Exploring the therapeutic power of narrative at the end of life: a qualitative analysis of narratives emerging in dignity therapy

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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Factors affecting quality of end-of-life hospital care - a qualitative analysis of free text comments from the i-CODE survey in Norway

BMC Palliative Care ◽

10.1186/s12904-020-00609-x ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Marit Irene Tuen Hansen ◽

◽

Dagny Faksvåg Haugen ◽

Katrin Ruth Sigurdardottir ◽

Anne Kvikstad ◽

...

Keyword(s):

Qualitative Analysis ◽

End Of Life ◽

Hospital Care ◽

Free Text ◽

Factors Affecting

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“Sharing in hopes and worries”—a qualitative analysis of the delivery of compassionate care in palliative care and oncology at end of life

International Journal of Qualitative Studies on Health and Well-Being ◽

10.1080/17482631.2019.1622355 ◽

2019 ◽

Vol 14 (1) ◽

pp. 1622355 ◽

Cited By ~ 2

Author(s):

Sarah Bessen ◽

Raina H. Jain ◽

W. Blair Brooks ◽

Manish Mishra

Keyword(s):

Palliative Care ◽

Qualitative Analysis ◽

End Of Life ◽

Compassionate Care

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Effect of Dignity Therapy on Distress and End-of-Life Experience in Terminally Ill Patients: A Randomised Controlled Trial

FOCUS The Journal of Lifelong Learning in Psychiatry ◽

10.1176/appi.focus.11.4.576 ◽

2013 ◽

Vol 11 (4) ◽

pp. 576-587 ◽

Cited By ~ 1

Author(s):

Harvey Max Chochinov ◽

Linda J Kristjanson ◽

William Breitbart ◽

Susan McClement ◽

Thomas F Hack ◽

...

Keyword(s):

Randomised Controlled Trial ◽

End Of Life ◽

Life Experience ◽

Controlled Trial ◽

Terminally Ill ◽

Terminally Ill Patients ◽

Dignity Therapy ◽

Randomised Controlled

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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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