Effects of Dignity Interventions on Psychosocial and Existential Distress in Terminally ill Patients: A Meta-analysis

ABSTRACT

PURPOSE: This study was done to evaluate the effects of dignity interventions on depression, anxiety and meaning of life in terminally ill patients. METHODS: PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL and several Korean databases were searched. The main search strategy combined terms indicating dignity intervention, presence of terminal illness and study design. Methodological quality was assessed using Cochrane's Risk of Bias for randomized studies and Risk of Bias Assessment tool for non randomized studies. Data were analyzed by the RevMan 5.2.11 program of Cochrane Library. RESULTS: Twelve clinical trials met the inclusion criteria with a total of 878 participants. Dignity intervention was conducted for a mean of 2.2 weeks, 2.8 sessions and an average of 48.7 minutes per session. Effect sizes were heterogeneous and subgroup analysis was done. Dignity interventions had a significant effect on depression (ES= -1.05, p<.001, I2=15%) and anxiety (ES= -1.01, p<.001, I2=0). For meaning of life, dignity interventions were effective (ES= -1.64, p=.005) and effect sizes were still heterogeneous. CONCLUSION: Results support findings that dignity interventions can assist terminal ill patients in reducing emotional distress and improving meaning of life. Further well-designed dignity studies will lead to better understanding of the effects of treatments on spiritual well-being.