Telling it like it was: dignity therapy and moral reckoning in palliative care

Abstract Objective Dignity therapy (DT) is a kind of psychotherapy that identifies the main concerns of end-of-life patients that affect their perception of dignity and helps them to find a new meaning in life. Most prior studies on DT analyze outcomes for palliative care patients. The aim of this systematic review is to explore the outcomes of DT in palliative care patients’ family members. Method In June 2020, a bibliographic search was performed using the terms “Dignity Therapy” and “Palliative Care” in the following databases: Cochrane library, TRIP database, PUBMED, Scopus, and Web of Knowledge. Of the 294 articles found, 8 met the selection criteria and were considered in the present study. No articles were excluded based on their publication date. Results Family members generally believe that DT helps them to better prepare the patient's end-of-life and overcome the bereavement phase. The legacy document was considered a source of comfort, and most would recommend DT to other people in their situation. DT is generally considered as important as any other aspect of the patient's treatment. Significance of results There is evidence of the benefits of DT for palliative patients’ family members. However, there are still few studies that evaluate these outcomes. The existing evidence is poorly generalized, and thus, further studies are needed to deeply explore the benefits of this therapy both for patients and their families.

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Dignity Therapy for End-of-Life Care Patients: A Literature Review

Journal of Patient Experience ◽

10.1177/2374373521996951 ◽

2021 ◽

Vol 8 ◽

pp. 237437352199695

Author(s):

Pearl Ed Cuevas ◽

Patricia Davidson ◽

Joylyn Mejilla ◽

Tamar Rodney

Keyword(s):

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Cultural Context ◽

Age Groups ◽

Empirical Support ◽

Family Care ◽

Life Care ◽

Dignity Therapy ◽

Meta Analyses

Dignity therapy as an intervention has been used for individuals receiving palliative care. The goal of this review is to explore the current state of empirical support to its use for end-of-life care patients. Data sources were articles extracted from search engines PubMed, Cochrane, Embase, CINAHL, Web of Science, and PsycINFO. The years searched were 2009 to 2019 (10-year period). The review process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results revealed the feasibility, acceptability, satisfaction, and effectiveness of dignity therapy for life-limiting cases/conditions of patients in different age groups. It also highlighted the importance of the therapy setting and the need to apply this in the cultural context. The meaning of dignity therapy to patients and their family care members also emerged. Findings showed most patients displayed the need to leave a legacy and from this their core values surfaced. In conclusion, this review highlighted the contribution of dignity therapy to the holistic care of patients who hope to leave a legacy. The therapy was also relevant to decrease the anxiety; depression, and burden of family members throughout the palliative care period of their loved ones.

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Dignity Impact as a Primary Outcome Measure for Dignity Therapy

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118777987 ◽

2018 ◽

Vol 35 (11) ◽

pp. 1417-1420 ◽

Cited By ~ 5

Author(s):

Lisa Scarton ◽

Sungho Oh ◽

Ashley Sylvera ◽

Ralph Lamonge ◽

Yingwei Yao ◽

...

Keyword(s):

Palliative Care ◽

Primary Outcome ◽

Outcome Measure ◽

Meaning Making ◽

Controlled Trial ◽

Intervention Group ◽

Primary Outcome Measure ◽

Care Group ◽

Dignity Therapy ◽

Feedback Questionnaire

Background: Feasibility of dignity therapy (DT) is well established in palliative care. Evidence of its efficacy, however, has been inconsistent and may stem from DT’s primary effects differing from the outcomes measured in previous studies. We proposed that DT effects were in the spiritual domain and created a new outcome measure, Dignity Impact Scale (DIS), from items previously used in a large randomized controlled trial (RCT). Objective: The purpose of this secondary analysis study was to examine properties of a new measure of dignity impact. Design: Using the DIS, we conducted reanalysis of posttest data from a large 3-arm, multi-site RCT study. Setting/Participants: Participants were receiving hospice/palliative care (n = 326, 50.6% female, mean age = 65.1 years, 89.3% white, all with a terminal illness with 6 months or less life expectancy). They had been randomized to standard palliative care (n = 111), client-centered care (n = 107), or DT (n = 108). Measurement: The 7-item DIS was derived from selected items in a posttest DT Patient Feedback Questionnaire. The DIS had strong internal consistency (α = 0.85). Results: The DT group mean DIS score (21.4 ± 5.0) was significantly higher than the usual care group mean score (17.7 ± 5.5; t = 5.2, df = 216, P < .001) and a client-centered intervention group mean score (17.9 ± 4.9; t = 5.2, df = 213, P < .001). Conclusion: We found that, compared to both other groups, patients who received DT reported significantly higher DIS ratings, which is consistent with the DT focus on meaning-making, preparation for death, and life completion tasks. We propose that the DIS be used as the primary outcome measure in evaluating the effects of DT.

