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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]
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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
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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
Cites
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Dignity in the terminally ill: a developing empirical model
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Self-citationDignity-Conserving Care—A New Model for Palliative Care: Helping the Patient Feel Valued
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Effects of dignity therapy on palliative patients’ family members: A systematic review
Grijó, L., Tojal, C., & Rêgo, F. M. P. D. S. (2021) · Palliative & Supportive Care · doi:10.1017/s147895152100033x · Cited by 24
“In the studies that assessed the DT effects on palliative patients, it is clear from the literature that DT has a positive impact in terms of acceptability especially in patients’ dignity (Chochinov et al., 2005; Chochinov et al., 2011; Houmann et al., 2014; Rudilla et al., 2015; Donato et al., 2016; Julião et al., 20…”
BackgroundInfluentialGonzález-Ling, A., Vazquez, O., Rascón-Gasca, M. L., Robles, R., & Chochinov, H. M. (2021) · Palliative & Supportive Care · doi:10.1017/s1478951521000468 · Cited by 24
Self-citationVincenzo, F. D., Lombardo, L., Iani, L., Maruelli, A., Durante, S., Ragghianti, M., Park, C. L., Innamorati, M., & Quinto, R. M. (2023) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2022-003696 · Cited by 24
Gao, W., Ho, Y. K., Verne, J., Gordon, E., & Higginson, I. J. (2014) · Health Services and Delivery Research · doi:10.3310/hsdr02420 · Cited by 26
Reflections on Using Biographical Approaches in End-of-Life Care
Lindqvist, O., Threlkeld, G., Street, A. F., & Tishelman, C. (2014) · Qualitative Health Research · doi:10.1177/1049732314549476 · Cited by 24
“…studies of DT, a majority of the participants were found to experience an increased sense of dignity, purpose, and meaning in life (Chochinov et al., 2005; Chochinov et al., 2011), with positive effects also found in alleviating grief and providing support for relatives (McClement et al., 2007).”
BackgroundDose, A. M., & Rhudy, L. M. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3833-2 · Cited by 24
“Challenges with delivery of DT in complex situations have been acknowledged, and include those in which participants can be undergoing rapid health decline, increasing physical symptoms, and increased emotional distress [14].”
Rodriguez, A., Smith, J., & McDermid, K. (2018) · International Journal of Palliative Nursing · doi:10.12968/ijpn.2018.24.7.339 · Cited by 24
Stacey, C. L., Pai, M., Novisky, M. A., & Radwany, S. M. (2018) · Social Science & Medicine · doi:10.1016/j.socscimed.2018.10.028 · Cited by 24
Spiritual Care in Palliative Medicine and End of Life: A Bibliometric Network Analysis
Ursoleo, J. D., Calì, C., Losiggio, R., Limone, V., Mucci, E., & Monaco, F. (2024) · Journal of Palliative Medicine · doi:10.1089/jpm.2024.0007 · Cited by 23
Nunziante, F., Tanzi, S., Alquati, S., Autelitano, C., Bedeschi, E., Bertocchi, E., Dragani, M., Simonazzi, D., Turola, E., Braglia, L., et al. (2021) · BMC Palliative Care · doi:10.1186/s12904-021-00821-3 · Cited by 23
“The patients’ dignity-related distress and feedback toward the intervention were assessed through the Patient Dignity Inventory and the Dignity Therapy Patient Feedback Questionnaire, respectively.”
MethodResultInfluentialHosseini, A. M., Rezaei, M., Bahrami, M., Abbasi, M., & Hariri, H. (2017) · PubMed Central · doi:10.4103/1735-9066.208157 · Cited by 24
“179 Iranian Journal of Nursing and Midwifery Research ¦ Volume 22 ¦ Issue 3 ¦ May-June 2017 their sense of dignity, and changed how their family saw and appreciated them.[17] Other studies have shown that dignity in terminally ill patients is positively associated with QOL, including physical, mental, functional, soci…”
BackgroundParpa, E., Kostopoulou, S., Tsilika, E., Galanos, A., Katsaragakis, S., & Mystakidou, K. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2017.07.002 · Cited by 23
Bentley, B., O’Connor, M., Williams, A., & Breen, L. J. (2020) · Digital Health · doi:10.1177/2055207620958527 · Cited by 23
“A convenience sample of Australian adults diagnosed with a life-limiting illness with a prognosis of six months or less but who were expected to survive at least four weeks where recruited for the study.(5,16) Participants were required to have home access to an internet-connected computer, smartphone, or tablet, be a…”
BackgroundMethodResultInfluentialDignity in Medicine: Definition, Assessment and Therapy
Grassi, L. G., Nanni, M. G., Riba, M., & Folesani, F. (2024) · Current Psychiatry Reports · doi:10.1007/s11920-024-01506-3 · Cited by 22
“Some RCTs compared DT and other forms of intervention (e.g., Client Centered Care) and showed that DT benefited the patients by improving their quality of life and sense of dignity, with better improvement on spiritual wellbeing, depression and sadness, and higher patients’ satisfaction [90].”
