Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-22T09:43:17.497Z Has data issue: false hasContentIssue false
  • English
  • Français

A Portuguese trial using dignity therapy for adults who have a life-threatening disease: Qualitative analysis of generativity documents

Published online by Cambridge University Press:  23 June 2021

Miguel Julião Open the ORCID record for Miguel Julião [Opens in a new window] ,
Maria Ana Sobral ,
Bridget Johnston ,
Ana Raquel Lemos ,
Sara Almeida ,
Bárbara Antunes Open the ORCID record for Bárbara Antunes [Opens in a new window] ,
Çiğdem Fulya Dönmez  and
Harvey Max Chochinov
Miguel Julião*
Affiliation:
Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Sintra, Portugal
Maria Ana Sobral
Affiliation:
Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Sintra, Portugal
Bridget Johnston
Affiliation:
School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK NHS Greater Glasgow and Clyde, Glasgow, UK
Ana Raquel Lemos
Affiliation:
Escola de Medicina da Universidade do Minho, Braga, Portugal
Sara Almeida
Affiliation:
Escola de Medicina da Universidade do Minho, Braga, Portugal
Bárbara Antunes
Affiliation:
Primary Care Unit, Department of Public Health and Primary care, University of Cambridge, Cambridge, UK Centro de Estudos e Investigação em Saúde da Universidade de Coimbra, Coimbra, Portugal
Çiğdem Fulya Dönmez
Affiliation:
School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
Harvey Max Chochinov
Affiliation:
Department of Psychiatry, Research Institute of Oncology and Hematology, Cancer Care Manitoba, Manitoba, Canada
*
Author for correspondence: Miguel Julião, Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Sintra, Portugal. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

Dignity therapy (DT) is a brief, individualized intervention, which provides terminally ill patients with an opportunity to convey memories, essential disclosures, and prepare a final generativity document. DT addresses psychosocial and existential issues, enhancing a sense of meaning and purpose. Several studies have considered the legacy topics most frequently discussed by patients near the end of life. To date, no Portuguese study has done that analysis.

Method

We conducted a qualitative analysis of 17 generativity documents derived from a randomized controlled trial (RCT). Inductive content analysis was used to identify emerging themes.

Results

From the 39 RCT participants receiving DT, 17 gave consent for their generativity document to undergo qualitative analysis. Nine patients were female; mean age of 65 years, with a range from 46 to 79 years. Seven themes emerged: “Significant people and things”; “Remarkable moments”; “Acknowledgments”; “Reflection on the course of life”; “Personal values”; “Messages left to others”; and “Requests and last wishes”.

Significance of results

Generativity document analysis provides useful information for patients nearing death, including their remarkable life moments and memories, core values, concerns, and wishes for their loved ones. Being conscious of these dominant themes may allow health providers to support humanized and personalized care to vulnerable patients and their families, enhancing how professionals perceive and respond to personhood within the clinical setting.

