Development And Evaluation Of Family Participatory Dignity Therapy Programme For Patients With Hematological Malignancies

Objectives1.To develop a family participatory dignity therapy programme for Chinese patients with hematological malignancies.2.To evaluate the effects of the FPDT on hope,spiritual well-being,and family cohesion and adaptability among patients with hematological malignancies.3.To evaluate the effects of the FPDT on anxiety,depression,and family cohesion and adaptability among family caregivers for patients with hematological malignancies.Methods1.A mixed-methods approach was applied to develop and revise the program.The FPDT was developed and validated using the Delphi survey,and its further improvement was explored with a simple one-group pre-post trial and semi-structured in-depth interviews.2.A single-blinded,two-arm parallel group,randomized controlled trial was conducted.A total of 68 eligible dyads agreed to participate in this study and were randomly assigned to the intervention group(n = 33)or the control group(n = 35).To evaluate the effects of FPDT on patients’ hope level,spiritual well-being,and family cohesion and adaptability,and their family caregivers’ depression,anxiety,and family cohesion and adaptability at 1-week after the intervention(T1),and at the 4-week follow-up(T2)compared with the control group.In the statistical analysis,two-way variance analysis of repeated measures was applied to the variables time,group,and time vs.group interaction.Independent-samples T test was used for pairwise comparison between two groups,and the paired-samples T test was used to compare outcomes of different time points within group(adjusted α=0.017).Results1.Most of the FPDT items were endorsed by experts and patient-family dyads.The Content Validity Index was 93.6% in the first round of the Delphi survey and 100% in the second round.The “hope,” “spiritual well-being” and “general health” scores of pre-post testing increased from 33.60±4.30 to 37.70±5.10(t=3.99,p=0.003);from30.30±3.65 to 38.80±7.29(t=4.13,p=0.003);and from 41.67±8.78 to 53.33±8.05(t=3.50,p=0.007),respectively.The qualitative data also indicated that the project was meaningful and well received.2.For patients,the results showed a significant difference(p<0.05)in hope,spiritual wellbeing,family cohesion and adaptability between the intervention and control groups.Simultaneously,the difference over time also showed a significant value in family adaptability(p=0.010).The interaction effects were statistically significant(p<0.05)in terms of hope,spiritual well-being,family cohesion and adaptability.The comparison between the intervention group and control group showed that there was a significant difference(p<0.05)in hope,spiritual well-being,family cohesion and adaptability at1-week after the intervention(T1),a significant difference(p<0.05)in hope,family cohesion and adaptability at the 4-week follow-up(T2).For family caregivers,the results showed no significant difference(p>0.05)in anxiety,family cohesion and adaptability between the intervention and control groups.The difference over time showed a significant value in family adaptability(p=0.007).The interaction effects were statistically significant(p<0.05)in terms of anxiety,depression,and family cohesion.The comparison between the intervention group and the control group showed that there was a significant difference(p<0.05)in anxiety,depression,family cohesion and adaptability at 1-week after the intervention(T1),a significant difference(p<0.05)in depression at the 4-week follow-up(T2).The results of this study also showed that the majority of patients(86.21%)and family caregivers(82.76%)gave positive evaluations(very satisfactory and relatively satisfactory)of the FPDT intervention.Conclusions1.FPDT was a valuable and feasible means of improving communication between patients with hematologic malignancies and their family caregivers in China by raising the hope and spiritual well-being,and promoting general health.2.FPDT offers patients with hematologic malignancies and their families an opportunity to talk about important issues and to disclosure mutual true feelings and concerns,facilitating a sincere conversation between them.It shows a positive effect on improving patients’ hope,spiritual well-being,family cohesion and adaptability,as well as alleviating FCs’ anxiety,depression,and enhancing family cohesion and adaptability.It can be used as a family-based psychological intervention in clinical application,but its long-term effect still needs to be further studied.