Effects of dignity therapy on psychological and behavioral outcomes in patients with end-stage renal disease undergoing hemodialysis: A randomized controlled trial.

BACKGROUND

Dignity therapy has been shown to enhance well-being and preserve a sense of dignity in palliative care. Patients with end-stage renal disease receiving hemodialysis also experience persistent threats to dignity related to treatment dependence and disease burden. Evaluating dignity therapy within a chronic illness context may help clarify its potential applicability beyond terminal care settings.

OBJECTIVE

To evaluate whether dignity therapy improves dignity-related distress, treatment adherence, hope, depressive symptoms, and quality of life among patients with end-stage renal disease undergoing maintenance hemodialysis.

DESIGN

A randomized, two-arm, parallel-group controlled trial.

SETTING AND

PARTICIPANTS

Ninety-two patients were recruited between June and July 2025 from two tertiary hemodialysis centers in China and were randomly assigned to the intervention group (n = 46) or the control group (n = 46).

METHODS

The intervention group received routine psychological care plus a contextually and culturally adapted dignity therapy for maintenance hemodialysis; the control group received routine psychological care alone. Outcomes were assessed at baseline and at 2, 4, and 8 weeks post-intervention and measured using the Patient Dignity Inventory, End-Stage Renal Disease Adherence Questionnaire, Herth Hope Index, Patient Health Questionnaire-9, 12-item Short Form Health Survey, and 24-item Kidney Disease Quality of Life instrument. Generalized estimating equations were used for analysis, and a per-protocol analysis was conducted to assess the robustness of the findings.

RESULTS

Dignity therapy significantly reduced overall dignity-related distress (β = -5.59, p = 0.030), with the greatest improvements observed in the dependency (β = -2.46, p = 0.002) and symptom distress (β = -1.37, p = 0.047) domains. At 2 weeks post-intervention, participants receiving dignity therapy also demonstrated higher treatment adherence (β = 6.50, p < 0.001), greater hope (β = 2.28, p = 0.005), and fewer depressive symptoms (β = -2.00, p = 0.011) than controls. However, these improvements diminished by week 8. No significant changes were detected in kidney disease-specific quality-of-life measures. Sensitivity analyses supported the robustness of the primary results.

CONCLUSIONS

Dignity therapy may provide short-term psychological and behavioral benefits for patients with end-stage renal disease receiving hemodialysis. Integrating dignity therapy within a chronic illness adaptation framework could enhance its theoretical coherence and long-term sustainability for non-palliative populations. Further multicenter studies with longer follow-up periods are warranted.

TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2500104449).