{"doi":"10.1089/jpm.2023.0336","title":"Engaging Mortality: Effective Implementation of Dignity Therapy","abstract":"Background: Patients consider the life review intervention, Dignity Therapy (DT), beneficial to themselves and their families. However, DT has inconsistent effects on symptoms and lacks evidence of effects on spiritual/existential outcomes. Objective: To compare usual outpatient palliative care and chaplain-led or nurse-led DT for effects on a quality-of-life outcome, dignity impact. Design/Setting/Subjects: In a stepped-wedge trial, six sites in the United States transitioned from usual care to either chaplain-led or nurse-led DT in a random order. Of 638 eligible cancer patients (age ≥55 years), 579 (59% female, mean age 66.4 ± 7.4 years, 78% White, 61% stage 4 cancer) provided data for analysis. Methods: Over six weeks, patients completed pretest/posttest measures, including the Dignity Impact Scale (DIS, ranges 7–35, low-high impact) and engaged in DT+usual care or usual care. They completed procedures in person (steps 1–3) or via Zoom (step 4 during pandemic). We used multiple imputation and regression analysis adjusting for pretest DIS, study site, and step. Results: At pretest, mean DIS scores were 24.3 ± 4.3 and 25.9 ± 4.3 for the DT (n = 317) and usual care (n = 262) groups, respectively. Adjusting for pretest DIS scores, site, and step, the chaplain-led (β = 1.7, p = 0.02) and nurse-led (β = 2.1, p = 0.005) groups reported significantly higher posttest DIS scores than usual care. Adjusting for age, sex, race, education, and income, the effect on DIS scores remained significant for both DT groups. Conclusion: Whether led by chaplains or nurses, DT improved dignity for outpatient palliative care patients with cancer. This rigorous trial of DT is a milestone in palliative care and spiritual health services research. clinicaltrials.gov: NCT03209440.","journal":"Journal of Palliative Medicine","year":2023,"id":340162,"datarank":0.5754094934031837,"base_score":2.833213344056216,"endowment":2.833213344056216,"self_citation_contribution":0.42498200160843247,"citation_network_contribution":0.1504274917947512,"self_endowment_contribution":0.42498200160843247,"citer_contribution":0.1504274917947512,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":11,"citers_with_citation_signal":6,"citers_with_endowment":6,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9628,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT03209440"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":665409,"name":"George Fitchett","orcid":"0000-0002-5054-8459","position":1,"is_corresponding":false},{"id":524051,"name":"Yingwei Yao","orcid":"0000-0001-5389-2717","position":2,"is_corresponding":false},{"id":776350,"name":"Tasha M. Schoppee","orcid":"0000-0003-4502-691X","position":3,"is_corresponding":false},{"id":311443,"name":"Marvin Omar Delgado-Guay","orcid":"0000-0002-6431-2658","position":4,"is_corresponding":false},{"id":343755,"name":"Joshua Hauser","orcid":"0000-0003-1512-0702","position":5,"is_corresponding":false},{"id":776351,"name":"Sheri Kittelson","orcid":"0000-0003-1271-0184","position":6,"is_corresponding":false},{"id":516072,"name":"Sean O’Mahony","orcid":"0000-0003-0809-5238","position":7,"is_corresponding":false},{"id":776353,"name":"Michael W. Rabow","orcid":"0000-0002-0095-8951","position":8,"is_corresponding":false},{"id":776352,"name":"Tammie E. Quest","orcid":"0000-0002-9448-4688","position":9,"is_corresponding":false},{"id":877189,"name":"Sheldon Solomon","orcid":"0000-0002-7035-2082","position":10,"is_corresponding":false},{"id":665408,"name":"George Handzo","orcid":"0000-0001-6683-7303","position":11,"is_corresponding":false},{"id":665407,"name":"Harvey Max Chochinov","orcid":"0000-0003-2656-4704","position":12,"is_corresponding":false},{"id":343754,"name":"Linda L. Emanuel","orcid":"0000-0003-4371-1999","position":13,"is_corresponding":false},{"id":445397,"name":"Diana J. Wilkie","orcid":"0000-0002-3954-8933","position":0,"is_corresponding":true}],"reference_count":31,"raw_metadata":null,"created_at":"2026-07-19T01:10:54.145367Z","pmid":"37676977","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}