Care of the human spirit and the role of dignity therapy: a systematic review of dignity therapy research

George Fitchett; Linda Emanuel; George Handzo; Lara Boyken; Diana J Wilkie

doi:10.1186/s12904-015-0007-1

BMC Palliative Care

Table 2 Qualitative studies of dignity therapy

From: Care of the human spirit and the role of dignity therapy: a systematic review of dignity therapy research

Study	Sample	Methods	Main study finding
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.
Tait et al., 2011 [40]		Constant comparative analysis of DT interviews	• 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.
Montross et al., 2011 [41]	27 US community-based hospice patients		• 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’.
Hall et al., 2013 [34]			• 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.

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