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Dignity therapy is a short-term psychotherapy used with patients towards the end of life to address existential distress. Chochinov developed the initial dignity therapy protocol, which is comprised of nine standard questions used in a conversation with a patient. The conversation is recorded, transcribed, edited, and then presented back to the patient. The patient can then present it to their chosen family as a document of their life. The goal is to instill a sense of value about their life and opinions, which can lead to improved dignity and patient experience as end of life approaches.
Dignity therapy has been studied in home care, oncology outpatient clinics and palliative care units. Both patients and family have reported positive outcomes from the engaging in the dignity therapy process, with patients experiencing high level of distress reporting greater benefit. While the literature describes positive benefits of dignity therapy for patients and family, few studies have assessed organizational feasibility, including time to deliver the intervention and cost. Kelly, 2023 conducted a study to assess the effect and feasibility of introducing dignity therapy into an established, hospital-based cancer care service.
Participants were recruited from an Australian ambulatory cancer treatment centre and randomly assigned to the intervention or control group for this feasibility study. Control group participants received standard care which included legacy document preparation, if requested by the patient. The intervention group attended individual dignity therapy sessions with a trained therapist. The therapist transcribed the conversation verbatim, edited the document and met with the participant again to review the document. Participants had an opportunity to request changes and once finalized the document was given to the participant.
Both control and intervention group participants completed the Patient Distress Thermometer and Patient Dignity Inventory at the time of recruitment and again 4-weeks later. Intervention group participants also completed a dignity therapy participant feedback questionnaire following the intervention.
The feasibility of implementing the intervention focussed on practicality by examining costs and availability of resources. The total time to deliver the intervention to each patient as well as the amount of time spent on each component of the process were recorded. The therapist’s notes were reviewed to identify resource challenges.
Fifteen patients completed the study. Patients randomized to the dignity therapy intervention reported lower distress compared to the control group at 4 weeks. All participants in the intervention group strongly agreed with the statement, “dignity therapy has been helpful to me”. The total average time to deliver dignity therapy was 10 hours, with most of the time spent transcribing and editing manuscripts. This equated to a cost of approximately $600 per participant. Time constraints of therapists and access to a quiet space were noted as resource limitations.
The authors concluded that although the study involved a small sample, there are benefits for patients participating in a dignity therapy intervention. The findings of this study can be used to develop realistic business plans for sustainable dignity therapy programs.
Source: Kelly, C., Kynoch, K., & Ramis, M. A. (2023). Implementing Dignity Therapy Service into an Acute Cancer Care Setting–A Feasibility Study. Journal of Palliative Care, 08258597231154221.
