Therapeutic Support to Strengthen Dignity, Mental Well-being and Quality of Life in Acute Palliative Care Patients.

Patient with a life-limiting serious illness commonly experience substantial emotional and spiritual distress, death anxieties, depressive symptoms and loss of dignity and purpose in life. Fostering dignity and meaning and relieving psychological distress have been identified as a core objective for end-of-life care. However, individual's needs for dignity and psychological support at the end of life may vary. Therefore, a personalized approach is needed. On the basis of theoretical frameworks and existing dignityfostering and meaning based interventions, and a workshop with international experts in the field of palliative care, we have developed a personalized modular intervention, consisting of three modules, including CALM Therapy, Dignity Therapy, and a mindfulness-based intervention.

The overall purpose of this study is to test the efficacy of the designed personalized modular intervention compared to the specialized palliative care service at the swiss acute palliative hospital care.

Patients are randomized to either receiving standard specialized palliative consultation (SSPC) and the modular intervention or standard palliative consultation services alone. Within the intervention group, participants can choose one of the three modules based on personal preference and the recommendation of the palliative care team (based on assessment). All three interventions consist of two structured sessions.

The control group will receive SSPC alone. According to needs standard specialized palliative care will include support of symptom control, shared decision making/ advance care planning, network planning and support of relatives.

SSPC is performed by specialized inter-professional palliative care service, including doctors and advanced nurse practitioners, certified by national standards for specialist palliative care. Other professions are involved depending on needs. Patients are seen as required at least twice a week.

Patients will be asked to fill in a set of questionnaires at baseline (T0), after the completion of the intervention (T1) and at 1-month follow-up (T2). A brief semi-structured qualitative interview will be conducted with the patients following completion of the intervention to assess perceived benefits and challenges of the intervention.

The primary objective is to evaluate if mental well-being tend to improve over the pre- versus post study design as measured by the Patient Dignity Inventory and if this effect is significantly larger in the modular intervention group as compared to the standard specialized palliative consultation (SSPC) group.

Inclusion criteria

• Informed Consent
• Patients seen by the palliative consultation-liaison service at the University Hospital Basel as an in- or outpatient
• Suffering from a life-limiting serious illness (≤ 18 months)
• ≥ 18 years of age
• Willingness and capacity to commit to three study visits

Exclusion criteria

• Delirious (ICD-10: F05.9)
• Inability to give consent (lack of decisional capacity to consent)
• Inability to follow the procedures of the study due to psychological disorders, dementia, or other cognitively impairment of the participant,
• Too ill to complete the requirements of the protocol
• Unable to understand, speak and read German