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Creating Discursive Order at the End of Life

Written Communication ◽

10.1177/0741088312439877 ◽

2012 ◽

Vol 29 (2) ◽

pp. 111-141 ◽

Cited By ~ 7

Author(s):

Catherine Schryer ◽

Allan McDougall ◽

Glendon R. Tait ◽

Lorelei Lingard

Keyword(s):

Palliative Care ◽

Life Events ◽

Genre Studies ◽

Psychotherapeutic Intervention ◽

Interview Protocol ◽

Dignity Therapy ◽

Dying Patients ◽

Rhetorical Genre ◽

Clinically Significant ◽

Genre Ecology

This article investigates an emerging practice in palliative care: dignity therapy. Dignity therapy is a psychotherapeutic intervention that its proponents assert has clinically significant positive impacts on dying patients. Dignity therapy consists of a physician asking a patient a set of questions about his or her life and returning to the patient with a transcript of the interview. After describing the origins of dignity therapy, the authors use a rhetorical genre studies framework to explore what the dignity interview is doing, how it shapes patients’ responses, and how patients improvise within the dignity interview’s genre ecology. Based on a discourse analysis of the interview protocol and 12 dignity interview transcripts (legacy documents) gathered in two palliative care settings in Canadian hospitals, the findings suggest that these patients appear to be using the material and genre resources (especially eulogistic strategies) associated with dignity therapy to create discursive order out of their life events. This process of genre negotiation may help to explain the positive psychotherapeutic results of dignity therapy.

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A prospective evaluation of Dignity Therapy in advanced cancer patients admitted to palliative care

Palliative Medicine ◽

10.1177/0269216313514883 ◽

2013 ◽

Vol 28 (5) ◽

pp. 448-458 ◽

Cited By ~ 40

Author(s):

Lise J Houmann ◽

Harvey M Chochinov ◽

Linda J Kristjanson ◽

Morten Aa Petersen ◽

Mogens Groenvold

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Prospective Evaluation ◽

Advanced Cancer Patients ◽

Dignity Therapy

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Effect of dignity therapy on end-of-life psychological distress in terminally ill Portuguese patients: A randomized controlled trial

Palliative & Supportive Care ◽

10.1017/s1478951516001140 ◽

2017 ◽

Vol 15 (6) ◽

pp. 628-637 ◽

Cited By ~ 22

Author(s):

Miguel Julião ◽

Fátima Oliveira ◽

Baltazar Nunes ◽

António Vaz Carneiro ◽

António Barbosa

Keyword(s):

Palliative Care ◽

Randomized Controlled Trial ◽

Psychological Distress ◽

End Of Life ◽

Controlled Trial ◽

Terminally Ill ◽

Control Group ◽

Randomized Controlled ◽

Dignity Therapy ◽

Desire For Death

ABSTRACTObjective:Dignity therapy (DT) is a brief form of psychotherapy developed for patients living with a life-limiting illness that has demonstrated efficacy in treating several dimensions of end-of-life psychological distress. Our aim was to determine the influence of DT on demoralization syndrome (DS), the desire for death (DfD), and a sense of dignity (SoD) in terminally ill inpatients experiencing a high level of distress in a palliative care unit.Method:A nonblinded phase II randomized controlled trial was conducted with 80 patients who were randomly assigned to one of two groups: the intervention group (DT + standard palliative care [SPC]) or the control group (SPC alone). The main outcomes were DS, DfD, and SoD, as measured according to DS criteria, the Desire for Death Rating Scale, and the Patient Dignity Inventory (PDI), respectively. All scales were assessed at baseline (day 1) and at day 4 of follow-up. This study is registered with http://www.controlled-trials.com/ISRCTN34354086.Results:Of the 80 participants, 41 were randomized to DT and 39 to SPC. Baseline characteristics were similar between the two groups. DT was associated with a significant decrease in DS compared with SPC (DT DS prevalence = 12.1%; SPC DS prevalence = 60.0%; p < 0.001). Similarly, DT was associated with a significant decrease in DfD prevalence (DT DfD prevalence = 0%; SPC DfD prevalence = 14.3%; p = 0.054). Compared with participants allocated to the control group, those who received DT showed a statistically significant reduction in 19 of 25 PDI items.Significance of results:Dignity therapy had a beneficial effect on the psychological distress encountered by patients near the end of life. Our research suggests that DT is an important psychotherapeutic approach that should be included in clinical care programs, and it could help more patients to cope with their end-of-life experiences.

