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Abstract
Background
Increasing the quality of life with short interventions for vulnerable patients is
one of the objectives of palliative care. Biographical approaches are used in a range
of different interventions which may require considerable resources of staff time
and energy. This study evaluated the feasibility of training hospice volunteers in
biographical interviews of patients confronted with a life-limiting disease. For the
purpose of this study, we evaluated resources such as time needed for training, coordination
and supervision, outcome such as completion of the intervention in appropriate time
and risks such as causing distress in patients or volunteers as major determinants
of feasibility.
Methods
Nine volunteers from a hospice service attended an advanced training with an introduction
to palliative care, biography work, interview techniques, transcribing and writing.
Volunteers interviewed a patient and developed a written narrative from the interview.
Volunteers completed a questionnaire before training and were interviewed at the end
of the project. The interviews were audiotaped, transcribed, and evaluated using descriptive
and qualitative content analysis.
Results
Patients provided positive feedback from the intervention. Volunteers felt that their
involvement was personally rewarding and were moved by the courage and confidence
of the patients. There were no systematic problems or negative experiences reported
neither by volunteers nor by patients.
Conclusions
We found the use of volunteers for biography work with patients in palliative care
feasible and effective in this study. Volunteers needed supervision and ongoing support
in providing this intervention.
Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face to face panel meeting. The resultant 12 item TIDieR checklist (brief name, why, what (materials), what (procedure), who provided, how, where, when and how much, tailoring, modifications, how well (planned), how well (actual)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with an explanation and elaboration for each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.
This study examined a novel intervention, dignity therapy, designed to address psychosocial and existential distress among terminally ill patients. Dignity therapy invites patients to discuss issues that matter most or that they would most want remembered. Sessions are transcribed and edited, with a returned final version that they can bequeath to a friend or family member. The objective of this study was to establish the feasibility of dignity therapy and determine its impact on various measures of psychosocial and existential distress. Terminally ill inpatients and those receiving home-based palliative care services in Winnipeg, Canada, and Perth, Australia, were asked to complete pre- and post-intervention measures of sense of dignity, depression, suffering, and hopelessness; sense of purpose, sense of meaning, desire for death, will to live, and suicidality; and a post-intervention satisfaction survey. Ninety-one percent of participants reported being satisfied with dignity therapy; 76% reported a heightened sense of dignity; 68% reported an increased sense of purpose; 67% reported a heightened sense of meaning; 47% reported an increased will to live; and 81% reported that it had been or would be of help to their family. Post-intervention measures of suffering showed significant improvement (P = .023) and reduced depressive symptoms (P = .05). Finding dignity therapy helpful to their family correlated with life feeling more meaningful (r = 0.480; P = .000) and having a sense of purpose (r = 0.562; P = .000), accompanied by a lessened sense of suffering (r = 0.327; P = .001) and increased will to live (r = 0.387; P = .000). Dignity therapy shows promise as a novel therapeutic intervention for suffering and distress at the end of life.
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