Keywords

Dignity therapyEnd-of-life careGenerativity documentPalliative careQualitative analysisTerminal care
Type
Original Article
Information
Palliative & Supportive Care , Volume 20 , Issue 2 , April 2022 , pp. 189 - 195
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andersson, M, Hallberg, IR and Edberg, AK (2008) Old people receiving municipal care, their experiences of what constitutes a good life in the last phase of life: A qualitative study. International Journal of Nursing Studies 45(6), 818–828.CrossRefGoogle ScholarPubMed
Breitbart, W, Rosenfeld, B, Pessin, H, et al. (2015) Meaning-centered group psychotherapy: An effective intervention for improving psychological well-being in patients with advanced cancer. Journal of Clinical Oncology 33(7), 749–754.CrossRefGoogle ScholarPubMed
Buron, B (2008) Levels of personhood: A model for dementia care. Geriatric Nursing 29(5), 324–332.CrossRefGoogle Scholar
Chochinov, HM (2002) Dignity-conserving care—a new model for palliative care: Helping the patient feel valued. JAMA 287(17), 2253–2260.CrossRefGoogle ScholarPubMed
Chochinov, HM (2011) Dignity Therapy: Final Words for Final Days. New York: Oxford University Press.CrossRefGoogle Scholar
Chochinov, HM, Hack, T, McClement, S, et al. (2002) Dignity in the terminally ill: A developing empirical model. Social Science & Medicine 54(3), 433–443.CrossRefGoogle ScholarPubMed
Chochinov, HM, Hack, T, Hassard, T, et al. (2005) Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. Journal of Clinical Oncology 23(24), 5520–5525.CrossRefGoogle ScholarPubMed
Chochinov, HM, Hassard, T, McClement, S, et al. (2008) The patient dignity inventory: A novel way of measuring dignity-related distress in palliative care. Journal of Pain and Symptom Management 36(6), 559–371.CrossRefGoogle ScholarPubMed
Chochinov, HM, Kristjanson, LJ, Breitbart, W, et al. (2011) The effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomised controlled trial. The Lancet Oncology 12(8), 753–762.CrossRefGoogle ScholarPubMed
Cottingham, AH, Cripe, LD, Rand, KL, et al. (2018) “My future is now”: A qualitative study of persons living with advanced cancer. The American Journal of Hospice and Palliative Care 35(4), 640–646.CrossRefGoogle ScholarPubMed
Dönmez, ÇF and Johnston, B (2020) Living in the moment for people appoaching the end of life: A concept analysis. International Journal of Nursing Studies 108, 103584.CrossRefGoogle Scholar
Dose, AM and Rhudy, LM (2018) Perspectives of newly diagnosed advanced cancer patients receiving dignity therapy during cancer treatment. Supportive Care in Cancer 26, 187–195.CrossRefGoogle ScholarPubMed
Erikson, EH (1963) Childhood and Society. New York, NY: Norton.Google Scholar
Fitchett, G, Emanuel, L, Handzo, G, et al. (2015) Care of the human spirit and the role of dignity therapy: A systematic review of dignity therapy research. BMC Palliative Care 14, 8.CrossRefGoogle ScholarPubMed
Goddard, C, Speck, P, Martin, P, et al. (2013) Dignity therapy for older people in care homes: A qualitative study of the views of residents and recipients of ‘generativity’ documents. Journal of Advanced Nursing 69(1), 122–132.CrossRefGoogle Scholar
Hack, TF, McClement, SE, Chochinov, HM, et al. (2010) Learning from dying patients during their final days: Life reflections gleaned from dignity therapy. Palliative Medicine 24(7), 715–723.CrossRefGoogle ScholarPubMed
Hall, S, Goddard, C, Opio, D, et al. (2012) Feasibility, acceptability and potential effectiveness of dignity therapy for older people in care homes: A phase II randomized controlled trial of a brief palliative care psychotherapy. Palliative Medicine 26, 703–712.CrossRefGoogle Scholar
Houmann, LJ, Chochinov, HM, Kristjanson, LJ, et al. (2014) A prospective evaluation of dignity therapy in advanced cancer patients admitted to palliative care. Palliative Medicine 28, 448–458.CrossRefGoogle ScholarPubMed
Johnston, B (2010) Can self-care become an integrated part of end-of-life care? Implications for palliative nursing. International Journal of Palliative Nursing 16(5), 212–214.CrossRefGoogle ScholarPubMed
Johnston, B, Östlund, U and Brown, H (2012) Evaluation of the Dignity Care Pathway for community nurses caring for people at the end of life. International Journal of Palliative Nursing 18(10), 483–489.CrossRefGoogle ScholarPubMed
Johnston, B, Lawton, S and Pringle, C (2015) ‘This is my story, how I remember it’: In-depth analysis of dignity therapy documents from a study of dignity therapy for people with early stage dementia. Dementia 16(5), 543–555.CrossRefGoogle Scholar
Johnston, B, Lawton, S, McCaw, C, et al. (2016) Living well with dementia: Enhancing dignity and quality of life, using a novel intervention, dignity therapy. International Journal of Older People Nursing 11(2), 107–120.CrossRefGoogle ScholarPubMed
Julião, M, Barbosa, A, Oliveira, F, et al. (2013) Efficacy of dignity therapy for depression and anxiety in terminally ill patients: Early results of a randomized controlled trial. Palliative Support Care 11(6), 481–489.CrossRefGoogle ScholarPubMed
Julião, M, Oliveira, F, Nunes, B, et al. (2014) Efficacy of dignity therapy on depression and anxiety in Portuguese terminally ill patients: A phase II randomized controlled trial. Journal of Palliative Medicine 17(6), 688–695.CrossRefGoogle ScholarPubMed
Julião, M, Oliveira, F, Nunes, B, et al. (2017) Effect of dignity therapy on end-of-life psychological distress in terminally ill Portuguese patients: A randomized controlled trial. Palliative Support Care 15(6), 628–637.CrossRefGoogle ScholarPubMed
Kitwood, T (1997) Dementia Reconsidered: The Person Comes First. Buckingham, UK: Open University Press.Google Scholar
Kyngas, H (2020) Inductive content analysis. In Kyngas, H, Mikkonen, K & Kaariainen, M (eds.), The Application of Content Analysis in Nursing Science Research. Oulu: Springer Press, pp. 13–21.CrossRefGoogle Scholar
Montross, L, Winters, KD and Irwin, SA (2011) Dignity therapy implementation in a community-based hospice setting. Journal of Palliative Medicine 14, 729–734.CrossRefGoogle Scholar
O'Gara, G, Tuddenham, S and Pattison, N (2018) Haemato-oncology patients’ perceptions of health-related quality of life after critical illness: A qualitative phenomenological study. Intensive & Critical Care Nursing 44, 76–84.CrossRefGoogle ScholarPubMed
Rudilla, D, Galiana, L, Oliver, A, et al. (2016) Comparing counseling and dignity therapies in home care patients: A pilot study. Palliative and Supportive Care 14, 321–329.CrossRefGoogle ScholarPubMed
Starks, H and Trinidad, SB (2007) Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory. Qualitative Health Research 17(10), 1372–1380.CrossRefGoogle Scholar
Testoni, I, Bingaman, KA, Dlapico, G, et al. (2019) Dignity as wisdom at the end of life: Sacrifice as value emerging from a qualitative analysis of generativity documents. Pastoral Psychology 68, 479–489.CrossRefGoogle Scholar
Tong, A, Sainsbury, P and Craig, J (2007) Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal of Quality Health Care 19(6), 349–357.CrossRefGoogle ScholarPubMed
Vuksanovic, D, Green, H, Morrissey, S, et al. (2017) Dignity therapy and life review for palliative care patients: A qualitative study. Journal of Pain and Symptom Management 54(4), 530–537.CrossRefGoogle ScholarPubMed
Yun, YH, Kim, KN, Sim, JA, et al. (2018) Priorities of a ‘good death’ according to cancer patients, their family caregivers, physicians, and the general population: A nationwide survey. Supportive Care in Cancer 26, 3479–3488.CrossRefGoogle ScholarPubMed