July 6, 2011 -- Dignity therapy -- a short course of psychotherapy that focuses on helping patients with terminal illnesses to go over things that are most meaningful to them and document their legacy -- can improve the end-of-life experience, a study shows.
"Dignity therapy can bring comfort and enable a sense of meaning and purpose for someone with life-threatening and life-limiting conditions and allow them to feel that their words will transcend even beyond their death," says study researcher Harvey Max Chochinov, MD, a psychiatrist at the University of Manitoba in Winnipeg, Canada.
The study is published in Lancet Oncology.
What Is Dignity Therapy?
Dignity therapy involves asking questions about life history and work, and helping patients to define and refine what their ultimate legacy is and what they want to pass down to the generations that follow. The form of therapy also encourages saying things to loved ones that have remain unsaid to achieve closure. The therapist then helps the patient craft a meaningful document based on the 60-minute sessions.
Of 326 terminally ill patients who had six months or less to live, those who participated in dignity therapy were more likely to say the treatment was helpful, improved their quality of life, and changed how their family members viewed and appreciated them, compared with patients offered standard end-of-life supportive care that addressed pain, stress, and other symptoms to improve comfort and quality of life.
Dignity therapy can also help relieve sadness and depression but did not show any improvements in distress levels compared with the other therapies, the study shows.
The document or transcript of the sessions provides something tangible to be passed down.
"People use it for a whole variety of purposes, [such as] to apologize for opportunities that were squandered or record biographical information such as the derivation of a daughter's name," Chochinov says. "When you read these documents, you want to walk away and say 'I understand.'"
Cheryl Nekolichuk, PhD, a psychologist at Grey Nuns Community Hospital in Edmonton, Canada, wrote an editorial accompanying the new study. "Dignity therapy is a very effective way for patients to find some meaning and purpose at the end of life and it provides an opportunity for them to share their life story and experiences with family members," she writes.
Healing Family Relations
Gisele Wolf-Klein, MD, the director of geriatric education at the North Shore-Long Island Jewish Health System in New Hyde Park, N.Y., says that dignity therapy is something that many doctors have been providing for a long time, but they didn't have a name for it.
"This is quite a remarkable study," she says. "It shows the incredible impact that the right approach and communication can have on ultimate quality of life."
"When you talk to people about their life, you allow them not to be a naked patient in a gown, but a mother, business executive, or whatever their role is," Wolf-Klein says. "This is much more satisfactory than if you are just treated like a number in a room."
It is about getting to know the person, not the patient, she says. "We want to understand their life history and what their roles have been in their family or community and what have they accomplished and are really proud of."
Donald Schumacher, PsyD, president and CEO of the National Hospice and Palliative Care Organization, a nonprofit group in Alexandria, Va., says that this type of therapy should be offered to all patients with terminal illnesses.
"It is very useful and helpful, and this study does point out very dramatically that people in last stages of life can benefit," he says. "The feeling had been that if you don't have a long time to be in therapy, it won't be helpful, but that is not true."
Dignity therapy "will help patients complete some of their life work and can go a way to healing familial relations that might be undone."