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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]
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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“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
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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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“Another short-term psychotherapy for patients living with life-limiting illness (Dignity Therapy) has been shown to be beneficial in terms of improving quality of life, increase sense of dignity and spiritual wellbeing.(8) One recent approach to treat depression and existential distress is the Managing Cancer and Livi…”
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“Recently, a form of psychotherapy, namely, dignity therapy, was developed to enhance patients' sense of dignity and improve end‐of‐life experiences.(50,51) The”
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Comparing counseling and dignity therapies in home care patients: A pilot study
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“…DT have demonstrated an improved sense of dignity (Chochinov et al., 2005; Houmann et al., 2014; Rudilla et al., 2015) and a better quality of life (Chochinov et al., 2011; Rudilla et al., 2015), as well as decreased depression (Chochinov et al., 2005; Houmann et al., 2014; Julião et al., 2014),…”
BackgroundMethodInfluentialEffects of Dignity Therapy on Family Members
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“Existential aspects of suffering are addressed by psycho-oncologic interventions directed at meaning [29,53,57] and dignity [35,54].”
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“In the case of dignity therapy, 2 randomized controlled trials showed inconsistent results regarding whether dignity therapy might be helpful in spiritual distress or not.(17,18) Many authors emphasize the importance of compassionate care, of being empathetically present to patients.”
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“Existential suffering, an important construct of suffering, was not separately identified, from the perspective that other identifiable senses of suffering all may potentially contribute to existential suffering [21,26-30,32-36,38,41-43,46-48].”
BackgroundInfluentialSpiritual quality of life in advanced cancer patients receiving radiation therapy
Piderman, K. M., Johnson, M. E., Frost, M. H., Atherton, P. J., Satele, D., Clark, M. M., Lapid, M. I., Sloan, J. A., & Rummans, T. A. (2013) · Psycho-Oncology · doi:10.1002/pon.3390 · Cited by 40
“The resulting discussions may lead to important life review and integration that inevitably leads to patient and caregiver well-being [13].”
BackgroundCurrent pharmacotherapy options for cancer anorexia and cachexia
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“[135] compared the effectiveness of dignity therapy, patient-centered care, and standard palliative care in 326 terminally ill patients in a randomized controlled trial.”
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“After delivery of the finalized generativity document, patients and relatives (as nominated by the patients and after having given informed consent) were asked to complete the DT Patient Feedback Questionnaire [15] and the DT Family Feedback Questionnaire [16] respectively.”
MethodKittelson, S. M., Scarton, L. J., Barker, P. C., Hauser, J. M., O’Mahony, S., Rabow, M. W., Delgado-Guay, M. O., Quest, T. E., Emanuel, L. L., Fitchett, G. A., et al. (2018) · JMIR Research Protocols · doi:10.2196/12213 · Cited by 40
“It is also possible that spiritual distress could moderate the DT effect on patients’ sense of meaning and purpose [1], which is an important part of dignity impact.”
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“Author, year Significant changes as compared to control group Non-significant changes Level of evidence II – quality strong Ando et al. (2010)24 FACIT-Sp Meaning/peace (post-intervention) SISC Suffering (post-intervention) Breitbart et al. (2010)29 FACIT-Sp Meaning/peace (post- intervention = 8 weeks, 4 months) BHS Ho…”
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“Results have been promising, with patients reporting feeling more helped by the therapy, with improved quality of life and sense of dignity than those receiving other interventions.(65,66)”
BackgroundKissane, D. W., Lethborg, C. E., Brooker, J., Hempton, C., Burney, S., Michael, N. G., Staples, M., Osicka, T. M., Sulistio, M., Shapiro, J., et al. (2019) · Palliative & Supportive Care · doi:10.1017/s1478951518000883 · Cited by 39
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Integrative and complementary therapies for patients with advanced cancer.
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“Although acceptability of the intervention and perceived benefit are measured in non RCTs, effect on outcome measures is less than robust in randomized control trials of the intervention (68-71).”
BackgroundPiderman, K. M., Breitkopf, C. R., Jenkins, S. M., Lovejoy, L. A., Dulohery, Y., Marek, D. V., Durland, H. L., Head, D. L., Swanson, S. W., Hogg, J. T., et al. (2014) · Journal of Cancer Education · doi:10.1007/s13187-014-0686-y · Cited by 37
“We developed a comprehensive, chaplain-led, spiritual life review interview guide based on (1) the spiritual assessment tool, known by the acronym, FICA (faith, importance and influence, community, activities) [4] (2) dignity therapy [5], and research on spiritual coping and spiritual struggle [6].”
von Heymann, A., Puggaard, L. B., Nissen, K. G., Benthien, K. S., Bidstrup, P. E., Coyne, J., Johansen, C., Kjellberg, J., Nordly, M., Sjøgren, P., et al. (2017) · Palliative & Supportive Care · doi:10.1017/s1478951517000141 · Cited by 37
““Dignity therapy” was experienced as helpful by patients but did not reduce distress (Chochinov et al., 2011).”
