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Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial
Open accessAbstract
Background Dignity therapy is a unique, individualised, short-term psychotherapy that was developed for patients (and their families) living with life-threatening or life-limiting illness. We investigated whether dignity therapy could mitigate distress or bolster the experience in patients nearing the end of their lives.Methods Patients (aged ≥18 years) with a terminal prognosis (life expectancy ≤6 months) who were receiving palliative care in a hospital or community setting (hospice or home) in Canada, USA, and Australia were randomly assigned to dignity therapy, client-centred care, or standard palliative care in a 1:1:1 ratio. Randomisation was by use of a computer-generated table of random numbers in blocks of 30. Allocation concealment was by use of opaque sealed envelopes. The primary outcomes--reductions in various dimensions of distress before and after completion of the study--were measured with the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale, Patient Dignity Inventory, Hospital Anxiety and Depression Scale, items from the Structured Interview for Symptoms and Concerns, Quality of Life Scale, and modified Edmonton Symptom Assessment Scale. Secondary outcomes of self-reported end-of-life experiences were assessed in a survey that was undertaken after the completion of the study. Outcomes were assessed by research staff with whom the participant had no previous contact to avoid any possible response bias or contamination. Analyses were done on all patients with available data at baseline and at the end of the study intervention. This study is registered with ClinicalTrials.gov, number NCT00133965.Findings 165 of 441 patients were assigned to dignity therapy, 140 standard palliative care, and 136 client-centred care. 108, 111, and 107 patients, respectively, were analysed. No significant differences were noted in the distress levels before and after completion of the study in the three groups. For the secondary outcomes, patients reported that dignity therapy was significantly more likely than the other two interventions to have been helpful (χ(2)=35·50, df=2; p<0·0001), improve quality of life (χ(2)=14·52; p=0·001), increase sense of dignity (χ(2)=12·66; p=0·002), change how their family saw and appreciated them (χ(2)=33·81; p<0·0001), and be helpful to their family (χ(2)=33·86; p<0·0001). Dignity therapy was significantly better than client-centred care in improving spiritual wellbeing (χ(2)=10·35; p=0·006), and was significantly better than standard palliative care in terms of lessening sadness or depression (χ(2)=9·38; p=0·009); significantly more patients who had received dignity therapy reported that the study group had been satisfactory, compared with those who received standard palliative care (χ(2)=29·58; p<0·0001).Interpretation 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.Funding National Cancer Institute, National Institutes of Health.
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“The intervention was administered by the first author as part of her PhD studies, who was trained in dignity therapy by Harvey Max Chochinov who developed dignity therapy [1,4].”
From Feasibility, acceptability and potential effectiveness of dignity therapy for family carers of people with motor neurone disease (2014) · cites this paper as [1]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Further, many interventions for adults with metastatic cancer (e.g., [14, 23]) are disconnected from the scientific evidence base on how to effectively reduce distress or change behavior.”
From A randomized controlled trial of a multi-modal palliative care intervention to promote advance care planning and psychological well-being among adults with advanced cancer: study protocol. (2022) · cites this paper as [14]
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“Many palliative care interventions address a single dimension of palliative care – e.g., ACP directive completion or sense of life meaning – or focus on patients in general rather than the anxious and depressed patients most in need of support [5, 13–15].”
From A randomized controlled trial of a multi-modal palliative care intervention to promote advance care planning and psychological well-being among adults with advanced cancer: study protocol. (2022) · cites this paper as [14]
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“Though notable meaning-focused interventions for metastatic cancer patients exist (e.g., [14, 15]), none directly target avoidance of internal experience [25]”
From A randomized controlled trial of a multi-modal palliative care intervention to promote advance care planning and psychological well-being among adults with advanced cancer: study protocol. (2022) · cites this paper as [14]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Dignity therapy was significantly better than client-centered care (but not standard palliative care) in improving spiritual well-being”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Chochinov et al. 2011
Experimental — accuracy not yet measured
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“it was significantly better than standard palliative care in terms of lessening sadness or depression”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Chochinov et al. 2011
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“Dignity therapy is a brief psychotherapeutic intervention which has been shown to enhance the end of life experience in people with life-limiting conditions [1].”
