**1. Introduction**

#### **1.1. Scientific aim of the project**

**Background:** Despite enormous progress that has been made in reducing the morbidity and mortality from a variety of neoplastic diseases, a large number of cancer patients progress to

advanced stages of malignancy. Such patients are usually referred for palliative care services, and if their prognosis is estimated to be less than 6 months, they are often admitted to the hospice setting [1]. In case of an incurable metastatic cancer, in addition to multiple diseaserelated physical symptoms, many of such patients painfully experience loss of purpose in life and severe distress [2]. Although palliative care is designed to provide holistic comfort care, spiritual and psychosocial support until the end of life (and also during bereavement, for family members), several hospice patients still suffer from psychological distress and decreased quality of life (QoL).

quality of life (QoL) among hospice patients. To respond to this challenge, innovative strategies are necessary. One such exemplary intervention is called dignity therapy (DT) [9]. DT is a psychotherapeutic intervention that was developed by Prof. Chochinov and colleagues, in 2012, in Canada. The main goal of DT is to decrease emotional and spiritual suffering, enhance quality of life, and increase a sense of meaning and purpose of life among terminally ill patients near death. In particular, DT attempts to help such patients reflect upon things that are most meaningful to them, and collect these memories in form of the "final

"Calendarium Vitae" for Hospice Patients and their Caregivers: A Pilot Study

http://dx.doi.org/10.5772/intechopen.70190

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Dignity therapy question protocol (DTQP) is a set of standard questions that a therapist asks during an interview (conveniently conducted at the bedside) with the patient [10]. Evidence from recent research studies (conducted in Canada, Australia, and the USA) has revealed significant reduction of sense of suffering, depressed mood, and improvement in sense of dignity among terminally ill patients [11]. In summary, DT was found to be satisfactory to the patients, helpful to their relatives during grief period, and acceptable to the hospice personnel (e.g., better relations with patients and increased job satisfaction were reported)

The proposed novel pilot study is going to explore the correlations between the perceived distress (anxiety, sadness, and depression) and emotional suffering (related to terminal stages of cancer), and DT intervention (in form of the Calendarium Vitae, CV) in hospice patients.

An analysis of the data from this pilot study is going to answer the following research

**1.** Is the DT intervention (used in the design of this study) feasible for the local hospice

**3.** Can this study estimate some effects in the area of psychological distress, and in quality of

**4.** Can this study assess the effects on psychophysical health of the caregivers (e.g., family members) of the hospice patients that are expected to happen with the DT intervention?

Although many hospice patients suffer from psychological distress (anxiety and depression), they are usually not aware of potential benefits of the DT intervention. According to the scientific literature, implementation of DT, as one of the components of comprehensive palliative care, represents a manageable therapeutic approach to hospice population that might, to some extent, improve coping with end of life psychosocial distress, and alleviate mental and spiritual suffering. Therefore, DT—as an innovative, simple, safe, patient-friendly, and

**2.** In which way the study should be adapted to the local hospice setting?

**2.3. Justification of the innovative character of the study**

life (QoL) that are expected to happen in relation with the DT intervention?

document" [9].

[12, 13].

questions:

system?

**2.2. Justification of the study theme**

To fulfill these unmet needs, novel interventions, able to directly address psychosocial sources of distress, among the hospice patients are needed [3–5]. One such intervention is dignity therapy (DT), defined as a brief, individualized psychotherapy, applied for the purpose of relieving psychological distress at the end of life [6]. Based on scientific evidence from published research in this field, derived from international studies, DT has been shown to be a feasible and effective novel strategy that targets psychophysical suffering in terminally ill patients [7]. In particular, DT attempts to help such patients reflect upon issues that are most meaningful to them, and document them in form of the "final document" [8]. However, DT is unknown in Eastern and Central Europe, and thus should be explored among hospice patients in these countries.

#### **1.2. The study hypothesis**

The study hypothesis is that the proposed pilot study will gather necessary information to create a foundation for a further randomized controlled trial (RCT) that will explore the correlations (or impact) of dignity therapy (DT) intervention with quality of life (QoL), and possible reduction of distress and suffering, among the hospice patients in Eastern and Central Europe.

It is expected that the patients in the DT intervention group (study group, SG) might have improved QoL, compared to the control group (CG), receiving a standard palliative care only. In addition, the caregivers of patients in the DT intervention group (SG) may also have improved QoL and psychophysical health condition during bereavement, compared to the control group (CG).