BackgroundMethodPatinadan, P. V., Tan-Ho, G., Choo, P. Y., & Ho, A. H. Y. (2020) · Death Studies · doi:10.1080/07481187.2020.1728426 · Cited by 37
“Though comprehensive, dignity therapy (Chochinov et al., 2011; Juliao et al., 2013; 2014; Vuksanovic et al., 2017) did not allow for the structured consideration and expression and facilitation of difficult grief-based emotions as well as familial involvement.”
BackgroundInfluentialDistress Reduction for Palliative Care Patients and Families With 5-Minute Mindful Breathing
Beng, T. S., Ahmad, F., Loong, L. C., Chin, L. E., Zainal, N. Z., Ng, C. G., Ann, Y. H., Li, L. M., & Meng, C. B. C. (2015) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909115569048 · Cited by 39
Resilience and Aging: Research and Practice
Lavretsky, H. (2014) · Project Muse (Johns Hopkins University) · Cited by 36
On behalf of the Working Group on Desire to Die of the German Palliative Care Guideline, Kremeike, K., Pralong, A., Boström, K., Bausewein, C., Simon, S. T., Lindner, R., & Voltz, R. (2021) · Annals of Palliative Medicine · doi:10.21037/apm-20-381 · Cited by 40
“They investigated two psychotherapeutic interventions, a meaning centered psychotherapy (24,25,28) and a dignity centered therapy (26,27).”
BackgroundDignity Therapy for End-of-Life Care Patients: A Literature Review
Cuevas, P. E. G., Davidson, P. M., Mejilla, J. L., & Rodney, T. W. (2021) · Journal of Patient Experience · doi:10.1177/2374373521996951 · Cited by 36
“Most importantly, dignity therapy decreases distress symptoms such as depression, desire for death, or suicidal thoughts (4,22).”
BackgroundDeath Anxiety and Correlates in Cancer Patients Receiving Palliative Care
Emanuel, L. L., Solomon, S., Chochinov, H. M., Delgado-Guay, M. O., Handzo, G. F., Hauser, J. M., Kittelson, S. M., O’Mahony, S., Quest, T. E., Rabow, M. W., et al. (2022) · Journal of Palliative Medicine · doi:10.1089/jpm.2022.0052 · Cited by 35
Self-citationMindfulness‐based Narrative Therapy for Depression in Cancer Patients
Vega, B. R., Bayón, C., Tarrero, Á. P., & Liria, A. F. (2013) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1847 · Cited by 41
Evaluating the psychometric properties of the Jacelon Attributed Dignity Scale
Jacelon, C. S., & Choi, J. (2014) · Journal of Advanced Nursing · doi:10.1111/jan.12372 · Cited by 35
“Other scientists have used surveys (Chochinov et al. 2006), randomized clinical trials (Chochinov et al. 2011) and instrument development (Chochinov et al. 2008, Jacelon et al. 2009, Periyakoil et al. 2010, Albers et al. 2011, Vlug et al. 2011).”
BackgroundMethodInfluentialTranslating Dignity Therapy into practice: Effects and lessons learned
Johns, S. A. (2013) · OMEGA - Journal of Death and Dying · doi:10.2190/om.67.1-2.p · Cited by 31
“The 30% who withdrew, combined with the 30% who died before completing their outcome measures, produced a non-completion/withdrawal rate of 60% in the project, which is significantly greater than the 22-35% non-completion/ withdrawal rates reported by other DT investigators (Chochinov et al., 2005; Chochinov et al., 2…”
ResultWulandari, B. T., & Rochmawati, E. (2023) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2023.104624 · Cited by 34
Selby, D., Seccaraccia, D., Huth, J., Kurrpa, K., & Fitch, M. I. (2016) · Journal of Palliative Medicine · doi:10.1089/jpm.2016.0135 · Cited by 34
“(11 ‘‘You know I remember some cases where a woman did confide to the team that she felt that God had let her down.”