From Feasibility, acceptability and potential effectiveness of dignity therapy for family carers of people with motor neurone disease (2014) · cites this paper as [1]
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“This is similar to the findings for terminally ill cancer patients, where distressed individuals had a decrease in anxiety and depression scores [2], but those with low baseline levels of distress showed no change [1].”
From Feasibility, acceptability and potential effectiveness of dignity therapy for family carers of people with motor neurone disease (2014) · cites this paper as [1]
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“Palliative care research has developed personally tailored, individually delivered interventions requiring significant resources (e.g., [14, 23, 38])”
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“Postintervention, the participants reported that dignity therapy was significantly more likely than the other two interventions to be helpful, improve QL, increase sense of dignity, change how their families saw and appreciated them, and help their families.”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Chochinov et al. 2011
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“Postintervention, the participants reported that dignity therapy was significantly more likely than the other two interventions to be helpful, improve QL, increase sense of dignity, change how their families saw and appreciated them, and help their families.”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Chochinov et al. 2011
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“Postintervention, the participants reported that dignity therapy was significantly more likely than the other two interventions to be helpful, improve QL, increase sense of dignity, change how their families saw and appreciated them, and help their families.”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Chochinov et al. 2011
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“Postintervention, the participants reported that dignity therapy was significantly more likely than the other two interventions to be helpful, improve QL, increase sense of dignity, change how their families saw and appreciated them, and help their families.”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Chochinov et al. 2011
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“Postintervention, the participants reported that dignity therapy was significantly more likely than the other two interventions to be helpful, improve QL, increase sense of dignity, change how their families saw and appreciated them, and help their families.”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Chochinov et al. 2011
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Citations
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“However, a subsequent multicenter RCT of 441 patients testing this intervention in a palliative care setting found no difference in distress levels between study groups, although the intervention was associated with subjective improvement in quality of life.(50)”
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InfluentialPsychosocial interventions for advanced cancer patients: a systematic review
Teo, I., Krishnan, A., & Lee, G. L. (2019) · Psycho-Oncology · doi:10.1002/pon.5103 · Cited by 205
“Dignity therapy was shown to decrease distress(48) and increase generativity and ego integrity,(45) although no significant changes in patient dignity was reported.(44,45) Life review demonstrated improved sense of meaning(49) and quality of life.”
BackgroundBalboni, T. A., Fitchett, G. A., Handzo, G. F., Johnson, K. S., Koenig, H. G., Pargäment, K. I., Puchalski, C. M., Sinclair, S., Taylor, E. J., & Steinhauser, K. E. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2017.07.029 · Cited by 204
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“Only one study [31] was powered to detect small or moderate effects in study outcomes (sample size = 441, divided into 3 groups).”
BackgroundResultInfluentialMartínez, M., Arantzamendi, M., Belar, A., Carrasco, J. M., Carvajal, A., Rullán, M., & Centeno, C. (2017) · Palliative Medicine · doi:10.1177/0269216316665562 · Cited by 215
An integrative review of dignity in end-of-life care
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“Chochinov et al.11 used the term “privacy boundary” to denote “the extent to which dignity can be influenced by having one’s personal environment encroached upon during the course of receiving care or support (p. 439).””
BackgroundPopulations and Interventions for Palliative and End-of-Life Care: A Systematic Review
Singer, A. E., Goebel, J. R., Kim, Y. S., Dy, S. M., Ahluwalia, S. C., Clifford, M., Dzeng, E. W., O’Hanlon, C. E., Motala, A., Walling, A. M., et al. (2016) · Journal of Palliative Medicine · doi:10.1089/jpm.2015.0367 · Cited by 197
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“Psychological growth 57 (20) 61 (18) 61 (20)”
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Death anxiety interventions in patients with advanced cancer: a systematic review
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Symptom burden, loss of dignity, and demoralization in patients with cancer: a mediation model
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“The link between the two constructs is also reflected by the similarity of basic techniques underlying Dignity Therapy and interventions proposed against loss of meaning and demoralization in cancer, such asMeaning-Centered Psychotherapy.”
BackgroundWang, C., Chow, A. Y. M., & Chan, C. (2017) · Palliative Medicine · doi:10.1177/0269216317705101 · Cited by 142
“Table 1 presents the characteristics of the included RCTs.”
