Special Talk Therapy Seems to Help Dying Patients
'Dignity therapy' can enhance their quality of life and their dignity, study finds
By Kathleen Doheny
THURSDAY, July 7 (HealthDay News) -- A therapeutic dialogue known as dignity therapy helped terminally ill patients improve their quality of life and boost their sense of dignity while changing how their family sees and appreciates them, according to new research.
The short-term therapy did not, however, ease those distressed by dying, as the researchers had hoped.
But it did offer many other benefits for the end-of-life experience, according to Dr. Harvey Max Chochinov, the lead author of the international study, which was published online July 7 in The Lancet Oncology.
Chochinov, from the University of Manitoba in Winnipeg, Canada, pioneered the concept of dignity therapy, which he defines as "a brief individualized psychotherapy designed for people nearing the end of life."
The treatment, he said, seems to "shine a light on personhood," as terminal illness can often make patients feel as if the person they were is gone.
It speaks to people's need to leave something of themselves behind, he added.
Dignity therapy involves a conversation between patient and therapist about the things that are important to the patient. That information is then audio-taped, transcribed and edited into a readable narrative that the patient can choose to share with loved ones.
"It can include biographical information, lessons learned, or wishes, hopes or dreams for people that they are about to leave behind," Chochinov said.
For the study, the first randomized trial of the therapy, Chochinov and his colleagues compared dignity therapy involving 108 patients to standard palliative care (making patients comfortable) for 111 patients and client-centered care (therapy focused on the here-and-now) for 107 patients.
While researchers found no difference in distress levels among the groups at the end of the study, there were differences in quality of life, feeling helpful to loved ones and an improved sense of dignity. The dignity groups had better results in all compared to the other two groups.
Dignity therapy also improved spiritual well-being better than did client-centered care, the investigators found, and it worked better than standard care to reduce sadness or depression.
One man, whose life goals had been derailed by drinking problems, said he hoped his kids and grandkids would use him as an example of a way not to live. Another, happily married, said he hoped his wife could find happiness with another partner after he died.
There's a reason the therapy is a transcript taken from an audio recording, rather than a video, Chochinov noted. The approach allows the patient to focus on the words and the message, not their appearance, which could be altered greatly from illness.
The fact that the research did not find an effect on distress "doesn't mean it isn't effective," said Dr. Cheryl Nekolaichuk, a psychologist in palliative care at Grey Nuns Community Hospital in Edmonton, Canada, who wrote a commentary on the study.
Nekolaichuk is familiar with dignity therapy and called it helpful for those who want "to put things in perspective at a very difficult time in life."
The therapy seems to help people build a legacy, added Dr. Alexi Wright, an instructor in medicine at Harvard Medical School and the Dana-Farber Cancer Institute in Boston.
"When that doesn't happen, families suffer," she said, noting that dignity therapy may help make a person's death easier on loved ones.
The research, which also involved researchers from three Australian universities and Memorial Sloan-Kettering Cancer Center in New York City, was funded by the U.S. National Cancer Institute.
To learn more about palliative care, visit the National Palliative Care Research Center.SOURCES: Harvey Max Chochinov, M.D., distinguished professor of psychiatry, University of Manitoba, Winnipeg, Canada; Cheryl Nekolaichuk, Ph.D., psychologist, Grey Nuns Community Hospital, Edmonton, Canada; Alexi Wright, M.D., instructor in medicine, Harvard Medical School, Dana-Farber Cancer Institute, Boston; July 7, 2011, The Lancet Oncology, online Related Articles
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