Narrative Interview

To determine the influence of dignity therapy on depression and anxiety in palliative care unit inpatients diagnosed with a terminal illness and experiencing high levels of distress

Dignity therapy (DT) is brief psychotherapy aimed at decreasing the loss of dignity for patients with a life-limiting illness. This nonblinded, phase II, randomized, controlled trial involved a control group receiving standard palliative care (SPC) and an intervention group receiving SPC plus DT. Participants received a baseline assessment of anxiety and depression, an explanation of DT, and a copy of the DT questions at T1 of the study. They were then randomized into two groups. Within two to three days, the intervention group received audio recorded 30–60-minute DT sessions that were transcribed verbatim within the next two to three days and transformed into a written narrative. The DT therapist read the narrative to the patient and received corrections, returning the final narrative to the patient. Follow-up measurements of depression and anxiety in both groups were conducted on days 4 (T2), 15 (T3), and 30 (T4). 

• N = 80  
• AGE RANGE = 28–90 years
• MALES: 46.25%, FEMALES: 53.75%
• KEY DISEASE CHARACTERISTICS: Life-threatening terminal illness (cancer = 92.55%; noncancer = 7.5%) with a prognosis of six months or fewer
• OTHER KEY SAMPLE CHARACTERISTICS: 95% Caucasian; 5% African American; two patients had Lou Gehrig disease; one patient had trigeminal neuralgia; inclusion criteria were no evidence of dementia or delirium and a Mini Mental State score of 20 or more; read and spoke Portuguese; written informed consent; available for four to five research encounters

• SITE: Single site    
• SETTING TYPE: Inpatient  
• LOCATION: S. Bento Menni’s 10-bed tertiary inpatient palliative medicine unit in Lisbon; recruitment took place over 36 months (May 2010 through May 2013)

• PHASE OF CARE: End-of-life care
• APPLICATIONS: Palliative care 

This nonblinded, phase II, randomized, controlled trial involved a control group receiving SPC and an intervention group receiving SPC plus DT.

• Hospital Anxiety and Depression Scale (HADS): Symptoms of depression and anxiety were measured with HADS at T1, T2, T3, and T4 of follow-up. Scores for anxiety and depression subscales also were reported separately.

Terminally ill patients experience high levels of depression and anxiety. DT was suggested as a feasible offering to people with increased or severe psychological distress. Participants who received DT experienced depression and anxiety score reductions, suggesting psychological benefits at least to the 30-day measurement period.

• Small sample (< 100)
• Risk of bias (no blinding)
• Findings not generalizable
• Intervention expensive, impractical, or training needs
• Other limitations/explanation: Relatively small sample size (N < 100) leaves findings nongeneralizable; specific training in the delivery of DT required

DT can be offered to patients with terminal conditions near the end of life (six-month prognosis). DT implementation requires careful training in the practice. Additional randomized, controlled trials testing DT against other psychological interventions in other populations of severely ill or terminally ill patients are needed.

To determine if a focused narrative-interview intervention can alleviate symptoms of suffering, anxiety, and depression in patients with advanced cancer

Patients in a hospice day unit were randomized to one of two groups. In one, patients received the study intervention; in the other, usual care. The intervention was a single focused narrative interview in which a patient was encouraged to discuss his or her perspectives; sense of meaning; sense of suffering; and psychological, physical, and spiritual well-being. The emphasis was on enabling each patient to tell his or her story. Study assessments were done at baseline and at two, four, and eight weeks after the intervention.

• The sample was composed of 100 participants.
• Mean patient age was 66 years. The age range was 31–89 years.
• Of all participants, 32% were male and 68% were female.
• All patients had advanced disease, and the sample included various tumor types. Of types of cancer represented in the sample, breast, lung, and colon cancer were the most common.
• Of all participants, 55% were married or cohabiting; 33.3% had been diagnosed with cancer within the last 12 months; and approximately 33.3% had, before cancer diagnosis, disorders related to depression or stress.

• Single site
• Outpatient
• United Kingdom

• Phase of care: end-of-life care
• Clinical applications: eldercare, palliative care

 Randomized controlled trial

• Brief Edinburgh Depression Scale (BEDS)
• Edmonton Symptom Assessment Scale (ESAS)
   

Baseline scores indicated, on average, probable depression. At four weeks investigators noted a slight, but nonsignificant improvement in the depression score. Authors noted no other changes or differences between groups.

As result of narrative interview intervention in a hospice day program, findings did not show any substantial improvement in measures of depression or other symptoms.

• The study had a small sample size, with fewer than 100 participants.
• The study had risks of bias due to no blinding and no appropriate attentional control condition.
• Authors did not describe usual care. Although the authors noted no significant differences as a result of the intervention, authors concluded that the intervention was effective.

Findings do not suggest that narrative interview, used as an intervention for depression and other symptoms, had any effect in this study.