BackgroundMethodInfluentialEfficacy of meaning-centered group psychotherapy for cancer survivors: a randomized controlled trial
van der Spek, N., Vos, J., van Uden-Kraan, C. F., Breitbart, W., Cuijpers, P., Holtmaat, K., Witte, B. I., Tollenaar, R. A. E. M., & Verdonck-de Leeuw, I. M. (2017) · Psychological Medicine · doi:10.1017/s0033291717000447 · Cited by 135
Self-citationPark, C. L., Pustejovsky, J. E., Trevino, K., Sherman, A. C., Esposito, C., Berendsen, M., & Salsman, J. M. (2019) · Cancer · doi:10.1002/cncr.32078 · Cited by 125
“A recent wave of interventions for patients with cancer has been specifically designed to address existential/ spiritual concerns or questions of personal meaning.(18-26) Psychosocial interventions designed to influence a wide array of psychological and even physical health outcomes might also affect meaning-related e…”
BackgroundJulião, M., Oliveira, F., Nunes, B., Vaz Carneiro, A., & Barbosa, A. (2014) · Journal of Palliative Medicine · doi:10.1089/jpm.2013.0567 · Cited by 117
“All dignity therapy sessions were completed by the principal in-vestigator (M.J.), who attended an international dignity therapy workshop held in Winnipeg, Canada, hosted by the developers of dignity therapy; all procedures for dignity therapy were conducted in accordance with those described and published by Chochino…”
InfluentialChan, C. L. W., Ho, A. H. Y., Leung, P. P. Y., Chochinov, H. M., Neimeyer, R. A., Pang, S. M. C., & Tse, D. M. W. (2012) · Journal of Ethnic And Cultural Diversity in Social Work · doi:10.1080/15313204.2012.729177 · Cited by 118
“Although Dignity Therapy is based on a Western individualistic paradigm that focuses solely on the patient, one can make use of its intervention components while shifting its intervention focus toward the family rather than the patient alone.”
BackgroundSelf-citationDeterminants of death anxiety in patients with advanced cancer
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“These include dignity therapy [35] and meaning-centered psychotherapy (MCP), and MCP was successful in improving psychological and spiritual distress in advanced cancer patients [36].”
Dignity Therapy and Life Review for Palliative Care Patients: A Randomized Controlled Trial
Vuksanovic, D., Green, H. J., Dyck, M. J., & Morrissey, S. A. (2016) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2016.09.005 · Cited by 106
Psychiatric considerations in the oncology setting
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“Dignity Therapy has been studied in both a singlearm study25 and an RCT.41 The single-arm study was conducted in 100 patients with advanced cancer, more than 50% of whom were men, with an average of 40 days from end of intervention to death, in two different countries (Canada and Australia).”
MethodInfluentialDiagnostik und Therapie des hepatozellulären Karzinoms
Greten, T. F., Malek, N. P., Schmidt, S., Arends, J., Bartenstein, P., Bechstein, W. O., Bernatik, T., Bitzer, M., Chavan, A., Dollinger, M. M., et al. (2013) · Zeitschrift für Gastroenterologie · doi:10.1055/s-0033-1355841 · Cited by 101
A prospective evaluation of Dignity Therapy in advanced cancer patients admitted to palliative care
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Self-citationKruizinga, R., Hartog, I. D., Jacobs, M., Daams, J. G., Scherer‐Rath, M., Schilderman, J. B. A. M., Sprangers, M. A. G., & Van Laarhoven, H. W. M. (2016) · Psycho-Oncology · doi:10.1002/pon.3910 · Cited by 96
“Only one study included in the meta-analysis reported data on a placebo group in addition to a control group [23]; therefore, we selected only the data from the control group as we did for the other studies.”
ResultXiao, J., Chow, K. M., Liu, Y., & Chan, C. W. H. (2019) · Psycho-Oncology · doi:10.1002/pon.5162 · Cited by 95
“The model guides the development of a dignity therapy question protocol to interview patients with the particular theme of dignity, enabling them to create a legacy document containing things they would want to be known or remembered about.12 Dignity therapy has been validated in Western countries, such as Canada and…”
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Adapting Meaning-Centered Psychotherapy for the palliative care setting: Results of a pilot study
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“The work of Chochinov in developing Dignity Therapy for advanced cancer patients has also to be cited [62].”
