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Abbreviated dignity therapy for adults with advanced-stage cancer and their family caregivers: Qualitative analysis of a pilot study

Published online by Cambridge University Press:  24 July 2018

Adrienne Beck ,
Ann H. Cottingham ,
Patrick V. Stutz ,
Rachel Gruber ,
Jennifer K. Bernat ,
Paul R. Helft ,
Laura Wilhelm ,
Karen Schmidt ,
Madison E. Stout  and
Claire Willard
...Show all authors
Adrienne Beck
Affiliation:
University of Chicago, Chicago, IL
Ann H. Cottingham
Affiliation:
Indiana University School of Medicine, Indianapolis, IN Regenstrief Institute, Inc., Indianapolis, IN
Patrick V. Stutz
Affiliation:
Regenstrief Institute, Inc., Indianapolis, IN
Rachel Gruber
Affiliation:
Regenstrief Institute, Inc., Indianapolis, IN
Jennifer K. Bernat
Affiliation:
Indiana University School of Nursing, Indianapolis, IN
Paul R. Helft
Affiliation:
Indiana University School of Medicine, Indianapolis, IN Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, IN Indiana University-Purdue University Indianapolis Research in Palliative and End of Life Communication and Training Center, Indianapolis, IN Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
Laura Wilhelm
Affiliation:
West Virginia University School of Medicine, Charleston, WV
Karen Schmidt
Affiliation:
Indiana University School of Medicine, Indianapolis, IN
Madison E. Stout
Affiliation:
Regenstrief Institute, Inc., Indianapolis, IN
Claire Willard
Affiliation:
Indiana University School of Medicine, Indianapolis, IN Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, IN Eskenazi Health, Indianapolis, IN
Shelley A. Johns*
Affiliation:
Indiana University School of Medicine, Indianapolis, IN Regenstrief Institute, Inc., Indianapolis, IN Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, IN Indiana University-Purdue University Indianapolis Research in Palliative and End of Life Communication and Training Center, Indianapolis, IN
*
Author for correspondence: Shelley A. Johns, Regenstrief Institute, Inc., 1101 West 10th Street, Indianapolis, IN 46202-4800. E-mail: sheljohn@iu.edu
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Abstract

Objective

Dignity therapy (DT) is designed to address psychological and existential challenges that terminally ill individuals face. DT guides patients in developing a written legacy project in which they record and share important memories and messages with those they will leave behind. DT has been demonstrated to ease existential concerns for adults with advanced-stage cancer; however, lack of institutional resources limits wide implementation of DT in clinical practice. This study explores qualitative outcomes of an abbreviated, less resource-intensive version of DT among participants with advanced-stage cancer and their legacy project recipients.

Method

Qualitative methods were used to analyze postintervention interviews with 11 participants and their legacy recipients as well as the created legacy projects. Direct content analysis was used to assess feedback from the interviews about benefits, barriers, and recommendations regarding abbreviated DT. The legacy projects were coded for expression of core values.

Result

Findings suggest that abbreviated DT effectively promotes (1) self-expression, (2) connection with loved ones, (3) sense of purpose, and (4) continuity of self. Participants observed that leading the development of their legacy projects promoted independent reflection, autonomy, and opportunities for family interaction when reviewing and discussing the projects. Consistent with traditional DT, participants expressed “family” as the most common core value in their legacy projects. Expression of “autonomy” was also a notable finding.

Significance of results

Abbreviated DT reduces resource barriers to conducting traditional DT while promoting similar benefits for participants and recipients, making it a promising adaptation warranting further research. The importance that patients place on family and autonomy should be honored as much as possible by those caring for adults with advanced-stage cancer.

