(126) Evaluating the Impact of Dignity Therapy on Quality of Life in Patients with Brain Tumour: A Pilot Study

BACKGROUND/SIGNIFICANCE: Brain tumours (BT) are associated with high morbidity, mortality and changes in sense-of-‎self early in the illness (Taphoorn et al., 2010). Dignity Therapy (DT) is a two-session intervention created for those at end-‎of-life (EOL), to regain sense of self, increase meaning, and reduce distress (Chochinov et al., 2005; Chochinov et al., 2013). ‎This study explored the impact of DT in patients with incurable BT earlier in the illness trajectory and at EOL.‎

Methods: 39 of 43 participants completed DT across two groups: EOL (a prognosis of less than 1-year, n=20), or non-EOL ‎‎(a prognosis of 1-10years, n=19). Participants completed questionnaires pre-intervention, 1-week (T1) and 5-weeks post-‎intervention (T2). Wilcoxon rank sum test assessed the impact of DT and explored between group differences. Generalized ‎Estimation Equations were used to examine the longitudinal between group change.‎

Results: Dignity improved for both groups at T1 (p=0.008) then decreased in both, but remained improved from baseline ‎by T2. Both groups reported low death anxiety throughout, with more in the EOL group. Death anxiety reduced in both ‎groups at T1 (p=0.033), then increased for both but remained improved from baseline by T2.‎

At baseline and T1, the EOL group reported greater social/family (p=0.079, p=0.065) and emotional wellbeing (p=0.047, ‎p=0.003) than the non-EOL group. Social/family wellbeing improved slightly for non-EOL by T2, but emotional wellbeing ‎decreased slightly for both groups.‎

The EOL group reported low posttraumatic growth (PTG) at baseline, with little impact of DT. The non-EOL group reported ‎moderate/high levels of PTG at baseline, which increased at both T1 and T2.‎

Analyses showed no significant difference in outcomes between groups, suggesting that the non-EOL group benefits from ‎DT as much as the EOL group.‎

Discussion: Our study confirmed the benefits of DT for dignity in patients with cancer (Chochinov et al., 2013). Those at ‎EOL possibly faced more challenges/losses, affecting their ability to sustain benefits. DT positively impacted death anxiety ‎and dignity in both groups, and PTG in non-EOL. Our finding that DT is helpful earlier in the illness trajectory for improving ‎dignity, PTG and death anxiety is a novel contribution to the literature.‎

CONCLUSION/IMPLICATIONS: The high completion rate signals that DT was also acceptable earlier in the illness trajectory. ‎Our results confirm our hypothesis that offering DT earlier in the illness trajectory could reduce patient distress, which is ‎highly relevant in this population. Limitations of this study include a small sample size, a non-randomized study design, and ‎short-term follow-up. Future research could explore the impact of DT on patients with other cancers earlier in the illness ‎trajectory and evaluate longer term impact.‎

REFERENCES
‎1. Chochinov HM, Hack T, Hassard T, Kristjanson LJ, et al.: A novel psychotherapeutic intervention for patients near the end-‎of-life. J Clin Oncol. 2005; 23(24):5520–5.‎
‎2. Chochinov HM, Kristjanson LJ, Breitbart W, et al.: Effect of dignity therapy on distress and end of-life experience in ‎terminally ill patients: a randomised controlled trial. Lancet Oncol. 2013;11(4):576–87.‎
‎3. Taphoorn MJB, Sizoo EM, Bottomley A: Review on quality-of-life issues in patients with primary brain tumors. The ‎Oncologist. 2010;15(6):618–26.‎