Acceptability and Feasibility of a Personalized, Modular Intervention to Promote Dignity, Meaning and Mindfulness in Palliative Patients in a Swiss Acute-Care Hospital: A Single-Center Feasibility Study

Abstract Background Patients with a life-limiting serious disease commonly experience substantial emotional and spiritual distress, death anxiety, depressive symptoms and loss of dignity. Fostering dignity and meaning and relieving psychological distress are central objectives of palliative care. To address the heterogeneous and individual needs of palliative patients, a personalized, modular intervention approach was developed for the acute care setting, consisting of Dignity Therapy, modified CALM Therapy and a mindfulness-based intervention (MBI). Aim We aimed to evaluate the acceptability of the modular intervention and assess feasibility in terms of eligibility, recruitment, retention, intervention completion and questionnaire completion; exploratory pre-post patient-reported outcomes were also examined. Methods In this single-center feasibility study, inpatients and outpatients receiving palliative consultation-liaison care at University Hospital Basel were screened for eligibility during 16 recruitment months between February 2020 and September 2023. Participants received standard specialized palliative consultation service plus one selected module of the personalized intervention: Dignity Therapy, modified CALM Therapy or an MBI. Acceptability was assessed using a post-intervention semi-structured interview with Likert-scale items and open questions. Feasibility was assessed using eligibility, recruitment, retention, intervention-completion and questionnaire-completion rates. Exploratory pre-post patient-reported outcomes included the Patient Dignity Inventory (PDI), Death and Dying Distress Scale (DADDS) and Patient Health Questionnaire-9 (PHQ-9). Results Of 580 screened patients, 79 (13.6%) were eligible and 12/79 eligible patients (15.2%) agreed to participate. Ten of 12 participants completed the post-intervention assessment and were included in the study, corresponding to a retention rate of 83.3%. During the final three months of recruitment, 26/108 screened patients (24.1%) were eligible and 6/26 eligible patients (23.1%) participated. Participants who completed the post-study interview rated the chosen module as highly helpful (mean 4.8, SD 0.42). Exploratory pre-post analyses suggested a reduction in PDI and PHQ-9 scores. Conclusion The personalized modular intervention was acceptable among participants who completed the evaluation, but recruitment and intervention completion remained challenging in the acute palliative care setting. The exploratory findings support further evaluation in a controlled trial before conclusions can be drawn about efficacy or routine implementation. Trial registration ClinicalTrials.gov NCT03744442. Trial registration ClinicalTrials.gov NCT03744442, prospectively registered on Nov 13th, 2018.