BackgroundDignity Therapy in Pediatrics: A Case Series
Schuelke, T., & Rubenstein, J. (2020) · Palliative Medicine Reports · doi:10.1089/pmr.2020.0015 · Cited by 22
“In response to these findings, Dignity Therapy was created as an intervention intended to support the following themes: (1) Generativity: the sense that the person has given something to future generations, (2) Continuity of Self: the sense that part of the person’s legacy will continue, (3) Role Preservation: the sen…”
InfluentialOunalli, H., Mamo, D. C., Testoni, I., Murri, M. B., Caruso, R., & Grassi, L. G. (2020) · Behavioral Sciences · doi:10.3390/bs10120178 · Cited by 23
“Since the first original Randomized Clinical Trials (RCTs) conducted in palliative care settings and showing the efficacy of DT in reducing sadness and depression and increasing dignity and will to live in terminally ill patients [57,58], DT has been the focus of a growing body of research, with both quantitative as w…”
BackgroundNursing, psychotherapy and advanced cancer: A scoping review
Malakian, A., Mohammed, S., Fazelzad, R., Ajaj, R., Artemenko, A., & Mayo, S. J. (2021) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2021.102090 · Cited by 22
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Hospice Staff Perspectives on Dignity Therapy
Montross, L. P., Meier, E. A., Cervantes-Monteith, K. D., Vashistha, V., & Irwin, S. A. (2013) · Journal of Palliative Medicine · doi:10.1089/jpm.2013.0030 · Cited by 22
“During the interview staff members were asked to provide ratings on the following questions: (1) to what extent they felt the treatment was worthwhile, (2) helpful, (3) able to reduce patients’ pain and suffering; (4) whether the treatment would help family members in the future; and (5) whether the staff would recomm…”
BackgroundBentley, B., Aoun, S. M., O’Connor, M., Breen, L. J., & Chochinov, H. M. (2012) · BMC Palliative Care · doi:10.1186/1472-684x-11-18 · Cited by 22
“To assess the acceptability of dignity therapy to family carers, a modified version of the dignity therapy Family Feedback Questionnaire [17] is being utilized to collect information on the views, experiences and opinions of the family carers about the intervention.”
MethodResultInfluentialSelf-citationZimmermann, F. F., Jordan, J., & Burrell, B. (2020) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2019.101715 · Cited by 21
Spiritual history taking in palliative home care: A cluster randomized controlled trial
Vermandere, M., Warmenhoven, F., Van Severen, E., De Lepeleire, J., & Aertgeerts, B. (2016) · Palliative Medicine · doi:10.1177/0269216315601953 · Cited by 67
Hearing and Heeding the Voices of those With Advanced Illnesses
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Majdabadi, F. H., Ashktorab, T., & Ilkhani, M. (2022) · European Journal of Cancer Care · doi:10.1111/ecc.13647 · Cited by 21
Responding to a Diagnosis of Localized Prostate Cancer
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Self-citationUsing Life Stories to Connect Veterans and Providers.
Ringler, T., Ahearn, E. P., Wise, M. E., Lee, E. R., & Krahn, D. D. (2015) · Europe PMC (PubMed Central) · Cited by 21
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Bernat, J. K., Helft, P. R., Wilhelm, L. R., Hook, N. E., Brown, L. F., Althouse, S. K., & Johns, S. A. (2015) · Psycho-Oncology · doi:10.1002/pon.3790 · Cited by 20
“Because our sample size was small and participants reported high levels of existential well-being and low levels of dignity-related distress at baseline, like past DT studies [2,5], we were not able to show significant improvement in secondary outcomes.”
