尊嚴療法提升癌末病人尊嚴感之成效

Effectiveness of Dignity Therapy in Enhancing the Sense of Dignity of Terminally Ill Cancer Patients

「尊嚴療法」(dignity therapy, DT)是一種新型、個別化的心理治療，用以提升病人的尊嚴感。本文旨在探討應用尊嚴療法，提升癌末病人尊嚴感之成效與臨床應用。採系統性文獻回顧法，遵循PRISMA(Preferred Reporting Items for Systematic Reviews and Meta-Analyses)準則搜尋從資料庫開始收錄至2021年4月前發表於Embase、Medline(Ovid)及Cochrane Central資料庫之文獻，經篩選、刪除重複文獻及評讀後，納入4篇符合主題之隨機控制試驗進行分析，證據等級為中，GRADE(Grading of Recommendations, Assessment, Development and Evaluations)建議強度為強。尊嚴療法介入成效以尊嚴感為主要結果指標，選用之量表為「病人尊嚴調查問卷(patient dignity inventory, PDI) 」，測量病人過去幾天面臨的生活困擾與心理困擾的程度，以利評估病人與尊嚴相關之受苦。研究結果顯示2篇文獻無顯著差異，2篇文獻應用尊嚴療法於癌末病人照護，比單僅接受生命回顧、以個人為中心的護理或安寧療護等介入措施，能有效提升病人尊嚴感或次要結果指標。臨床建議在癌末病人身體、認知功能尚可配合時宜及早介入，由接受過尊嚴療法正規培訓之醫療人員執行標準化介入措施，有助於提升病人尊嚴感。

Dignity therapy (DT) is a new and individualized psychotherapy aimed at improving patients’ sense of dignity. This study discussed the clinical application of DT and its effectiveness in improving the sense of dignity in patients diagnosed with terminal cancer. The systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, relevant studies published in Embase, Medline (Ovid), and Cochrane Central databases before April 2021 were searched. After eliminating duplicate studies and reviews, 4 studies relevant to the research topic and involving randomized controlled trials were selected for analysis. The 4 studies have medium-level evidence, the grade of recommendation which was rated high by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). The primary outcome indicator of DT is dignity-related distress. Patient Dignity Inventory (PDI) was used to measure the degree of life distress and psychological distress faced by the patient in the past few days. The results of the two studies showed that there is no significant difference in the effectiveness of DT. The other two studies indicated that dignity therapy is more effective than life review, individual-centered care, and palliative care in improving the sense of dignity in patients with terminal cancer as well as their secondary outcome indicators. When the physical and cognitive functions of patients with terminal cancer still allow them to cooperate, dignity therapy intervention should be conducted in a standardized manner by medical professionals who have received formal training to improve the patients’ sense of dignity.