Spiritual Well-Being and Correlated Factors in Subjects With Advanced COPD or Lung Cancer
Hasegawa, T., Kawai, M., Kuzuya, N., Futamura, Y., Horiba, A., Ishiguro, T., Yoshida, T., Sawa, T., & Sugiyama, Y. (2017) · Respiratory Care · doi:10.4187/respcare.05282 · Cited by 34
Weru, J. K., Gatehi, M., & Musibi, A. (2020) · BMC Palliative Care · doi:10.1186/s12904-020-00614-0 · Cited by 34
Yoon, S., Suh, S., Kim, S., Park, J., Kim, Y. J., Kang, B., Park, Y., Kwon, J. H., Park, K., Shin, D. W., et al. (2018) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2018.09.001 · Cited by 34
Mindfulness-Based Supportive Therapy (MBST)
Beng, T. S., Chin, L. E., Ng, C. G., Yee, A. H. A., Wu, C., Jane, L. E., & Meng, C. B. C. (2013) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909113508640 · Cited by 36
Risk Factors for Suicidal Ideation in Patients Feeling Severely Affected by Multiple Sclerosis
Strupp, J., Ehmann, C., Galushko, M., Bücken, R., Perrar, K. M., Hamacher, S., Pfaff, H., Voltz, R., & Golla, H. (2016) · Journal of Palliative Medicine · doi:10.1089/jpm.2015.0418 · Cited by 33
Psychological Aspects of Care in Cancer Patients in the Last Weeks/Days of Life
Ann‐Yi, S., & Bruera, E. D. (2022) · Cancer Research and Treatment · doi:10.4143/crt.2022.116 · Cited by 38
Psychotherapy for Depression Among Patients with Advanced Cancer
Akechi, T. (2012) · Japanese Journal of Clinical Oncology · doi:10.1093/jjco/hys152 · Cited by 34
Efficacy of spiritual interventions in palliative care: An umbrella review of systematic reviews
Austin, P. D., Lee, W., Keall, R. M., & Lovell, M. R. (2024) · Palliative Medicine · doi:10.1177/02692163241287650 · Cited by 37
“21 Findings from studies only reviewing the effects of dignity therapy suggest that this therapy is most effective for reducing levels of existential distress 27,30,33,35,37,46 and improving quality of life.”
HALL, S. L., Davies, J. M., Gao, W., & Higginson, I. J. (2014) · Palliative Medicine · doi:10.1177/0269216314533740 · Cited by 32
The role of geriatric palliative care in hospitalized older adults
Santivasi, W. L., Partain, D. K., & Whitford, K. J. (2019) · Hospital Practice · doi:10.1080/21548331.2019.1703707 · Cited by 36
Li, Y., Feng, Y., Chiang, H., Ma, S., & Wang, H. (2020) · Asian Nursing Research · doi:10.1016/j.anr.2020.04.003 · Cited by 32
‘I don't want to burden my family’: handling communication challenges in geriatric oncology
Delgado-Guay, M. O., la Cruz, M. G. D., & Epner, D. E. (2013) · Annals of Oncology · doi:10.1093/annonc/mdt263 · Cited by 32
Roikjær, S. G., Missel, M., Bergenholtz, H., Schoenau, M. N., & Timm, H. U. (2019) · Palliative Medicine · doi:10.1177/0269216319866651 · Cited by 31
Crespo, I., Rodríguez‐Prat, A., Monforte‐Royo, C., Wilson, K. G., Porta-Sales, J., & Balaguer, A. (2020) · Palliative Medicine · doi:10.1177/0269216320904607 · Cited by 31
Chen, J., Yan, J., Wang, C., Wang, Y., Wu, Y., & Hu, R. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06227-4 · Cited by 31
“Consistent with the research on dignity therapy in other cancer patients [19, 20, 37] or terminally ill patients [15, 34], this study showed that dignity therapy can also improve emotional and social functioning among patients with hematologic neoplasms.”
BackgroundResultDifficult conversations: from diagnosis to death.
Marcus, J. D., & Mott, F. E. (2014) · PubMed Central · Cited by 31
Allen, R. S., Azuero, C. B., Csikai, E. L., Parmelee, P. A., Shin, H. J., Kvale, E. A., Durkin, D. W., & Burgio, L. D. (2015) · The Gerontologist · doi:10.1093/geront/gnu167 · Cited by 31
“Similar to Chocinov’s Dignity Therapy (Chochinov et al., 2011; Chochinov, 2012), the LIFE intervention focuses patients’ attention on lifetime accomplishments, relationships, and values, using techniques such as reminiscence and creative activity to facilitate meaning reconstruction.”
