Dignity therapy, psycho-spiritual well-being and quality of life in the terminally ill: systematic review and meta-analysis

OBJECTIVES: Dignity therapy (DT) is a brief, individualised psychotherapy that aims to alleviate psychosocial and spiritual distress in the final stages of life. It is unknown yet whether DT can enhance sense of dignity and improve psychological and spiritual well-being as well as quality of life of terminally ill patients. METHODS: We searched PubMed, EMBASE, CINAHL plus, ProQuest Health & Medical Complete, PsycINFO and the Cochrane Library, as well as Chinese databases including Weipu Data, Wanfang Data and China National Knowledge Infrastructure from inception to 30 April 2021, for randomised controlled trials (RCTs) assessing the effects of DT on dignity, psycho-spiritual well-being and quality of life of terminally ill patients receiving palliative care. RESULTS: We identified 507 unique records, and included 9 RCTs (871 participants). Comparator was standard palliative care. DT did not improve terminally ill patients' sense of dignity (p=0.90), hope (p=0.15), spiritual well-being (p=0.99) and quality of life (p=0.23). However, DT reduced anxiety and depression after intervention (standardised mean difference, SMD=-1.13, 95% CI (-2.21 to -0.04), p=0.04; SMD=-1.22, 95% CI (-2.25 to -0.18), p=0.02, respectively) and at 4 weeks post-intervention (SMD=-0.89, 95% CI (-1.71 to -0.07), p=0.03; SMD=-1.26, 95% CI (-2.38 to -0.14), p=0.03, respectively). CONCLUSION: DT can be offered as a psychological intervention for terminally ill patients to reduce their anxiety and depression. More studies are needed to further evaluate the effects of DT on terminally ill patients' dignity, spiritual well-being and quality of life.