1002/pon.5162.CrossRefGoogle ScholarPubMed
Zigmond, AS and Snaith, RP (1983) The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67(6), 361370. doi:10.1111/j.1600-0447.1983.tb09716.x.CrossRefGoogle ScholarPubMed