Dignity Therapy at End-of-Life
Dignity Therapy was developed by Dr. Harvey Max Chochinov to assist people dealing with the imminent end of their lives.
This brief intervention can help conserve the dying patient’s sense of dignity by addressing sources of psychosocial and existential distress. It gives patients a chance to record the meaningful aspects of their lives and leave something behind that can benefit their loved ones in the future.
During a 30 to 60 minute session, the therapist asks a series of open-ended questions that encourage patients to talk about their lives or what matters most to them. The conversation is recorded, transcribed, edited and then returned within a few days to the patient, who is given the opportunity to read the transcript and make changes before a final version is produced. Many choose to share the document with family and friends.
This section outlines:
Advantages of Dignity Therapy
Dignity Therapy gives patients an opportunity to share the moments that shaped their lives.
Dignity Therapy borrows elements from other supportive techniques, such as life review, logotherapy and existential psychotherapy. Unlike life review, Dignity Therapy is not a historical recounting of events – it is a recounting of thoughts, ideas and events that are particularly relevant and meaningful for patients to recount and pass along to others. For most patients, it is an opportunity to share the moments that shaped their lives.
An important difference of Dignity Therapy is its grounding in sound research into dying patients’ self-reported notions of dignity. It addresses the dying patient’s need to feel that life has had meaning, and to do something for loved ones that will endure beyond the patient’s own life. It also helps the patient get in touch with the accomplishments and experiences that have made them unique and valued human beings.
1- It is brief
2- Can be done at the bedside
3- Has the potential to favourably influence patients as well as their loved ones
4- Places less weight on interpretation, insight and “working through,” and more emphasis on the meaning-enhancing process itself
How Dignity Therapy addresses end-of-life concerns
Dignity Therapy deals with emotional pain by targeting its source. The content, protocol and questions are all guided by the Dignity Model sub-themes.
The dying patient’s strong need for “generativity” and “legacy” is the basis for the therapy. The therapy creates something that will transcend the patient’s death and extend his or her influence across time. Capturing the patient’s thoughts in written form is particularly effective because it increases the sense that whatever is said will be preserved for the future.
However, simply creating the legacy document is not enough. Those who practice Dignity Therapy must listen to these stories with genuine empathy, attentiveness, interest and sensitivity. Anything less will fail to meet the patient’s need for treatment that is unconditionally positive and caring in tone.
The questions asked during Dignity Therapy are shaped by the Dignity-Conserving Perspectives and Aftermath Concerns that are identified in the Dignity Model. Each area of inquiry lets patients speak to issues that may reinforce their sense of personhood and sustain a sense of meaning, purpose and self-worth – thereby decreasing distress and improving their quality of life.
Satisfaction with Dignity Therapy
The first clinical trial using Dignity Therapy has overwhelmingly affirmed the value of this method for patients and families.
Patient satisfaction with Dignity Therapy
| Satisfied or highly satisfied | 91% |
| Helpful or very helpful | 86% |
| Increased sense of dignity | 76% |
| Increased sense of purpose | 68% |
| Heightened sense of meaning | 67% |
| Increased will to live | 47% |
| Believed it had or would help their family | 81% |
Families’ perceived benefits for the patient
| Helped the patient | 95% |
| Would recommend it to other patients | 95% |
| Gave the patient a greater sense of dignity | 78% |
| Heightened the patient’s sense of purpose | 72% |
| Helped the patient prepare for death | 65% |
| Was an important as aspect of care for their deceased loved ones as anything else that was done on their behalf | 65% |
| Reduced patient’s suffering | 43% |
Benefits for the family
| Helped surviving family during time of grief | 78% |
| Will continue to comfort family | 77% |
Questions asked during Dignity Therapy
“Tell me a little about your life history, particularly the parts that you either remember most, or think are the most important. When did you feel most alive?”
“Are there specific things that you would want your family to know about you, and are there particular things you would want them to remember?”
“What are the most important roles you have played in life (family roles, vocational roles, community service roles, etc.)? Why were they so important to you, and what do you think you accomplished in those roles?”
“Are there particular things that you feel still need to be said to your loved ones, or things that you would want to take the time to say once again?”
“What are your hopes and dreams for your loved ones?”
“What have you learned about life that you would want to pass along to others? What advice or words of guidance would you wish to pass along to your (son, daughter, husband, wife, parents, others)?”
“Are there words or perhaps even instructions you would like to offer your family to help prepare them for the future?”
“In creating this permanent record, are there other things that you would like included?”
“What are your most important accomplishments, and what do you feel most proud of?”
Reproduced with permission from the Journal of the American Medical Association.
In their own words
In their own words. Since the first trial, hundreds of patients have participated in Dignity Therapy in Canada, the United States, Australia, China, Japan, Denmark and Sweden. The most compelling evidence of its effectiveness is the stories of those who have experienced it.
Comments from patients:
“I see (taking part in this study) as one reason why I am alive.”
“It’s helped bring my memories, thoughts and feelings into perspective instead of all jumbled emotions running through my head. The most important thing has been that I’m able to leave a sort of ‘insight’ of myself for my husband and children and all my family and friends.”
“This experience has helped me to delve within myself and see more meaning to my life. I really look forward to sharing it with my family. I have no doubt that it will be enlightening to them.”
“It’s helped bring my memories, thoughts and feelings into perspective instead of all jumbled emotions running through my head. The most important thing has been that I’m able to leave a sort of ‘insight’ of myself for my husband and children and all my family and friends.”
“Dignity Therapy was a lovely experience. Getting down on paper what I thought was a dull, boring life really opened my eyes to how much I really have done.”
Comments from families:
“Mom was extremely closed emotionally and had huge difficulties expressing her feelings. This gave her an opportunity to do so without feeling vulnerable.”
“Being able to read his words will be a way of helping me to remember him, and to think of him. I didn’t always understand him, because he was a free spirit and I was the worrier. Maybe I didn’t trust God enough. I’m glad I’ll have his words to comfort me.”
“He felt that our grandsons – including our latest, whom unfortunately he never lived to see – would get some idea of his life and what he had achieved.”
“I would say that it was more helpful than any mourning aspect. It helped me move past it. Family and friends are certainly a support but through the document, my mom was also able to provide support.”
“It is something to hold onto at the time of Dad’s passing and it made Dad’s life and ways alive and tender.”
“He had something to say, wanted to be heard, wanted to pass on a message of hope. It helped him find some value in what he had done and remember who he was.”
“(The transcript was) magnificent. (My husband) wanted to contribute. The interview gave him a ‘second chance’ to do something to help.”
“Reading the document gave my mom a sense of accomplishment, I believe. It gave her a tangible way of looking back at a life well-lived.”
“Dignity Therapy legitimizes your life and provides an opportunity to put down on paper what you hope is your legacy.”
“I think the Dignity Therapy truly helped him feel as though he were doing something useful and to be able to leave behind a part of himself. That in turn has helped myself and the children as it is almost like receiving a special gift of his words that we can have for our lifetime.”