Integrating Evidence on Dignity Therapy in Cancer Care: A Review.

Abstract

As psychosocial treatments become increasingly important in palliative care, dignity therapy (DT) emerges as a promising intervention. This systematic review aims to synthesize and critically evaluate the evidence on DT interventions in adults with cancer by integrating findings from randomised controlled trials (RCTs), quasi-experimental, qualitative, and mixed-methods studies. The search terms 'Dignity Therapy' AND 'Cancer' were used to identify RCTs, quasi-experimental, mixed methods and qualitative studies related to DT implemented in adult cancer patients from Scopus and Web of Science databases on 20th November, 2024. Critical Appraisal Skills Programme checklists were used to assess the risk of bias in the studies. Twenty studies were included after a two-stage screening process, out of which 7 were RCTs, 6 were quasi-experimental studies, 5 were qualitative studies and 2 were mixed-method studies. These studies demonstrate that DT enhances dignity, reduces psychological distress and improves family dynamics, particularly in culturally adapted formats. Quantitative findings demonstrate significant improvements in dignity-related outcomes (p < 0.01; d = 1.04-2.45), anxiety (d = 1.73), depression (d = 0.94) and physical symptoms including nausea and insomnia (p < 0.05). Qualitative themes reveal core therapeutic mechanisms: Legacy creation, meaning-making, communion, being heard and cultural adaptation reinforcing DT's psychosocial value. DT was effectively delivered by diverse providers, with family-integrated approaches showing promise in collectivist cultures. The geographical scope restricts generalisability to other cultural settings. High attrition rates (up to 44.2%) and small sample sizes weaken statistical power, and the absence of long-term follow-up data obscures DT's sustained effects. The lack of standardised outcome measures also introduces subjectivity, particularly in qualitative analyses, potentially biasing results. This systematic review concludes that while the report underscores DT's promise in palliative care, mixed findings and methodological gaps highlight the need for more robust, inclusive research to solidify its therapeutic role.