Dignity Therapy for Patients Near the End of Life (DRAFT)

Mapping Intimacies ◽

10.1093/med/9780190658618.003.0028 ◽

2018 ◽

Author(s):

Marvin Omar Delgado-Guay

Keyword(s):

End Of Life ◽

Clinical Case ◽

Psychological Therapy ◽

Final Version ◽

Dignity Therapy ◽

Existential Distress ◽

Will To Live ◽

Existential Issues

The objective of this study was to establish the feasibility of dignity therapy and determine its impact on psychosocial and existential distress in 100 patients near the end of life. Dignity therapy helped patients to discuss issues that matter most or that they would mostly want to be remembered. Sessions were transcribed and edited, with a returned final version to the patient. This psychological therapy was well accepted, and it did help patients at the end-of-life in many psychosocial and existential issues and increased will to live. This chapter describes the basics of the study, briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case

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Dignity Therapy: A Novel Psychotherapeutic Intervention for Patients Near the End of Life

Journal of Clinical Oncology ◽

10.1200/jco.2005.08.391 ◽

2005 ◽

Vol 23 (24) ◽

pp. 5520-5525 ◽

Cited By ~ 497

Author(s):

Harvey Max Chochinov ◽

Thomas Hack ◽

Thomas Hassard ◽

Linda J. Kristjanson ◽

Susan McClement ◽

...

Keyword(s):

End Of Life ◽

Terminally Ill ◽

Sense Of Purpose ◽

Care Services ◽

Dignity Therapy ◽

Existential Distress ◽

Home Based ◽

Palliative Care Services ◽

Will To Live ◽

Desire For Death

Purpose This study examined a novel intervention, dignity therapy, designed to address psychosocial and existential distress among terminally ill patients. Dignity therapy invites patients to discuss issues that matter most or that they would most want remembered. Sessions are transcribed and edited, with a returned final version that they can bequeath to a friend or family member. The objective of this study was to establish the feasibility of dignity therapy and determine its impact on various measures of psychosocial and existential distress. Patients and Methods Terminally ill inpatients and those receiving home-based palliative care services in Winnipeg, Canada, and Perth, Australia, were asked to complete pre- and postintervention measures of sense of dignity, depression, suffering, and hopelessness; sense of purpose, sense of meaning, desire for death, will to live, and suicidality; and a postintervention satisfaction survey. Results Ninety-one percent of participants reported being satisfied with dignity therapy; 76% reported a heightened sense of dignity; 68% reported an increased sense of purpose; 67% reported a heightened sense of meaning; 47% reported an increased will to live; and 81% reported that it had been or would be of help to their family. Postintervention measures of suffering showed significant improvement (P = .023) and reduced depressive symptoms (P = .05). Finding dignity therapy helpful to their family correlated with life feeling more meaningful (r = 0.480; P = .000) and having a sense of purpose (r = 0.562; P = .000), accompanied by a lessened sense of suffering (r = 0.327; P = .001) and increased will to live (r = 0.387; P = .000). Conclusion Dignity therapy shows promise as a novel therapeutic intervention for suffering and distress at the end of life.

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The need for increased education and training of pharmacy learners in the care of older, critically ill, and end-of-life patients

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab177 ◽

2021 ◽

Author(s):

Marianne F Ivey ◽

Tyler A Vest ◽

David A Zilz

Keyword(s):

End Of Life ◽

Critically Ill ◽

Education And Training ◽

Final Version ◽

Final Article ◽

And Training

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

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Effects of dignity therapy on palliative patients’ family members: A systematic review

Palliative & Supportive Care ◽

10.1017/s147895152100033x ◽

2021 ◽

pp. 1-10

Author(s):

Leonor Grijó ◽

Carolina Tojal ◽

Francisca Rego

Keyword(s):

Systematic Review ◽

Palliative Care ◽

End Of Life ◽

Meaning In Life ◽

Family Members ◽

Cochrane Library ◽

Publication Date ◽

Dignity Therapy ◽

Bibliographic Search ◽

Palliative Patients

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 Therapy: Narratives at the End of Life (FR414)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2015.12.193 ◽