BackgroundResultAdorno, G., & Wallace, C. L. (2017) · Palliative & Supportive Care · doi:10.1017/s1478951516001012 · Cited by 20
“Empirical support is growing for palliative interventions that facilitate processes to support a sense of generativity, dignity, and life closure through legacy and life review activities (Ando et al., 2007; Chochinov et al., 2011; LeMay & Wilson, 2008).”
BackgroundCompassionate Release Policy Reform: Physicians as Advocates for Human Dignity
Mitchell, A., & Williams, B. A. (2017) · The AMA Journal of Ethic · doi:10.1001/journalofethics.2017.19.9.peer2-1709 · Cited by 20
“To optimize such care, Chochinov identifies several tasks of “dignity-conserving care” [25], which include settling relationships, sharing words of love, and preparing a legacy document for loved ones [27-29].”
BackgroundByrne, C. M., & Morgan, D. D. (2019) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909119891148 · Cited by 20
“Other ways to help nonreligious spiritual struggle might include psychotherapy, such as Chochinov Dignity Therapy, which helps people appreciate the importance of their own life has had and has been shown to be helpful particularly for those who are deeply distressed.(47) Identifying meaning, exploring the power of fo…”
BackgroundWang, C., Chen, J., Wang, Y., Hu, R., & Wu, Y. (2020) · European Journal of Cancer Care · doi:10.1111/ecc.13204 · Cited by 20
Weis, J., Brehm, F., Hufeld, J. M., Blettner, G., Bruns, G., Gruber, H., Maatouk, I., Mathiak, K., Dinkel, A., Kreikenbohm, T., et al. (2022) · Die Onkologie · doi:10.1007/s00761-022-01194-9 · Cited by 20
“[31]) sowie „dignity therapy“ (würdeorientierte Therapie; [8, 24]) einbezogen.”
Wang, N., Wang, K., Lu, X., Zhang, S., Sun, X., & Zhang, Y. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e28593 · Cited by 19
Sakaguchi, S., & Okamura, H. (2014) · Palliative & Supportive Care · doi:10.1017/s1478951514000194 · Cited by 19
Distressing Visions at the End of Life: Case Report and Review of the Literature
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“Interventions such as dignity therapy and meaning-centered psychotherapy have been shown to improve spiritual wellbeing, lessen sadness and depression, and sustain or enhance a sense of meaning, peace, and purpose at the end of life (Chochinov et al., 2011; Breitbart et al., 2012).”
BackgroundEpstein, A. S., O'Reilly, E. M., Shuk, E., BREITBART, W. S., Shah, M. A., Ly, M., Tayler, R., & Volandes, A. E. (2016) · Psycho-Oncology · doi:10.1002/pon.4167 · Cited by 19
“The questions were also designed in order to be used in Part 2 of the study as a modified Dignity Therapy [4] program.”
MethodSelf-citationHALL, S. L., Goddard, C., Martin, P., Opio, D., & Speck, P. W. (2012) · Psycho-Oncology · doi:10.1002/pon.3206 · Cited by 19
“Cognitive impairment resulting from distress can result in distortions and dissatisfied recipients [5].”
BackgroundMethodInfluentialMeaning and Purpose (MaP) therapy I: Therapeutic processes and themes in advanced cancer
Lethborg, C. E., Kissane, D. W., & Schofield, P. E. (2019) · Palliative & Supportive Care · doi:10.1017/s1478951518000871 · Cited by 19
Construction and validation of nursing diagnoses for people in palliative care
da Silva, R. S., Pereira, Á., da Nóbrega, M. M. L., & Mussi, F. C. (2017) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.1862.2914 · Cited by 19
“In a randomized clinical trial(25), developed in New York City with patients in palliative care, the “Dignity Therapy” intervention, a brief psychotherapy, was provided, offering patients the opportunity to talk about what matters the most for them faced with the death and dying process.”
BackgroundHealth-related expectations of the chronically critically ill: a multi-perspective qualitative study
Howard, A. F., Crowe, S., Choroszewski, L., Kovatch, J., Haynes, A. J., Ford, J. S., Beck, S. M., & Haljan, G. J. (2021) · BMC Palliative Care · doi:10.1186/s12904-020-00696-w · Cited by 22
“Research is needed to explore among CCI individuals and family the use of existing interventions designed to foster hope in other populations, such as The Living with Hope Program [40], Dignity Therapy [41, 42], Life-Review Therapy [43] and the use of a hope conversation guide [44].”