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“A unique, individualized short-term psychotherapy is Dignity Therapy [77].”
BackgroundPringle, J., Johnston, B. M., & Buchanan, D. (2015) · Palliative Medicine · doi:10.1177/0269216315575681 · Cited by 88
Lee, E. E., Bangen, K. J., Avanzino, J. A., Hou, B., Ramsey, M., Eglit, G., Liu, J., Tu, X. M., Paulus, M., & Jeste, D. V. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.0821 · Cited by 85
Julião, M., Oliveira, F., Nunes, B., Carneiro, A. V., & Barbosa, A. (2017) · Palliative & Supportive Care · doi:10.1017/s1478951516001140 · Cited by 86
“Aside from higher levels of anxiety and depression, the participants in our study also experienced more pronounced dignity-related distress compared with those reported in the prior DT RCT (Chochinov et al., 2011).”
BackgroundMethodResultInfluentialMilbury, K., Li, Y., Durrani, S., Liao, Z., Tsao, A. S., Carmack, C., Cohen, L., & Bruera, E. (2020) · The Oncologist · doi:10.1634/theoncologist.2020-0125 · Cited by 78
Psilocybin‐assisted group therapy in patients with cancer diagnosed with a major depressive disorder
Agrawal, M., Richards, W., Beaussant, Y., Shnayder, S., Ameli, R., Roddy, K., Stevens, N., Richards, B., Schor, N., Honstein, H., et al. (2024) · Cancer · doi:10.1002/cncr.35010 · Cited by 88
“8,9 Psilocybin is a serotonergic agonist that interacts with 5 ‐ HT 2A receptors and modulates neural networks to alter perception, affect, and ego function.”
BackgroundAn Integrated view of Suffering in Palliative Care
Krikorian, A., & Limonero, J. T. (2012) · Journal of Palliative Care · doi:10.1177/082585971202800107 · Cited by 84
“By addressing these factors, we can assist the patient to cope, maintain his or her dignity, and achieve well-being (80).”
BackgroundChallenge of Prognostic Uncertainty in the Modern Era of Cancer Therapeutics
Temel, J. S., Shaw, A. T., & Greer, J. A. (2016) · Journal of Clinical Oncology · doi:10.1200/jco.2016.67.8573 · Cited by 84
Julião, M., Barbosa, A., Oliveira, F., Nunes, B., & Carneiro, A. V. (2013) · Palliative & Supportive Care · doi:10.1017/s1478951512000892 · Cited by 81
Eisenbeck, N., Carreno, D. F., & Pérez‐Escobar, J. A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.648383 · Cited by 92
“seem to be especially effective among cancer patients, fostering improvements in spiritual well-being, quality of life, depression, and anxiety, among other areas (e.g., Breitbart et al., 2010; Chochinov et al., 2011).”
BackgroundExistential distress and meaning-focused interventions in cancer survivorship
Vehling, S., & Philipp, R. (2017) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0000000000000324 · Cited by 82
Xiao, J., Chow, K. M., Choi, K. C., Ng, M. S. N., Huang, C., Ding, J., & Chan, C. W. H. (2022) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2022.104217 · Cited by 79
Aoun, S. M., Chochinov, H. M., & Kristjanson, L. J. (2015) · Journal of Palliative Medicine · doi:10.1089/jpm.2014.0213 · Cited by 74
Self-citationWarth, M., Kessler, J., Koehler, F., Aguilar-Raab, C., Bardenheuer, H. J., & Ditzen, B. (2019) · Palliative Medicine · doi:10.1177/0269216318818011 · Cited by 77
“20 However, this seems less likely considering that the excluded study by Ando et al. 21 also used the FACIT-SP and found a very large effect size.”
BackgroundResultInfluentialPiderman, K. M., Breitkopf, C. R., Jenkins, S. M., Lapid, M. I., Kwete, G. M., Sytsma, T. T., Lovejoy, L. A., Yoder, T. J., & Jatoi, A. (2015) · Psycho-Oncology · doi:10.1002/pon.4031 · Cited by 74
“The Dignity Therapy question, ‘What are the most important roles you have played in life?’”