2016 ◽

Vol 51 (2) ◽

pp. 350

Author(s):

Michelle Weckmann ◽

Emily White ◽

Lori Montross Thomas

Keyword(s):

End Of Life ◽

Dignity Therapy

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Spiritual and Existential Issues in the Care of the Dying

Psychosocial Palliative Care ◽

10.1093/med/9780199917402.003.0011 ◽

2014 ◽

pp. 115-126

Author(s):

William S. Breitbart

Keyword(s):

Palliative Care ◽

Terminal Illness ◽

Spiritual Community ◽

Psychotherapeutic Interventions ◽

Existential Distress ◽

Spiritual Issues ◽

Cognitive Therapies ◽

Loss Of Dignity ◽

Existential Issues ◽

Existential Concerns

Spirituality is important in the lives of patients with serious illnesses. Terminally patients may experience a number of spiritual issues, including lack of meaning, guilt, shame, hopelessness, loss of dignity, loneliness, anger toward God, abandonment by God, feeling out of control, grief, and spiritual suffering. Assessment of a patient’s spiritual beliefs, assessing the importance of spirituality in his or her life, exploring whether he or she belongs to a spiritual community, and offering chaplaincy referral or connection with the patient’s religious or spiritual leaders comprise essential components of a spiritual assessment. Psycho-oncologists should seek both specialized training, as well as referrals to appropriate sources, in order to help patients deal more effectively with the often complicated and painful spiritual issues that arise as a consequence of serious illness. Existential concerns are intrinsic to the human experience of facing mortality in palliative care settings. Patients diagnosed with terminal cancer often confront universal existential issues such as death anxiety, isolation, and meaninglessness. Psycho-oncologists must therefore be familiar with these existential concerns, their manifestations, and approaches to deal with existential issues. Psycho-oncologists have the unique ability to use a variety of psychotherapeutic interventions to alleviate existential distress in palliative care settings including cognitive therapies to help patients and families modify their appraisal of their lives with terminal illness, known as cognitive restructuring, life review techniques to facilitate a constructive reappraisal of life events, dignity-conserving therapies, and meaning-centered therapies have been shown to effectively reduce existential distress in this patient population.

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Improving Dignity of Care in Community-Dwelling Elderly Patients with Cognitive Decline and Their Caregivers. The Role of Dignity Therapy

Behavioral Sciences ◽

10.3390/bs10120178 ◽

2020 ◽

Vol 10 (12) ◽

pp. 178

Author(s):

Heifa Ounalli ◽

David Mamo ◽

Ines Testoni ◽

Martino Belvederi Murri ◽

Rosangela Caruso ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Decline ◽

Early Stage ◽

Psychosocial Interventions ◽

The Elderly ◽

Community Dwelling ◽

Anticipatory Grief ◽

Dignity Therapy ◽

Existential Distress ◽

Age Related

Demographic changes have placed age-related mental health disorders at the forefront of public health challenges over the next three decades worldwide. Within the context of cognitive impairment and neurocognitive disorders among elderly people, the fragmentation of the self is associated with existential suffering, loss of meaning and dignity for the patient, as well as with a significant burden for the caregiver. Psychosocial interventions are part of a person-centered approach to cognitive impairment (including early stage dementia and dementia). Dignity therapy (DT) is a therapeutic intervention that has been shown to be effective in reducing existential distress, mood, and anxiety symptoms and improving dignity in persons with cancer and other terminal conditions in palliative care settings. The aims of this paper were: (i) To briefly summarize key issues and challenges related to care in gerontology considering specifically frail elderly/elderly with cognitive decline and their caregivers; and (ii) to provide a narrative review of the recent knowledge and evidence on DT in the elderly population with cognitive impairment. We searched the electronic data base (CINAHL, SCOPUS, PSycInfo, and PubMed studies) for studies regarding the application of DT in the elderly. Additionally, given the caregiver’s role as a custodian of diachronic unity of the cared-for and the need to help caregivers to cope with their own existential distress and anticipatory grief, we also propose a DT-dyadic approach addressing the needs of the family as a whole.

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