Keywords

Dignity therapyExistentialAutonomyPalliative careAdvanced-stage cancer
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 3 , June 2019 , pp. 262 - 268
Copyright
Copyright © Cambridge University Press 2018 

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References

Aoun, SM, Chochinov, HM, & Kristjanson, LJ (2015) Dignity therapy for people with motor neuron disease and their family caregivers: A feasibility study. Journal of Palliative Medicine 18, 31–37.Google Scholar
Arrieta, Ó, Angulo, LP, Núñez-Valencia, C, et al. (2013) Association of depression and anxiety on quality of life, treatment adherence, and prognosis in patients with advanced non-small cell lung cancer. Annals of Surgical Oncology 20, 1941–1948.10.1245/s10434-012-2793-5Google Scholar
Beebe, J (2001) Rapid assessment process: An introduction. Lanham: AltaMira Press.Google Scholar
Bernat, JK, Helft, PR, Wilhelm, LR, et al. (2015) Piloting an abbreviated dignity therapy intervention using a legacy-building web portal for adults with terminal cancer: A feasibility and acceptability study. Psycho-oncology 24, 1823–1825.10.1002/pon.3790Google Scholar
Chochinov, HM (2012) Dignity therapy: Final words for final days. New York: Oxford University Press.Google Scholar
Chochinov, HM, Hack, T, Hassard, T, et al. (2005) Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. Journal of Clinical Oncology 23, 5520–5525.Google Scholar
Chochinov, HM, Hack, T, McClement, S, et al. (2002) Dignity in the terminally ill: A developing empirical model. Social Science & Medicine 54, 433–443.10.1016/S0277-9536(01)00084-3Google Scholar
Chochinov, HM, Kristjanson, LJ, Breitbart, W, et al. (2011) Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomised controlled trial. The Lancet Oncology 12, 753–762.10.1016/S1470-2045(11)70153-XGoogle Scholar
Ferlay, J, Soerjomataram, I, Dikshit, R, et al. (2015) Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer 136, E359–E386.10.1002/ijc.29210Google Scholar
Fitchett, G, Emanuel, L, Handzo, G, et al. (2015) Care of the human spirit and the role of dignity therapy: A systematic review of dignity therapy research. BMC Palliative Care 14, 1.Google Scholar
Gillies, B and Johnston, G (2004) Identity loss and maintenance: Commonality of experience in cancer and dementia. European Journal of Cancer Care 13, 436–442.10.1111/j.1365-2354.2004.00550.xGoogle Scholar
Goddard, C, Speck, P, Martin, P, et al. (2013) Dignity therapy for older people in care homes: A qualitative study of the views of residents and recipients of “generativity” documents. Journal of Advanced Nursing 69, 122–132.Google Scholar
Hack, TF, McClement, SE, Chochinov, HM, et al. (2010) Learning from dying patients during their final days: Life reflections gleaned from dignity therapy. Palliative Medicine 24, 715–723.10.1177/0269216310373164Google Scholar
Hall, S, Goddard, C, Opio, D, et al. (2012) Feasibility, acceptability and potential effectiveness of Dignity Therapy for older people in care homes: A phase II randomized controlled trial of a brief palliative care psychotherapy. Palliative Medicine 26, 703–712.10.1177/0269216311418145Google Scholar
Hall, S, Goddard, C, Speck, P, et al. (2013) “It makes you feel that somebody is out there caring:” A qualitative study of intervention and control participants’ perceptions of the benefits of taking part in an evaluation of dignity therapy for people with advanced cancer. Journal of Pain and Symptom Management 45, 712–725.Google Scholar
Johns, SA (2013) Translating dignity therapy into practice: Effects and lessons learned. OMEGA-Journal of Death and Dying 67, 135–145.10.2190/OM.67.1-2.pGoogle Scholar
Kissane, DW (2012) The relief of existential suffering. Archives of Internal Medicine 172, 1501–1505.Google Scholar
Martínez, M, Arantzamendi, M, Belar, A, et al. (2016) ‘Dignity therapy’, a promising intervention in palliative care: A comprehensive systematic literature review. Palliative Medicine 31, 492–509.Google Scholar
McClement, S, Chochinov, HM, Hack, T, et al. (2007). Dignity therapy: Family member perspectives. Journal of Palliative Medicine 10, 1076–1082.10.1089/jpm.2007.0002Google Scholar
Montross, L, Winters, K, & Irwin, S (2011) Dignity therapy implementation in a community-based hospice setting. Journal of Palliative Medicine 14, 729–734.Google Scholar
Peterman, AH, Fitchett, G, Brady, MJ, Hernandez, L, & Cella, D (2002) Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy–spiritual well-being scale (FACIT-Sp). Annals of Behavioral Medicine 24, 49–58.Google Scholar