BackgroundMethodInfluentialSanjida, S., McPhail, S. M., Shaw, J., Couper, J., Kissane, D., Price, M. A., & Janda, M. (2018) · Psycho-Oncology · doi:10.1002/pon.4794 · Cited by 74
Rodin, G., An, E., Shnall, J., & Malfitano, C. (2020) · Journal of Clinical Oncology · doi:10.1200/jco.19.00058 · Cited by 81
Aoun, S. M., & Nekolaichuk, C. (2014) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2014.01.007 · Cited by 72
Depressive Spectrum Disorders in Cancer: Diagnostic Issues and Intervention. A Critical Review
Caruso, R., GiuliaNanni, M., Riba, M. B., Sabato, S., & Grassi, L. G. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0785-7 · Cited by 75
Oechsle, K., Wais, M. C., Vehling, S., Bokemeyer, C., & Mehnert, A. (2014) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2013.10.022 · Cited by 71
Zhang, Y., Li, J., & Hu, X. (2022) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2022.104273 · Cited by 70
Nkhoma, K. B., Cook, A., Giusti, A., Farrant, L., Petrus, R., Petersen, I., Gwyther, L., Venkatapuram, S., & Harding, R. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-054386 · Cited by 68
Suffering in Advanced Cancer: A Randomized Control Trial of a Narrative Intervention
Wise, M. E., Marchand, L. R., Roberts, L. J., & Chih, M. (2017) · Journal of Palliative Medicine · doi:10.1089/jpm.2017.0007 · Cited by 72
“31 The authors, as did we, reported high baseline wellbeing and challenges with measuring complex effects with simple survey instruments.”
Beatty, L., Kemp, E., Butow, P., Girgis, A., Schofield, P., Turner, J., Hulbert‐Williams, N. J., Levesque, J. V., & Koczwara, B. (2018) · Psycho-Oncology · doi:10.1002/pon.4445 · Cited by 65
Palliative Care Psychiatry: Update on an Emerging Dimension of Psychiatric Practice
Fairman, N. P., & Irwin, S. A. (2013) · Current Psychiatry Reports · doi:10.1007/s11920-013-0374-3 · Cited by 68
Kasl‐Godley, J., King, D. A., & Quill, T. E. (2014) · American Psychologist · doi:10.1037/a0036735 · Cited by 68
Cicely Saunders, ‘Total Pain’ and emotional evidence at the end of life
Wood, J. (2021) · Medical Humanities · doi:10.1136/medhum-2020-012107 · Cited by 66
Bentley, B., O’Connor, M., Kane, R. T., & Breen, L. J. (2014) · PLoS ONE · doi:10.1371/journal.pone.0096888 · Cited by 64
“has been shown to alleviate existential distress in a palliative care population where most people had malignant conditions [18,19].”
BackgroundMethodResultInfluentialon behalf of the RT Prepare project team, Halkett, G. K. B., O’Connor, M., Jefford, M., Aranda, S. K., Merchant, S., Spry, N. A., Kane, R. T., Shaw, T., Youens, D., et al. (2018) · British Journal of Cancer · doi:10.1038/s41416-018-0112-z · Cited by 63
Psychotherapy at the End of Life
Saracino, R. M., Rosenfeld, B. D., BREITBART, W. S., & Chochinov, H. M. (2019) · The American Journal of Bioethics · doi:10.1080/15265161.2019.1674552 · Cited by 63
Self-citationJohnston, B. M., Lawton, S., McCaw, C., Law, E., Murray, J., Gibb, J., Pringle, J., Munro, G., & Rodriguez, C. (2015) · International Journal of Older People Nursing · doi:10.1111/opn.12103 · Cited by 63
“Dignity Therapy has been carried out with people at the end of their lives with the reported benefits of increasing a sense of dignity, improving quality of life and being of help to families (Chochinov et al 2011).”
BackgroundDemoralization: A Life-Preserving Diagnosis to Make for the Severely Medically Ill
Kissane, D. W. (2014) · Journal of Palliative Care · doi:10.1177/082585971403000402 · Cited by 63
“A new intervention — dignity therapy — makes use of the life narrative to affirm accomplishments and significant roles and to create a legacy of meaning for the patient’s family (19).”
