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An exploratory study of dignity therapy for older people in care homes
ISRCTN ISRCTN37589515
DOI 10.1186/ISRCTN37589515
ClinicalTrials.gov identifier
EudraCT number
Public title An exploratory study of dignity therapy for older people in care homes
Scientific title A phase II randomised controlled trial assessing the feasibility, acceptability and potential effectiveness of Dignity Therapy for older people in care homes
Acronym N/A
Serial number at source N/A
Study hypothesis The broad aims of this phase II randomised controlled trial (RCT) are to assess the feasibility, acceptability and potential effectiveness of Dignity Therapy to reduce psychological and spiritual distress in older people in care homes. The specific objectives are to:
1. Determine whether Dignity Therapy is likely to increase peoples' sense of dignity and reduce psychological or spiritual distress
2. Determine whether it is feasible to provide Dignity Therapy to older people in care homes
3. Determine whether Dignity Therapy is acceptable to residents and their families
4. Pilot methods for a larger randomised controlled trial (e.g., recruitment, randomisation, follow-up, suitability of measures)
Lay summary Not provided at time of registration
Ethics approval Joint South London and Maudsley and the Institute of Psychiatry Research Ethics Committee, approved on 24/11/2008 (ref: 08/H0807/75)
Study design Phase II randomised controlled open-label trial
Countries of recruitment United Kingdom
Disease/condition/study domain Ageing: in need of care
Participants - inclusion criteria Residents (males and females) aged 65 years old or over, living in one of six care homes for older people, are included. Not all residents have a "terminal" illness and they are not selected on the basis of receiving palliative care. However, all residents in nursing homes are frail and could be considered as reaching the end of life. Participants are not screened for spiritual or psychological distress, or loss of dignity, however, these are assessed at baseline, to explore the potential moderating effects of these variables on the impact of the intervention.
Participants - exclusion criteria 1. Residents who are considered by the care home managers to be too ill to be interviewed
2. Unable to provide informed consent either due to cognitive problems, or to the severity of their illness, or because they are unable to understand English
Anticipated start date 01/12/2008
Anticipated end date 31/03/2010
Status of trial Completed
Patient information material Not available in web format, please use the contact details below to request a patient information sheet
Target number of participants 64
Interventions Dignity Therapy: This is a brief psychotherapy to foster a sense of dignity and reduce psychological and spiritual distress in people reaching the end of life. The therapy involves a therapist conducting an interview with the resident using a standard framework of questions. This is given to residents at least a day before the therapy session to give them the opportunity to think about their responses beforehand. The question framework provides a flexible guide for the therapist to shape the interview, based on patients' level of interest and responses. The therapist follows the residents' cues, helping then to structure and organise their thoughts, for example, by asking questions about time sequences, how events are causally related to each other and facilitating the disclosure of thoughts, feelings and memories. These interviews are tape-recorded, quickly transcribed verbatim then shaped into a narrative using a formatted editing process. This includes clarifications (eliminating colloquialisms, non-starters and sections not related to the "generativity" material, such an interruptions), chronological corrections, tagging and editing any content that might inflict significant harm on recipients of the document (after discussion with the resident) and finding a suitable ending for the document which is appropriate to the residents' overall message. Another session is arranged for the therapist to read the edited transcript to the participants, who are invited to make any editorial suggestions, including identifying errors of omission or commission. Once the resident is satisfied with the document, they can give it, or bequeath it, to people of their choosing. Dignity therapy is given in addition to standard psychological care.

The control group will receive standard psychological care. None of the care homes provide dignity therapy. Information on the nature of standard care is being collected as part of the trial. In addition residents in the control group have at least three interviews with the research assistant. Completing the measures and taking part in the interview gives them an opportunity to talk about their feelings. The extent to which they feel that this is therapeutic is explored in the interviews.
Primary outcome measure(s) Residents' sense of dignity, assessed using the Patient Dignity Inventory at baseline, 1 and 8 weeks post-intervention, and the equivalent in the control group. Themes covered by this questionnaire include physical, psychosocial, existential and spiritual domains of concern or distress.
Secondary outcome measure(s) 1. Potential effectiveness, assessed at baseline, 1 and 8 weeks post-intervention, and the equivalent in the control group, by the following:
1.1. Geriatric Depression Scale
1.2. Herth Hope Index
1.3. Euroqol EQ-5D
1.4. A two-item measure of quality of life specifically designed to assess the effectiveness of the Dignity Therapy

2. Feasibility, recruitment (residents and their family and friends), assessed at the end of the trial:
2.1. Exclusions, drop-out rates
2.2. Time taken to obtain informed consent and organise and conduct the dignity therapy sessions, transcribe and edit narratives and collect outcomes
2.3. Deviations from the therapy protocol and uncompleted interventions and the reasons for this
2.4. Therapist's perceptions of competence as a result of training

3. Acceptability, assessed by semi-structured interviews with residents to obtain their views on Dignity Therapy (intervention group only) and on taking part in the study (both groups). These qualitative interviews will be conducted before quantitative measures are collected, 1 and 8 weeks post-intervention, and the equivalent in the control group. The therapist records her experiences of delivering the therapy and observations of resident's responses. Case reports will be produced for any difficult cases and, with the consent of participants, a detailed qualitative analysis of the therapy transcripts will be carried out. The latter might provide insight into concerns which might impact on the effectiveness of the intervention.
Sources of funding The Dunhill Medical Trust (UK)
Trial website
Publications 1. 2012 results in http://www.ncbi.nlm.nih.gov/pubmed/21859743
Contact name Dr  Sue  Hall
  Address Department of Palliative Care, Policy & Rehabilitation
Weston Education Centre
Cutcombe Road
  City/town London
  Zip/Postcode SE5 9RJ
  Country United Kingdom
Sponsor King's College London (UK)
  Address c/o Prof Robert Lechler
King's College School of Medicine
James Clerk Maxwell Building
  City/town London
  Zip/Postcode SE1 8WA
  Country United Kingdom
  Sponsor website: http://www.kcl.ac.uk/
Date applied 20/01/2009
Last edited 19/12/2012
Date ISRCTN assigned 30/01/2009
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