MethodJulião, M., Sobral, M. A., Johnston, B. M., Lemos, A. R., Almeida, S., Antunes, B., Dönmez, Ç. F., & Chochinov, H. M. (2021) · Palliative & Supportive Care · doi:10.1017/s1478951521000754 · Cited by 30
“DT has been successfully tested and developed in many countries such as Canada, Australia, Scotland, Portugal, England, Spain, Denmark, and USA (Chochinov et al., 2002, 2005, 2008, 2011; Hall et al., 2012; Julião et al., 2013, 2014, 2017; Houmann et al., 2014; Johnston et al., 2015, 2016; Rudilla et al., 2016).”
MethodSelf-citationWisdom at the end of life: Hospice patients’ reflections on the meaning of life and death
Wright, S. T., Breier, J. M., Depner, R. M., Grant, P. C., & Lodi‐Smith, J. (2017) · Counselling Psychology Quarterly · doi:10.1080/09515070.2016.1274253 · Cited by 30
“A second approach, dignity therapy (e.g. Chochinov et al., 2011), aims to foster a sense of generativity in clients by assisting them in writing a brief book (intended to be bequeathed to loved ones) capturing important memories, recording the patient’s legacy, and reflecting their most important…”
BackgroundKozlov, E., Niknejad, B., & Reid, M. C. (2017) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909117723860 · Cited by 30
“The psychological sciences have amassed an impressive literature demonstrating the efficacy of various interventions to alleviate psychological symptoms such as depression and anxiety, for example, modified CBT,(27) meaning-centered psychotherapy,(28) and dignity therapy.(29) Palliative care researchers should draw on…”
BackgroundDignity Impact as a Primary Outcome Measure for Dignity Therapy
Scarton, L. J., Oh, S., Sylvera, A., Lamonge, R., Yao, Y., Chochinov, H. M., Fitchett, G. A., Handzo, G. F., Emanuel, L. L., & Wilkie, D. J. (2018) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909118777987 · Cited by 30
“Dignity therapy is generally well accepted by patients,(3-9) but its effects on patients’ distressing physical or emotional symptoms of life-threatening illness have been inconsistent across studies,(10) with statistically significant findings in some(11-14) and not statistically significant in others,(4,15) including…”
InfluentialSelf-citationOriani, A., Dunleavy, L., Sharples, P., Algorta, G. P., & Preston, N. J. (2020) · BMC Palliative Care · doi:10.1186/s12904-019-0506-6 · Cited by 32
HALL, S. L., Goddard, C., Speck, P. W., & Higginson, I. J. (2012) · Palliative Medicine · doi:10.1177/0269216312449272 · Cited by 29
“Sex N (%) Male 20 (33) 18 (36) 14 (39) Female 40 (67) 32 (64) 22 (61) Ethnic group N (%) White British 42 (70) 37 (74) 27 (75) White Irish 9 (15) 8 (16) 5 (13) White other 2 (3) 1 (2) 0 (0) Black Caribbean 2 (3) 1 (2) 1 (3) Black African 2 (3) 1 (2) 1 (3) Asian Indian 1 (2) 1 (2) 1 (3) Asian Pakistani 1 (2) 1 (2) 1 (3…”
Ichihara, K., Ouchi, S., Okayama, S., Kinoshita, F., Miyashita, M., Morita, T., & Tamura, K. T. (2019) · Palliative & Supportive Care · doi:10.1017/s1478951518000901 · Cited by 22
Duberstein, P. R., Maciejewski, P. K., Epstein, R. M., Fenton, J. J., Chapman, B. P., Norton, S. A., Hoerger, M. P., Wittink, M. N., Tancredi, D. J., Xing, G., et al. (2019) · Journal of Palliative Medicine · doi:10.1089/jpm.2019.0078 · Cited by 29
“Even though the VOICE intervention did not explicitly attempt to address existential issues, 47,48 it aimed to support caregivers and convey that their contributions to patient care were vital.”
BackgroundManookian, A., Zaki-Nejad, M., Nasrabadi, A. N., & Shamshiri, A. R. (2020) · Iranian Journal of Nursing and Midwifery Research · doi:10.4103/ijnmr.ijnmr_51_19 · Cited by 29
“Several studies have assessed the effects of dignity therapy on quality of life of patients, all of which emphasize the importance of dignity therapy as a supportive treatment in the quality of life of patients with cancer.[2,3,11,12,18,19]”
BackgroundResidents learning from a narrative experience with dying patients: a qualitative study
Tait, G. R., & Hodges, B. D. (2012) · Advances in Health Sciences Education · doi:10.1007/s10459-012-9411-y · Cited by 29
“A subsequent trial of dignity therapy found it to be helpful in quality of life and sense of dignity, among other secondary measures (Chochinov et al. 2011).”
