Aplicación de la Dignity Therapy en pacientes oncológicos en situación avanzada.

The Dignity Therapy was designed to cope with suffering, psychosocial and existential distress among patients with advanced or terminal disease. This paper is a cuasi experimental study with sixteen cancer patients in advanced stages of the disease. The aim of the study is to apply, in our context, the Dignity Therapy as a proposal for intervention for the relief of suffering such patients, in order to assess whether there is pre and post intervention changes. The results of Wilcoxon’s test, show statistically significant differences comparing the pre-intervention and the post-intervention for the variables Anxiety and Well-being. Nevertheless, statistically significant differences are not observed for the variables Depression and Serenity. The subjects agreed to participate voluntarily, and all the subjects felt satisfied after the application of the Dignity Therapy and noted that they found it useful enough or very useful. These results suggest that it is an appropriate therapeutic approach to these patients.La Dignity Therapy fue diseñada para hacer frente al sufrimiento, la angustia psicosocial y existencial entre los pacientes con enfermedad avanzada o terminal. El presente trabajo es un estudio cuasi experimental con dieciséis pacientes oncológicos en estado avanzado de la enfermedad. El objetivo del estudio fue aplicar, en nuestro contexto, la Dignity Therapy como propuesta de intervención para el alivio del sufrimiento a dichos pacientes, evaluando si existen cambios pre y post intervención. Tras obtener resultados mediante la prueba de Wilcoxon, se obtienen diferencias estadísticamente significativas comparando la pre-intervención y la post-intervención para las variables Ansiedad y Bienestar. Sin embargo, no se observa diferencias estadísticamente significativas para las variables Depresión y Serenidad. Los sujetos accedieron a participar de forma voluntaria y todos se sintieron satisfechos tras la aplicación de la Dignity Therapy, destacando que les había resultado bastante útil o muy útil. Estos resultados apuntan a que se trata de un acercamiento terapéutic

Application of dignity therapy in cancer patients in advanced state

The Dignity Therapy was designed to cope with suffering, psychosocial and existential distress among patients with advanced or terminal disease. This paper is a cuasi experimental study with sixteen cancer patients in advanced stages of the disease. The aim of the study is to apply, in our context, the Dignity Therapy as a proposal for intervention for the relief of suffering such patients, in order to assess whether there is pre and post intervention changes. The results of Wilcoxon’s test, show statistically significant differences comparing the pre-intervention and the post-intervention for the variables Anxiety and Well-being. Nevertheless, statistically significant differences are not observed for the variables Depression and Serenity. The subjects agreed to participate voluntarily, and all the subjects felt satisfied after the application of the Dignity Therapy and noted that they found it useful enough or very useful. These results suggest that it is an appropriate therapeutic approach to these patients

Internet-based Cognitive Behavioral Therapy for Depression : An Individual Patient Data Network Meta-Analysis

This is the author accepted manuscript. The final version is available from the American Medical Association via the DOI in this recordNote the slight change of title between acceptance and publicationImportance Personalized treatment choices would increase the effectiveness of internet-based cognitive behavioral therapy (iCBT) for depression to the extent that patients differ in interventions that better suit them. Objective To provide personalized estimates of short-term and long-term relative efficacy of guided and unguided iCBT for depression using patient-level information. Data Sources We searched PubMed, Embase, PsycInfo, and Cochrane Library to identify randomized clinical trials (RCTs) published up to January 1, 2019. Study Selection Eligible RCTs were those comparing guided or unguided iCBT against each other or against any control intervention in individuals with depression. Available individual patient data (IPD) was collected from all eligible studies. Depression symptom severity was assessed after treatment, 6 months, and 12 months after randomization. Data Extraction and Synthesis We conducted a systematic review and IPD network meta-analysis and estimated relative treatment effect sizes across different patient characteristics through IPD network meta-regression. Main Outcomes and Measures Patient Health Questionnaire–9 (PHQ-9) scores. Results Of 42 eligible RCTs, 39 studies comprising 9751 participants with depression contributed IPD to the IPD network meta-analysis, of which 8107 IPD were synthesized. Overall, both guided and unguided iCBT were associated with more effectiveness as measured by PHQ-0 scores than control treatments over the short term and the long term. Guided iCBT was associated with more effectiveness than unguided iCBT (mean difference [MD] in posttreatment PHQ-9 scores, −0.8; 95% CI, −1.4 to −0.2), but we found no evidence of a difference at 6 or 12 months following randomization. Baseline depression was found to be the most important modifier of the relative association for efficacy of guided vs unguided iCBT. Differences between unguided and guided iCBT in people with baseline symptoms of subthreshold depression (PHQ-9 scores 5-9) were small, while guided iCBT was associated with overall better outcomes in patients with baseline PHQ-9 greater than 9. Conclusions and Relevance In this network meta-analysis with IPD, guided iCBT was associated with more effectiveness than unguided iCBT for individuals with depression, benefits were more substantial in individuals with moderate to severe depression. Unguided iCBT was associated with similar effectiveness among individuals with symptoms of mild/subthreshold depression. Personalized treatment selection is entirely possible and necessary to ensure the best allocation of treatment resources for depression.National Institute for Health Research (NIHR)Netherlands Organization for Health Research and Development (NWO)Swiss National Science Foundation (SNSF