BackgroundCarreno, D. F., Eisenbeck, N., Uclés‐Juárez, R., & García‐Montes, J. M. (2023) · Psycho-Oncology · doi:10.1002/pon.6244 · Cited by 23
Legacy in End-of-Life Care: A Concept Analysis
Timóteo, C., Vitorino, J., Ali, A. M., & Laranjeira, C. (2024) · Nursing Reports · doi:10.3390/nursrep14030177 · Cited by 23
Wagner, C. D., Johns, S. A., Brown, L. F., Hanna, N. H., & Bigatti, S. M. (2015) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909115575709 · Cited by 21
“The intervention, developed by the research team, consisted of experiential activities drawn from clinical practice and extensive literature review of successful meaningbased interventions.(4,15,20,30,31) The intervention consisted of four 60-minute sessions.”
MethodBeck, A., Cottingham, A. H., Stutz, P. V., Gruber, R. N., Bernat, J. K., Helft, P. R., Wilhelm, L. R., Schmidt, K., Stout, M. E., Willard, C. A., et al. (2018) · Palliative & Supportive Care · doi:10.1017/s1478951518000482 · Cited by 18
Dose, A. M., Hubbard, J. M., Mansfield, A. S., McCabe, P. J., Krecke, C. A., & Sloan, J. A. (2017) · Oncology nursing forum · doi:10.1188/17.onf.e194-e202 · Cited by 18
“They also stated that it improved their overall QOL and sense of dignity, promoted spiritual well-being, and lessened sadness (Chochinov et al., 2011).”
BackgroundInfluential‘Song of Life’: music therapy in terminally ill patients with cancer
Warth, M., Keßler, J., van Kampen, J., Ditzen, B., & Bardenheuer, H. J. (2018) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2017-001475 · Cited by 20
Global Aspects of Palliative Care
Connor, S. R. (2018) · Springer eBooks · doi:10.1007/978-3-319-31738-0_4-1 · Cited by 18
Psychotherapeutic Considerations for Patients With Terminal Illness
Kredentser, M. S., & Chochinov, H. M. (2020) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.20190048 · Cited by 17
Self-citationEngaging Mortality: Effective Implementation of Dignity Therapy
Wilkie, D. J., Fitchett, G. A., Yao, Y., Schoppee, T. M., Delgado-Guay, M. O., Hauser, J. M., Kittelson, S. M., O’Mahony, S., Rabow, M. W., Quest, T. E., et al. (2023) · Journal of Palliative Medicine · doi:10.1089/jpm.2023.0336 · Cited by 17
“A central hypothesis of our study was that DT influences important spiritual and existential domains, such as the need for meaning, concerns about family, and need for a legacy, 4 which are included in our primary efficacy outcome, the DIS.”
BackgroundSelf-citationMateo-Ortega, D., Gómez‐Batiste, X., Maté-Méndez, J., Beas, E., Ela, S., Lasmarías, C., & Limonero, J. T. (2018) · Journal of Palliative Medicine · doi:10.1089/jpm.2017.0355 · Cited by 17
“Our findings are consistent with those obtained by Breitbart and colleagues, 15,16 who observed that meaning-based group psychotherapy improved patient perception of meaning in life and of well-being, thus reducing their suffering.”