Supportive Care in Cancer Unit at the National Cancer Institute of Milan
Ripamonti, C. I., Pessi, M. A., & Boldini, S. (2012) · Current Opinion in Oncology · doi:10.1097/cco.0b013e328352eabc · Cited by 29
Gupta, S., Kumar, A., Mathur, R., Gursahani, R., Bhatnagar, S., Deodhar, J. K., Nasa, P., Mani, R. K., Salins, N. S., Kulkarni, P., et al. (2024) · Indian Journal of Critical Care Medicine · doi:10.5005/jp-journals-10071-24661 · Cited by 31
La versione italiana della Demoralization Scale: uno studio di validazione
Costantini, A., Picardi, A., Brunetti, S., Trabucchi, G., Bersani, F. S., Minichino, A., & Marchetti, P. (2013) · Rivista di psichiatria · doi:10.1708/1292.14291 · Cited by 29
“Tra questi, la Meaning Centered Psychotherapy (25) e la Dignity Therapy (26) si sono dimostrati gli approcci più efficaci; anche il supporto spirituale e la gestione attiva dei sintomi si sono rivelati utili nel trattamento della demoralizzazione nei pazienti oncologici (27).”
Dose, A. M., McCabe, P. J., Krecke, C. A., & Sloan, J. A. (2018) · Journal of Hospice and Palliative Nursing · doi:10.1097/njh.0000000000000461 · Cited by 27
Jenewein, J., Moergeli, H., Meyer-Heim, T., Muijres, P., Bopp-Kistler, I., Chochinov, H. M., & Peng‐Keller, S. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.795813 · Cited by 27
Self-citationOrdons, A. R. D., Lockyer, J., Hartwick, M., Sarti, A. J., & Ajjawi, R. (2016) · BMC Palliative Care · doi:10.1186/s12904-016-0107-6 · Cited by 27
“How physicians communicate with patients and families about palliative and EOL care varies across settings [6] and impacts the illness experience [7] and treatment decisions [8].”
BackgroundWarth, M., Koehler, F., Weber, M., Bardenheuer, H. J., Ditzen, B., & Keßler, J. (2019) · BMC Palliative Care · doi:10.1186/s12904-019-0397-6 · Cited by 27
“Although patients, relatives and professionals generally report high satisfaction and an improved end-of-life experience through life review interventions [17, 22], empirical findings remain inconclusive concerning reproducible effects on validated quality of life measures [23, 24].”
BackgroundMethodFei, F., Koffman, J., Zhang, X., & Gao, W. (2021) · Western Journal of Nursing Research · doi:10.1177/0193945921995773 · Cited by 25
“Strategies for managing psychological symptoms, including depression and anxiety, involve exercise, cognitive behavioral techniques, dignity therapy, and spiritual support (Chochinov et al., 2011; Kunik et al., 2008).”
BackgroundDignity Through Integrated Symptom Management: Lessons From the Breathlessness Support Service
Gysels, M., Reilly, C. C., Jolley, C. J., Pannell, C., Spoorendonk, F., Moxham, J., Bausewein, C., & Higginson, I. J. (2016) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2016.04.010 · Cited by 26
“Dignity therapy tends to target dignity via the dignity conserving repertoire and most interventions are directed towards greater patients’ autonomy by involving them in decision-making about their treatment, or help patients leave a legacy by realizing a product that documents their life[26-28].”
BackgroundSchulz, V., Crombeen, A. M., Marshall, D., Shadd, J., LaDonna, K. A., & Lingard, L. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2017.07.041 · Cited by 27
Korman, M. B., Ellis, J., Moore, J., Bilodeau, D., Dulmage, S., Fitch, M. I., Mueller, C., Sahgal, A., & Moroney, C. (2020) · Annals of Palliative Medicine · doi:10.21037/apm-20-553 · Cited by 25
Research on psychological and social factors in palliative care: An invited commentary
Rodin, G. (2013) · Palliative Medicine · doi:10.1177/0269216313499961 · Cited by 29
Bekelman, D. B., Allen, L. A., Peterson, J., Hattler, B. G. J., Havranek, E. P., Fairclough, D. L., McBryde, C. F., & Meek, P. (2016) · Contemporary Clinical Trials · doi:10.1016/j.cct.2016.09.002 · Cited by 27
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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