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Dignity Therapy and Life Review for Palliative Care Patients: A Qualitative Study

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2017.07.016 ◽

2017 ◽

Vol 54 (4) ◽

pp. 530-537.e1 ◽

Cited By ~ 8

Author(s):

Dean Vuksanovic ◽

Heather Green ◽

Shirley Morrissey ◽

Sharelle Smith

Keyword(s):

Palliative Care ◽

Qualitative Study ◽

Life Review ◽

Dignity Therapy

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Providing dignity therapy to patients with advanced cancer: a feasibility study within the setting of a hospital palliative care unit

BMC Palliative Care ◽

10.1186/s12904-021-00821-3 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Francesca Nunziante ◽

Silvia Tanzi ◽

Sara Alquati ◽

Cristina Autelitano ◽

Enrica Bedeschi ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Real Life ◽

Hospital Setting ◽

Palliative Care Unit ◽

Evaluation Procedure ◽

Advanced Cancer Patients ◽

Dignity Therapy ◽

Feedback Questionnaire

Abstract Background Dignity is a basic principle of palliative care and is intrinsic in the daily practice of professionals assisting individuals with incurable diseases. Dignity Therapy (DT) is a short-term intervention aimed at improving the sense of purpose, meaning and self-worth and at reducing the existential distress of patients facing advanced illness. Few studies have examined how DT works in countries of non-Anglo Saxon culture and in different real-life settings. Moreover, most studies do not provide detailed information on how DT is conducted, limiting a reliable assessment of DT protocol application and of its evaluation procedure. The aim of this study was to assess the feasibility and acceptability of a nurse-led DT intervention in advanced cancer patients receiving palliative care. Method This is a mixed-method study using before and after evaluation and semistructured interviews. Cancer patients referred to a hospital palliative care unit were recruited and provided with DT. The duration of sessions, and timeframes concerning each step of the study, were recorded, and descriptive statistical analyses were performed. The patients' dignity-related distress and feedback toward the intervention were assessed through the Patient Dignity Inventory and the Dignity Therapy Patient Feedback Questionnaire, respectively. Three nurses were interviewed on their experience in delivering the intervention, and the data were analyzed qualitatively. Results A total of 37/50 patients were enrolled (74.0%), of whom 28 (75.7%) completed the assessment. In 76.7% of cases, patients completed the intervention in the time limit scheduled in the study. No statistically significant reduction in the Patient Dignity Inventory scores was observed at the end of the intervention; most patients found DT to be helpful and satisfactory. Building opportunities for personal growth and providing holistic care emerged among the facilitators to DT implementation. Nurses also highlighted too great of a time commitment and a difficult collaboration with ward colleagues among the barriers. Conclusions Our findings strongly support the acceptability, but only partially support the feasibility, of nurse-led DT in advanced cancer patients in a hospital setting. Further research is needed on how to transfer the potential benefits of DT into clinical practice. Trial registration Retrospectively registered on ClinicalTrial.gov NCT04738305.

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Patients’ priorities in a reminiscence and legacy intervention in palliative care

Palliative Care and Social Practice ◽

10.1177/2632352419892629 ◽

2019 ◽

Vol 13 ◽

pp. 263235241989262

Author(s):

Michaela Hesse ◽

Simon Forstmeier ◽

Gülay Ates ◽

Lukas Radbruch

Keyword(s):

Palliative Care ◽

Well Being ◽

Life Review ◽

University Hospital ◽

Self Awareness ◽

Growing Up ◽

Philosophy Of Life ◽

Dignity Therapy ◽

And Coping ◽

The University

Background: Reminiscence is used in a range of different interventions in palliative care, for example, Dignity Therapy or Life Review. However, literature has focused mainly on the methodology, and little has been published on patients’ priorities and primary concerns. Objective: This study looks at themes emerging in a reminiscence intervention with patients confronted with a life-limiting disease. Interviews were audiotaped and transcribed verbatim. Transcripts were analysed using thematic analysis. Setting/subjects: Seventeen patients who were receiving palliative care at the University Hospital Bonn participated in interviews reviewing parts or phases of their lives. Results: Patients expressed satisfaction and a sense of well-being with the intervention. Major themes emerging in the interviews were the factors involved in the development and expression of personality, such as character-forming influences, self-image, self-awareness, and philosophy of life. Talking about personality was entangled with influences from growing up, qualification/job, partner/spouse, children, resources, twists of fate/crossroads, and coping. Conclusion: The topics emerging from the interviews differed from the scope of guiding questions in common reminiscence methods like Life Review or Dignity Therapy. The underlying motivation of patients seemed to be the search for identity and continuity in one’s life.

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