BackgroundRipamonti, C. I., Buonaccorso, L., Maruelli, A., Bandieri, E., Pessi, M. A., Boldini, S., Primi, C., & Miccinesi, G. (2012) · Tumori Journal · doi:10.1177/030089161209800415 · Cited by 62
Health-related quality of life among patients with advanced cancer: an integrative review
Freire, M. E. M., Sawada, N. O., de França, I. S. X., da Costa, S. . G., & Oliveira, C. D. B. (2014) · Revista da Escola de Enfermagem da USP · doi:10.1590/s0080-6234201400002000022 · Cited by 62
Maia, L. O., Beaussant, Y., & Garcia, A. C. M. (2022) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2022.01.024 · Cited by 70
Goddard, C., Speck, P. W., Martin, P., & HALL, S. L. (2012) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2012.05999.x · Cited by 58
Suffering and dying well: on the proper aim of palliative care
den Hartogh, G. A. (2017) · Medicine Health Care and Philosophy · doi:10.1007/s11019-017-9764-3 · Cited by 58
“Cf. Chochinov et al. (2011), reporting beneficial effects on patients’ level of well-being. is structured by a series of interview questions, such as the following: • Tell me a little about your life history; particularly the parts that you either remember most or think are the most important?”
BackgroundExperience of meaning in life in bereaved informal caregivers of palliative care patients
Brandstätter, M., Kögler, M., Baumann, U., Fensterer, V., Küchenhoff, H., Borasio, G. D., & Fegg, M. J. (2014) · Supportive Care in Cancer · doi:10.1007/s00520-013-2099-6 · Cited by 63
“Newer interventions in endof-life care have been aimed at increasing the feeling of dignity [14] and meaning in patients' lives [15–17]; however, they have mostly neglected promotion of meaning in life (MiL) in relatives and caregivers so far.”
Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory.
Carlson, L. E. (2023) · Annual Review of Psychology · doi:10.1146/annurev-psych-032620-031757 · Cited by 56
“Dignity therapy was significantly better than client-centered care (but not standard palliative care) in improving spiritual well-being, and it was significantly better than standard palliative care in terms of lessening sadness or depression (Chochinov et al. 2011”
BackgroundCurrent Grief Support in Pediatric Palliative Care
Schuelke, T., Crawford, C., Kentor, R. A., Eppelheimer, H., Chipriano, C., Springmeyer, K., Shukraft, A., & Hill, M. A. (2021) · Children · doi:10.3390/children8040278 · Cited by 61
“Created by Harvey Chochinov and colleagues as an intervention to support dying adults in their final days, the dignity therapy intervention reaffirms the person’s value and worth [123].”
BackgroundThe Importance of Patient Dignity in Care at the End of Life.
Kennedy, G. (2016) · PubMed Central · Cited by 56
Iani, L., Vincenzo, F. D., Maruelli, A., Chochinov, H. M., Ragghianti, M., Durante, S., & Lombardo, L. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01468 · Cited by 56
“This finding is consistent with most previous research showing that there were no differences between DT and control groups on dignity-related distress (Chochinov et al., 2011; Hall et al., 2011; Vuksanovic et al., 2017).”
ResultSelf-citationHo, A. H. Y., Car, J., Ho, M. R., Tan-Ho, G., Choo, P. Y., Patinadan, P. V., Chong, P. H., Ong, W. Y., Fan, G. K. T., Tan, Y. P., et al. (2017) · Trials · doi:10.1186/s13063-017-2325-5 · Cited by 54
Self-citationGlobal Aspects of Palliative Care
Connor, S. R. (2019) · Springer eBooks · doi:10.1007/978-3-319-77740-5_4 · Cited by 54
“…leads to effective symptom control (Shu-Yu et al. 2016), improved quality of life (Temel et al. 2010), less unnecessary hospitalization (Morrison et al. 2008), realization of dignity (Chochinov et al. 2011), and reduced cost both for patients and families as well as providers (Smith et al. 2014).”
