Effectiveness Not Established

Narrative Interview

for Anxiety

A narrative interview is an interview in which the interviewee can tell his or her story and experience and express feelings. This approach is aimed at allowing patients to focus on issues that are of concern to them and reflect on actions that might be helpful to them. Researchers have studied the use of the narrative interview as a treatment for anxiety and depression in patients with cancer.

Research Evidence Summaries

Julião, M., Oliveira, F., Nunes, B., Vaz Carneiro, A., & Barbosa, A. (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, 688–695. 

Study Purpose

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

Intervention Characteristics/Basic Study Process

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). 

Sample Characteristics

  • 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

Setting

  • 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 and Clinical Applications

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

Study Design

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

Measurement Instruments/Methods

  • 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.

Results

There were no significant differences between the control and intervention groups at baseline. Between and within groups, results were similar. Intervention group scores showed a significant (p = 0.001) decrease in depression scores at T2 and T4, but not at T3, and a significant (p = 0.0001; p = 0.001; p = 0.013) decrease in anxiety scores at all time points. The SPC group showed a significant (p = 0.045; p = 0.004; p = 0.006) increase in depression scores between baseline and all assessment periods. The SPC group showed an insignificant increase in the HADS anxiety subscale between baseline and all measurement periods.

Conclusions

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.

Limitations

  • 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

Nursing Implications

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.

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