Dignity Therapy: a new psychoterapeutic approach for people facing advanced disease

Abstract

Background: The fear of loss of dignity is a recurring concern among oncological patients, especially in the advanced stage of illness, for those who are in advanced stage of their disease. Chochinov has made the model of Dignity Therapy (DT) used primarily with people who were terminally ill. It consists of a short-term psychotherapy intervention that includes 3 major issues: physical aspects related to the disease and symptoms; existential/spiritual based on the patient's life history; social relationships linked to the quality of the relationship between the patient, practitioners and family members. The DT is a multi-dimensional psychosocial intervention for patient-centered care and it depends on experiences of generativity and the pursuit of purpose and meaning. It invites patients to discuss issues that matter most or that they would (most) want mainly to remember. Methods: Since 2016 we applied to 4 patients the DT in the perspective of simultaneous care with metastatic disease, in psychological therapy and still in chemotherapy. We are using the Italian validate version of semi-structured interview. The intervention takes place in 3-4 meetings, lasting 1 hour each, after informed consent. The interview uses 10 core questions and the responses are used to create a written legacy document to family members. The DT session is audio-recorded, transcribed, edited and given back to the patient. Content includes lifetime events that are most significant in the life of the patient, who can later personalize adding photos, images, titles or more. Results: Because the our small sample, we do not have a statistically relevant data, but we have noticed that the common themes that emerge in patients mainly concern the attributed value to the affections and the family and the experiences that have contributed to building their identity. The introduction of topics such as dignity, searching for meaning, has proved to be a valuable tool for the development of the true meaning of one's life, despite the changes in the disease. Moreover, in some cases, it has contributed to allowing the person to find a way of self-reliance in relation to loved ones. Conclusion: In our experience, DT showed to be a new promising therapeutic intervention for suffering and distress at the end of life. The literature review finds robust evidence for DT’s overwhelming acceptability, rare for any medical intervention, especially in psychosocial-spiritual care.