Effects of dignity therapy on psychological distress and wellbeing of palliative care patients and family caregivers - a randomized controlled study.

BACKGROUND: This study extended the original Dignity Therapy (DT) intervention by including partners and family caregivers (FCs) of terminally-ill cancer patients with the overall aim of evaluating whether DT can mitigate distress in both patients nearing the end of life and their FCs. METHODS: In this multicenter, randomized controlled trial (RCT), a total of 68 patients with life expectancy < 6 months and clinically-relevant stress levels (Hospital Anxiety Depression total score; HADStot ≥ 8) including their FCs were randomly assigned to DT, DT + (including their FCs), or standard palliative care (SPC) in a 1:1:1 ratio. Study participants were asked to complete a set of questionnaires pre- and post-intervention. RESULTS: The coalesced group (DT and DT +) revealed a significant increase in patients' perceived quality of life (FACIT-Pal-14) following the intervention (mean difference 6.15, SD = 1.86, p < 0.01). We found a statistically significant group-by-time interaction effect: while the HADStot of patients in the intervention group remained stable over the pre-post period, the control group's HADStot increased (F = 4.33, df = 1, 82.9; p < 0.05), indicating a protective effect of DT. Most patients and their FCs found DT useful and would recommend it to other individuals in their situation. CONCLUSIONS: The DT intervention has been well-received and shows the potential to increase HRQoL and prevent further mental health deterioration, illness burden and suffering in terminally-ill patients. The DT intervention holds the potential to serve as a valuable tool for facilitating end-of-life conversations among terminally-ill patients and their FCs. However, the implementation of DT within the framework of a RCT in a palliative care setting poses significant challenges. We suggest a slightly modified and less resource-intensive version of DT that is to provide the DT inventory to FCs of terminally-ill patients, empowering them to ask the questions that matter most to them over their loved one's final days. TRIAL REGISTRATION: This study was registered with Clinical Trial Registry (ClinicalTrials.gov -Protocol Record NCT02646527; date of registration: 04/01/2016). The CONSORT 2010 guidelines were used for properly reporting how the randomized trial was conducted.

Evaluation of knowledge about gestational diabetes mellitus among postpartum women and its connection with women's sociodemographic and clinical characteristics: a quantitative cross-sectional study.

OBJECTIVE: to define the knowledge level among postpartum women affected by gestational diabetes and identify its association with women's sociodemographic and clinical characteristics. DESIGN AND SETTING: a cross-sectional comparative study was conducted. Data collection took place in a single university hospital in the German speaking part of Switzerland. PARTICIPANTS: a total of 107 postpartum women diagnosed with gestational diabetes in the current pregnancy completed a gestational diabetes mellitus specific knowledge questionnaire (GDMKQ) in German or English in their postpartum period. Further, sociodemographic and clinical characteristics were collected. RESULTS: Women were between 24 and 45 years old, 56.1% had an academic degree, 60.7% were migrant women coming mainly from other European countries, 17.8% had a previous history of gestational diabetes, and 31.8% had a family history of diabetes. As measured with the GDMKQ, women with a higher educational level obtained higher scores and therefore showed a better knowledge level about gestational diabetes compared to women with primary and secondary educational levels (M 13.3 vs M 11.1 and 12.5; χ2 (2) = 13.003, p = .002). In addition, women with a previous history of gestational diabetes also reached higher scores compared to women with no history of gestational diabetes (M 13.6 vs M 12.5, Z = - 2.278, p = .023). CONCLUSION AND IMPLICATION FOR PRACTICE: Even if the knowledge status among women attending this single Swiss hospital is presently very good, a lower educational level was associated with a lower knowledge level and identified as the main factor to hinder women's comprehension of gestational diabetes. More individually tailored consultations by health care professionals may serve to meet women's needs more adequately and support them better in the understanding of their condition.

Implementing Family Systems Care Through an Educational Intervention With Nurses and Midwives in Obstetrics and Gynecological Care: A Mixed-Methods Evaluation.

This mixed-methods study examined Family Systems Care (FSC) implementation through a 1-day educational session combined with 4 months of guided application of FSC knowledge and skills in obstetrics and gynecology settings. Nurses and midwives' (n = 47) attitudes toward families and their practice skills with families were assessed before the educational intervention began (Time 0), after the completion of the 1-day educational session (Time 1), and after 4 months of the FSC guided implementation phase that included coaching and mentoring (Time 2). Four focus groups with the nurses and midwives explored their FSC implementation experiences. Participants reported an initial drive to implement FSC, which faltered over time. A perceived fit to the needs of families in obstetrics and gynecology, a supportive context, and facilitated learning on the units promoted FSC uptake. Participants understood FSC as: (a) involving family members in care, a practice they felt confident about; (b) assessing families' situations, needs, concerns, which were practices that were new and stressful; and (c) offering family nursing interventions, which they felt insufficiently prepared for. Practice skills in FSC increased after the 1-day educational session but decreased to baseline after the FSC guided implementation phase. Attitudes of the nurses and midwives toward the families did not change. Following the education and guided implementation, participants' ability to work with families in a relational, systemic way could not be fully established or sustained.