Table 2 Qualitative studies of dignity therapy

Hack et al., 2010 [39]

50 edited DT transcripts (17 Canadian and 33 Australian) from patients with terminal illness in inpatient palliative care programs, sample from Chochinov et al., 2005 [17]

Content analysis, constant comparative analysis of completed DT legacy document by three investigators

• Throughout DT interview patients reflect on two to three personally meaningful core values, such as ‘family’, ‘pleasure’, ‘caring’, and ‘sense of accomplishment’.

• DT is used by patients to confirm personal identity.

• Investigators suggest more theoretical analysis of “meaning-making” construct in end-of-life care needed.

Tait et al., 2011 [40]

12 Canadian patients with terminal illness in inpatient palliative care

Constant comparative analysis of DT interviews

• Three main ‘types of interviews’ emerge: ‘Evaluation narratives’, focusing on life prior to illness; ‘transition narratives’, focusing on change in health status and its meaning; ‘legacy narratives’, focusing on future without the patient.

• Investigators suggest narrative themes share commonality with medical interview and eulogy genres.

Montross et al., 2011 [41]

27 US community-based hospice patients

Coding consensus, co-occurrence, and comparison analysis of DT legacy documents

• Similar findings to Hack et al., 2010 [39], core values consistently expressed in transcripts.

• DT is feasible in a community-based setting.

Hall et al., 2013 [34]

49 UK pts in older care homes, sample from Hall et al., 2012 [35,36]

Framework analysis of qualitative interviews conducted at T1 and T2; interviews on resident views of DT and/or being a study participant (control group).

• Of 9 themes, 3 were unique to intervention group: ‘views of legacy document’; ‘generativity’; and ‘reminiscence’.

• DT not recommended by investigators, in current form, with participants with cognitive impairment: findings suggest DT document may reflect ‘distorted sense of self’ and prompt distress.

Hall et al., 2013 [42]

29 UK pts with advanced cancer, sample from Hall et al., 2011 [32,33]

Framework analysis of qualitative interviews conducted at T1 and T2; interviews on pt views of DT and/or being a study participant (control group).

• 5 of 7 themes in Dignity Model theory present in both interviews groups; ‘generativity’ found only in intervention group.

• No evidence of ‘role preservation’ as described in Dignity Model in this sample.

• Qualitative interview reporting of higher levels of hopefulness in both groups from participating in study, despite no change in quantitative component of study.