Dignity therapy improves end-of-life experience

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A form of psychotherapy designed to relieve distress for dying patients and their families showed great effectiveness in a recent study.

 “Although the ability of dignity therapy to mitigate outright distress such as depression, desire for death, or suicidality has yet to be proven, its benefits in terms of self-reported end-of-life experiences support its clinical application for patients nearing death,” wrote a research group headed by Harvey Max Chochinov, MD, of the University of Manitoba in Winnipeg, Canada, in an online report for The Lancet Oncology.

The investigators describe dignity therapy as a unique, individualized, short-term form of psychotherapy that was developed for patients (and their families) living with life-threatening or life-limiting illness. Patients are asked to discuss any matters that might enhance a sense of meaning, purpose, continued sense of self, and overall sense of dignity—for example, they can talk about their most important accomplishments and life roles, their greatest sources of pride, or how they would like their family members to remember them. In this study, dignity therapy was provided by a psychologist, a psychiatrist, or an experienced palliative care nurse.

The international team of researchers analyzed the end-of-life experience of 326 terminally ill patients (life expectancy 6 months or less), aged 18 years and older, who were receiving palliative care in hospitals, in hospices, or at home in Canada, the United States, and Australia. One-third (108) of the patients were assigned to dignity therapy, 107 to client-centered care (in which a research nurse therapist guided participants through discussions focusing on here-and-now issues such as their illness and symptoms), and 111 to standard palliative care (which gave these and all study patients access to all available palliative care support services including physicians and nurses specializing in the management of pain and symptoms, social workers, chaplains, and psychologists and psychiatrists; dignity therapy was not provided as part of these services).         

Outcomes were assessed using five instruments such as the Patient Dignity Inventory and the Hospital Anxiety and Depression Scale, as well as through patient surveys completed at the end of the study. Compared with persons in the other two interventions, those receiving dignity therapy were significantly more likely to report that the approach was helpful and that it improved their quality of life, increased their sense of dignity, changed how their family saw and appreciated them, and was helpful to their family. This intervention also significantly outperformed client-centered care in improving the patient's spiritual well-being, and was significantly better than standard palliative care in terms of lessening sadness or depression.

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