Abstract
Dignity therapy (DT) is a guided process conducted by a health professional for reviewing one's life to promote dignity through the illness process. Empathic communication has been shown to be important in clinical interactions but has yet to be examined in the DT interview session. The Empathic Communication Coding System (ECCS) is a validated, reliable coding system used in clinical interactions. The aims of this study were (1) to assess the feasibility of the ECCS in DT sessions and (2) to describe the process of empathic communication during DT sessions. We conducted a secondary analysis of 25 transcripts of DT sessions with older cancer patients. These DT sessions were collected as part of larger randomized controlled trial. We revised the ECCS and then coded the transcripts using the new ECCS-DT. Two coders achieved inter-rater reliability (κ = 0.84) on 20% of the transcripts and then independently coded the remaining transcripts. Participants were individuals with cancer between the ages of 55 and 75. We developed the ECCS-DT with four empathic response categories: acknowledgment, reflection, validation, and shared experience. We found that of the 235 idea units, 198 had at least one of the four empathic responses present. Of the total 25 DT sessions, 17 had at least one empathic response present in all idea units. This feasibility study is an essential first step in our larger program of research to understand how empathic communication may play a role in DT outcomes. We aim to replicate findings in a larger sample and also investigate the linkage empathic communication may have in the DT session to positive patient outcomes. These findings, in turn, may lead to further refinement of training for dignity therapists, development of research into empathy as a mediator of outcomes, and generation of new interventions.
Highlights
500,000 older Americans die a cancer-related death each year (Xu et al, 2018)
To test the feasibility of the Empathic Communication Coding System (ECCS) with Dignity therapy (DT) sessions, we followed these steps: (1) The first and second author conducted an initial trial of applying the ECCS to several DT sessions, concluding in the realization that the coding system would need revisions to be feasible in the DT context. (2) Subsequently, we open-coded a portion of the transcripts (n = 15) using an inductive qualitative thematic analysis process (Braun and Clarke, 2006)
Despite the adoption of DT in cancer care, there has been little exploration of the therapeutic processes, such as empathic communication, that occur during DT sessions
Summary
500,000 older Americans die a cancer-related death each year (Xu et al, 2018). The DT process involves reviewing one’s life story (Chochinov et al, 2005), affording patients individualized psychosocial support through encounters with a dignity therapist We use this term, dignity therapist, to describe providers (e.g., nurses, chaplains, and mental health therapists) who receive standard training and use explicit interview tools (e.g., Guiding Questions, see Table 1) to facilitate the patient’s feeling that their life has had meaning and their accomplishments and experiences are uniquely valued (Pasupathi and Rich, 2005). Research on life story sharing (Habermas and Bluck, 2000; McAdams and McLean, 2013) suggests that the listener plays a crucial role in shaping how individuals recall and evaluate their personal past (Pasupathi and Rich, 2005), as occurs centrally during DT It follows that empathic communication should be central in DT. The aims of the current study were: (1) to assess the applicability and feasibility of the ECCS in DT sessions; (2) to describe empathic communication as a process in DT
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