InfluentialJohnson, R. J. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1651-9 · Cited by 17
Race and Ethnicity in the Evidence for Integrating Palliative Care Into Oncology
Pirl, W. F., Saez-Flores, E., Schlumbrecht, M. P., Nipp, R. D., Traeger, L. N., & Kobetz, E. K. (2018) · Journal of Oncology Practice · doi:10.1200/jop.17.00016 · Cited by 18
Söderman, A., Östlund, U., Harstäde, C. W., & Blomberg, K. (2020) · Palliative & Supportive Care · doi:10.1017/s1478951520000139 · Cited by 17
Lou, C., Lou, K. K. W., & Ridley, J. (2020) · Palliative Medicine · doi:10.1177/0269216320956809 · Cited by 17
Meanings Emerging From Dignity Therapy Among Cancer Patients
Buonaccorso, L., Tanzi, S., Panfilis, L. D., Ghirotto, L., Autelitano, C., Chochinov, H. M., Leo, S. D., & Martucci, G. (2021) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2021.02.028 · Cited by 17
Self-citationMeaning in Life in Patients With Progressive Supranuclear Palsy
Fegg, M. J., Kögler, M., Abright, C., Hensler, M., & Lorenzl, S. (2013) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909113492411 · Cited by 17
Bovero, A., Tosi, C., Botto, R., Cito, A. L., Malerba, V., Molfetta, V., Ieraci, V., & Torta, R. (2019) · Journal of Cancer Education · doi:10.1007/s13187-019-01577-4 · Cited by 17
Patient Spirituality as a Component of Supportive Care: Assessment and Intervention
D'Souza, K. M., & Astrow, A. B. (2020) · Current Treatment Options in Oncology · doi:10.1007/s11864-020-0701-y · Cited by 19
Montross-Thomas, L. P., Irwin, S. A., Meier, E. A., Gallegos, J. V., Golshan, S., Roeland, E. J., McNeal, H., Munson, D. L., & Rodseth, L. (2015) · BMC Palliative Care · doi:10.1186/s12904-015-0041-z · Cited by 16
“The second session will involve the completion of a life reflection interview using the standardized interview protocol [13, 15, 17, 19].”
BackgroundMethodLin, J., Guo, Q., Xi, L., Zhang, H., Liu, F., Zheng, R., & Liu, W. (2023) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2023.102301 · Cited by 16
Schultz, M., Baziliansky, S., Mitnik, I., Ulitzur, N., Illouz, S., Katra, D., Givoli, S., Campisi‐Pinto, S., Bar‐Sela, G., & Zalman, D. (2023) · The Oncologist · doi:10.1093/oncolo/oyad037 · Cited by 16
Good death from cancer–the patient view: systematic review of qualitative studies
Wang, G., Xiao, J., Chen, Z., Huang, C., Deng, Y., & Tang, S. (2023) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2022-004146 · Cited by 17
Xie, M., Wang, C., Li, Z., Xu, W., Wang, Y., Wu, Y., & Hu, R. (2023) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2023.104668 · Cited by 16
Wang, T., Cheung, K., & Cheng, H. (2024) · Palliative Medicine · doi:10.1177/02692163241238900 · Cited by 16
Aoun, S. M., O’Connor, M., Breen, L. J., Deas, K., & Skett, K. (2012) · Health & Social Care in the Community · doi:10.1111/hsc.12002 · Cited by 16
“Our experience was recently echoed by Nekolaichuk (2011) who commented that RCTs pose substantial challenges for research into psychosocial interventions, in the context of Dignity Therapy (Chochinov et al. 2011) where there were no significant differences in the primary outcome of distress in favour of dignity therap…”
BackgroundMaking the Call: A Proactive Ethics Framework
Pavlish, C., Brown‐Saltzman, K., Fine, A., & Jakel, P. (2013) · HEC Forum · doi:10.1007/s10730-013-9213-5 · Cited by 16
“Programs that focus on family and patient knowledge, communication deficits, patient vulnerabilities, poor patient prognosis, and clinician collaboration exemplify risk reduction strategies (Boyle and Kochinda 2004; Brown-Saltzman et al. 2010; Campbell and Guzman 2003; Chochinov et al. 2011; McDonagh et al. 2004; Pent…”
BackgroundA review of biographical work in palliative care
Hesse, M., Forstmeier, S., Mochamat, M., & Radbruch, L. (2019) · Indian Journal of Palliative Care · doi:10.4103/ijpc.ijpc_16_19 · Cited by 16
Warth, M., Koehler, F., Aguilar‐Raab, C., Bardenheuer, H. J., Ditzen, B., & Keßler, J. (2020) · European Journal of Cancer Care · doi:10.1111/ecc.13249 · Cited by 17
Rodrigues, M. G. D. R., Pautex, S., & Shaha, M. (2019) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2019.01.006 · Cited by 16
Positive Psychiatry Interventions in Geriatric Mental Health
Lam, J. A., Aftab, A., Lee, E., & Jeste, D. V. (2020) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-020-00228-6 · Cited by 17
Psycho-existential distress in cancer patients: A return to “entheogens”
Blinderman, C. D. (2016) · Journal of Psychopharmacology · doi:10.1177/0269881116675761 · Cited by 16
“To date, there are no approved pharmacotherapies or evidence-based psychosocial interventions for existential distress, though some approaches show promise and are associated with improvement in patients’ sense of meaning and purpose, for example dignity therapy (Chochinov et al., 2011; Faller et al., 2013) and meanin…”
BackgroundIsenberg, S. R., Aslakson, R. A., & Smith, T. J. (2017) · Epidemiologic Reviews · doi:10.1093/epirev/mxw002 · Cited by 16
“The CPGs list evidence quality as intermediate (3, 13, 15, 16) and strength of recommendation as moderate.”