BackgroundA comprehensive review of palliative care in patients with cancer
Jaiswal, R., Alici, Y., & BREITBART, W. S. (2014) · International Review of Psychiatry · doi:10.3109/09540261.2013.868788 · Cited by 53
Self-citationKleijn, G., Lissenberg-Witte, B. I., Bohlmeijer, E. T., Steunenberg, B., Knipscheer-Kuijpers, K., Willemsen, V., Becker, A., Smit, E. F., Eeltink, C. M., Bruynzeel, A. M. E., et al. (2018) · PLOS ONE · doi:10.1371/journal.pone.0197277 · Cited by 52
Mosher, C. E., Seçinti, E., Johns, S. A., O’Neil, B. H., Helft, P. R., Shahda, S., Jalal, S. I., & Champion, V. L. (2017) · Quality of Life Research · doi:10.1007/s11136-017-1620-7 · Cited by 51
Arch, J. J., Fishbein, J. N., Ferris, M. C., Mitchell, J. L., Levin, M. E., Slivjak, E. T., Andorsky, D. J., & Kutner, J. S. (2020) · Journal of Palliative Medicine · doi:10.1089/jpm.2019.0398 · Cited by 48
“Previous interventions address only a limited number of these broad psychosocial and ACP needs, 5 require regular access to palliative care specialists, of whom there is a serious short-age, 6 or target patients in general, 7,8 rather than the anxious or depressed patients most in need of support.”
Jeste, D. V., Thomas, M. L., Liu, J., Daly, R. E., Tu, X. M., Treichler, E. B. H., Palmer, B. W., & Lee, E. E. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.09.033 · Cited by 50
“several spirituality interventions reported improvements in depression and anxiety (Ando et al., 2010; Chan et al., 2012; Chochinov et al., 2011; Rickhi et al., 2011; Sankhe et al., 2017; Wachholtz and Pargament, 2005).”
BackgroundBentley, B., O’Connor, M., Breen, L. J., & Kane, R. (2014) · BMC Palliative Care · doi:10.1186/1472-684x-13-12 · Cited by 46
“After controlling for the pre-post decrease in physical functioning of the person with MND, the pre-post increase in the carer burden was no longer significant (F [1,32] = 3.”
BackgroundMethodResultInfluentialPaley, C. A., Boland, J. W., Santarelli, M., Murtagh, F. E., Ziegler, L. E., & Chapman, E. (2023) · BMC Palliative Care · doi:10.1186/s12904-023-01202-8 · Cited by 57
Metadata
- Authors
- Chochinov, H. M., Kristjanson, L. J., Breitbart, W., McClement, S., Hack, T. F., Hassard, T., & Harlos, M.
- Affiliations
- CancerCare Manitoba (CA)
- Edith Cowan University (AU)
- Memorial Sloan Kettering Cancer Center (US)
- University of Manitoba (CA)
- Winnipeg Regional Health Authority (CA)
- Corresponding author
- Chochinov, Harvey Max
- Venue
- The Lancet Oncology
- Publisher
- Elsevier BV
- Published
- 2011-08
- Volume
- 12
- Issue
- 8
- Pages
- 753-762
- ISSN
- 1470-2045 (ISSN-L)
- PMC
- PMC3185066
- OpenAlex
- W2041265397
- Cited by
- 775
- References
- 35
- Citations by year
- 2026: 40 · 2025: 46 · 2024: 60 · 2023: 51 · 2022: 52 · 2021: 49 · 2020: 112 · 2019: 46 · 2018: 41 · 2017: 60 · 2016: 46 · 2015: 47 · 2014: 45 · 2013: 43 · 2012: 32
- FWCI
- 38.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Lancet Oncology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Edith Cowan University Research Online (Edith Cowan University) (submittedVersion)
- eSpace (Curtin University) (submittedVersion)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion)
- Funders
- Memorial Sloan-Kettering Cancer Center
- Canada Research Chairs
- Canadian Institutes of Health Research
- National Cancer Institute (R01CA102201)
- Topics
- Health Sciences › Nursing › Issues, ethics and legal aspects › Patient Dignity and Privacy
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- dignity therapy, terminal illness, end-of-life care, palliative care, distress, quality of life, sense of dignity, spiritual well-being, client-centred care, patient experience, symptom burden, anxiety and depression, patient-centered care
- MeSH terms
- Aged, Australia, Canada, Counseling, Female, Humans, Male, Middle Aged, Neoplasms, Palliative Care, Psychotherapy, Brief, Quality of Life, Surveys and Questionnaires, Stress, Psychological, United States, Treatment Outcome, Terminally Ill
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