BackgroundMeasuring Patients’ Experiences of Respect and Dignity in the Intensive Care Unit: A Pilot Study
Aboumatar, H. J., Beach, M. C., Yang, T., Branyon, E. D., Forbes, L., & Sugarman, J. (2015) · Narrative Inquiry in Bioethics · doi:10.1353/nib.2015.0005 · Cited by 15
“Furthermore, the fi ndings on the PDI in this study were similar to those reported from patients at other settings such as those receiving non–acute palliative care services (Chochinov et al., 2011).”
Toward a Conceptual Model of Affective Predictions in Palliative Care
Ellis, E. M., Barnato, A. E., Chapman, G. B., Dionne-Odom, J. N., Lerner, J. S., Peters, E. M., Nelson, W. L., Padgett, L. S., Suls, J. M., & Ferrer, R. A. (2019) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2019.02.008 · Cited by 15
Improving Spiritual Well-Being in Patients with Lung Cancers
Piderman, K. M., Sytsma, T. T., Frost, M. H., Novotny, P. J., Rausch, S. M., Nes, L. S., Patten, C. A., Sloan, J. A., Rummans, T. A., Bronars, C. A., et al. (2015) · Journal of Pastoral Care & Counseling Advancing theory and professional practice through scholarly and reflective publications · doi:10.1177/1542305015602711 · Cited by 15
“They could also take the lead in tailoring interventions that have been helpful in mixed cancer populations, such as dignity therapy (Chochinov et al., 2011), spiritual legacy preparation (Piderman et al.”
BackgroundMehdipour‐Rabori, R., Abbaszadeh, A., & Borhani, F. (2016) · PubMed Central · Cited by 15
Qualitative study on perceived dignity of cancer patients undergoing chemotherapy in China
Xiao, J., Chow, K. M., Chan, C. W. H., Li, M., & Deng, Y. (2019) · Supportive Care in Cancer · doi:10.1007/s00520-019-05123-2 · Cited by 15
Exceptional patients: Narratives of connections
Engebretson, J. C., Peterson, N. E., & Frenkel, M. A. (2013) · Palliative & Supportive Care · doi:10.1017/s147895151300014x · Cited by 14
“…can offer interventions such as Dignity Therapy, an individualized, short-term therapy to help patients and their families improve their quality of life, while having an increased sense of dignity, decreased sadness, and possible change in how the family perceives them (Chochinov et al., 2011).”
BackgroundDignity and Related Factors in Patients with Cancer: A Cross-Sectional Study
Li, Y., Feng, Y., Ma, S., & Wang, H. (2022) · Asian Nursing Research · doi:10.1016/j.anr.2022.12.001 · Cited by 14
Loss of Personal Autonomy and Dignity-Related Distress in End-Of-Life Cancer Patients
Bovero, A., Botto, R., Mellano, E., Gottardo, F., Berchialla, P., Carletto, S., & Geminiani, G. C. (2023) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091231166373 · Cited by 14
“10 In this context an empirically based model of dignity has been developed by Chochinov et al, 11 to describe the concept of dignity-conserving care in palliative care.”
BackgroundSpiritual Care in Hospice and Palliative Care
FERRELL, B. R. (2017) · The Korean Journal of Hospice and Palliative Care · doi:10.14475/kjhpc.2017.20.4.215 · Cited by 14
“(41,42), and others have tested interventions to support patient dignity and what has become known as meaning-focused psychotherapy.”
BackgroundManagement of Grief, Depression, and Suicidal Thoughts in Serious Illness.
McKee, K. Y., & Kelly, A. (2020) · The Medical clinics of North America · doi:10.1016/j.mcna.2020.01.003 · Cited by 12
Xiao, J., Chow, K. M., Tang, S., & Chan, C. W. H. (2022) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2022.100078 · Cited by 14
Perceptions of the meaning of life among Korean patients with advanced cancer: A mixed-methods study
Koh, S., Kang, K., Kim, H., Cheon, J., Im, H.-S., Lee, J.-H., Ock, M., Cho, J., & Lee, E.-H. (2022) · Palliative & Supportive Care · doi:10.1017/s1478951522000979 · Cited by 14
Lebensrückblick bei Anpassungsproblemen und Lebenskrisen
Forstmeier, S. (2012) · Springer eBooks · doi:10.1007/978-3-642-28199-0_5 · Cited by 14
Ratkowski, K. L., Washington, K. T., Craig, K. W., & Albright, D. L. (2014) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909114540034 · Cited by 14
“Dignity therapy is a short-term therapy for patients facing a terminal or potentially terminal illness that focuses on relieving stress in patients and families through focusing on what matters most to the patient or what the patient would want remembered after his or her death.(24) Dignity therapy appears promising a…”
BackgroundPalliative Care as a Primary Therapeutic Approach in Advanced Dementia: A Narrative Review
Zahradnik, E. K., & Grossman, H. T. (2014) · Clinical Therapeutics · doi:10.1016/j.clinthera.2014.10.006 · Cited by 15
“Keep the faith”: Spirituality as a contributor to resiliency in five elderly people
Sytsma, T. T., Schmelkin, L. A., Jenkins, S. M., Lovejoy, L. A., Lapid, M. I., & Piderman, K. M. (2018) · Journal of Religion Spirituality & Aging · doi:10.1080/15528030.2018.1441095 · Cited by 14
“Finding meaning at the end of life is an important aspect of overall wellbeing and QOL (Chochinov et al., 2011).”
BackgroundMoosavi, S., Borhani, F., Akbari, M. E., Sanee, N., & Rohani, C. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05390-4 · Cited by 14
Viladot, M., Gallardo-Martínez, J.-L., Hernandez-Rodríguez, F., Izcara-Cobo, J., Majó-LLopart, J., Peguera-Carré, M., Russinyol-Fonte, G., Saavedra-Cruz, K., Barrera, C., Chicote, M., et al. (2023) · Cancers · doi:10.3390/cancers15164182 · Cited by 13
Existential Suffering Part 2: Clinical Response and Management #320
Grech, A., & Marks, A. D. (2016) · Journal of Palliative Medicine · doi:10.1089/jpm.2016.0423 · Cited by 13
Volunteers in a biography project with palliative care patients – a feasibility study
Hesse, M., Forstmeier, S., Cuhls, H., & Radbruch, L. (2019) · BMC Palliative Care · doi:10.1186/s12904-019-0463-0 · Cited by 13
Patients’ priorities in a reminiscence and legacy intervention in palliative care
Hesse, M., Forstmeier, S., Ateş, G., & Radbruch, L. (2019) · Palliative Care and Social Practice · doi:10.1177/2632352419892629 · Cited by 13
Psychological aspects of meaning-centered group psychotherapy: Spanish experience
Fraguell, C., Limonero, J. T., & Gil, F. (2017) · Palliative & Supportive Care · doi:10.1017/s1478951517000293 · Cited by 13
“…intervention postdiagnosis can have beneficial effects in terms of quality of life, and can prevent unnecessary suffering by encouraging patients to evaluate their lives and question the meaning they attribute to the fact of living with cancer (Lee et al., 2004; Chochinov et al., 2011).”
BackgroundA developmental perspective on existential distress and adaptation to advanced disease
Lo, C. (2018) · Psycho-Oncology · doi:10.1002/pon.4767 · Cited by 13
“When individuals speak of dignity at the end of life, they may often be concerned about the erosion of these most basic of competencies, which include the capacity for autonomy and self‐care.(6) The stages and their respective psychological conflicts may serve as a framework to organize the existential themes that hav…”
BackgroundAdvance Care Planning and End-of-Life Issues in Head and Neck Cancer
Mott, F. E., & Adams, K. C. O. (2018) · Journal of Palliative Care · doi:10.1177/0825859718788768 · Cited by 13
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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