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Dignity Therapy


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Table of Contents

Chapter 1: Dignity and the End of Life Why Study Dignity? Dignity and Empirical Research The Model of Dignity in the Terminally Ill Illness-Related Concerns - Level of Independence - Symptom Distress Dignity-Conserving Repertoire - Dignity-Conserving Perspectives - Dignity-Conserving Practices Social Dignity Inventory - Privacy Boundaries - Social Support - Care Tenor - Burden to Others - Aftermath Concerns References Chapter 2: Moving Dignity into Care How the Dignity Model Informs Dignity Therapy - Form - Tone - Content Dignity Therapy Revealed The First Clinical Trial is Published What about Families? Gold Standard Evidence Time to Move On References Chapter 3: Introducing Dignity Therapy to Patients and Families Patient Selection for Dignity Therapy Who Should Not Take Part in Dignity Therapy? Chapter 4: Doing Dignity Therapy Setting up the Dignity Therapy Session The Role of the Dignity Therapist References Chapter 5: The Generativity Document The Rationale for Editing Dignity Therapy Transcripts Transcribing the Audio-Recorded Interview Editing the Verbatim Transcript - Cleaning Up the Transcript - Clarifying the Transcript - Finding a Suitable Ending - The Patient Has the Final Say Chapter 6. From Start to Finish Chapter 7. Moving Forward

About the Author

Dr. Harvey Max Chochinov is an international leader in palliative care. He is Distinguished Professor of Psychiatry at the University of Manitoba and Director of the Manitoba Palliative Care Research Unit at CancerCare Manitoba. His seminal publications on psychosocial issues in advanced illness have helped define core competences and standards of palliative end-of-life care. Dr. Chochinov has been a guest lecturer in many major academic institutions around the world. He has been lauded for his contributions to palliative care, with awards and recognitions coming from the Canadian Medical Association, the International Psycho-oncology Society, the Canadian Cancer Society, the Canadian Association of Psychosocial Oncology, the Canadian Psychiatric Association, the Academy of Psychosomatic Medicine, and the American Association of Hospice and Palliative Medicine. He is Fellow of the Royal Society of Canada and the Canadian Academy of Health Sciences. In 2014 he was inducted as an Officer in the Order of Canada.


"This is truly a remarkable book-- it simultaneously brings together the best we know of the science of palliative care with the essence and best of compassionate care." -- Jimmie C. Holland, Wayne E. Chapman Chair in Psychiatric Oncology and Attending Psychiatrist, Memorial Sloan-Kettering Cancer Center "For all health professionals who find themselves struggling to help patients face the complex process of dying, this book is both a detailed roadmap and an extraordinary guide that dispels the myth that 'there is nothing else they can do.' Embodying the essence of professionalism and caring, this text describes an innovative, evidence-based, therapeutic intervention to address the psychological and existential distress of patients with serious life threatening illnesses. Most importantly, the book sets a high standard for creating an environment that enables patients' exploration of personhood and suffering and enhances their dignity in the final days of their lives." -- Kathleen M. Foley, Attending Neurologist, Pain and Palliative Care Service, Memorial Sloan-Kettering Cancer Center "People often ask how palliative care clinicians can do this work day in, day out. I struggle to articulate the profound experience of witnessing patients and families find meaning and transcendence through their illness, but now I will refer them to Dr. Chochinov's remarkable book. He not only relays story after story of such healing, but he also gives us all clear guidance to help our patients and their families to make meaning of their lives in a consistent and standardized manner. Because it will help us to better help our patients and their families, his work is a gift to palliative care clinicians everywhere." -- Diane E. Meier, Director, Center to Advance Palliative Care; Director, Hertzberg Palliative Care Institute; and Professor of Geriatrics and Internal Medicine, Mount Sinai School of Medicine "Dr. Chochinov has pioneered the work of dignity therapy, and through his scholarship, the field of palliative care has been deeply influenced. Dignity Therapy is a rich blend of a deep understanding of the existential concerns of the seriously ill and dying, and an incredibly practical resource for clinicians." -- Betty Ferrell, Professor and Research Scientist, City of Hope Medical Center "Without careful characterization, concepts like dignity are ephemeral and profoundly difficult to address in a therapeutic paradigm. In Dignity Therapy: Final Words for Final Days, Harvey Chochinov brings clarity to the factors that influence the dignity of seriously and terminally ill persons. He expounds upon a well-developed and pragmatic therapeutic approach that has already been of help to thousands of patients across the world. This is not your usual medical text-- it is written with profound sensitivity, humanity, and wisdom that is both inspiring and practical." -- Nathan I. Cherny, Norman Levan Chair in Humanistic Medicine and Director of Cancer Pain and Palliative Care Service, Department of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel "In this elegant book, Harvey Chochinov shows how the interrelatedness of one human being with another affects an individual's intrinsic sense of dignity, and he examines the implications of this on the care environment. Every palliative care service will find this book enriching and will look with refreshed eyes on the work of providing care to others." -- Baroness Ilora Finlay of Llandaff, Professor of Palliative Medicine, Cardiff University, and Member, House of Lords, UK "As a clinical psychologist and hospice professional, I have always been an advocate of offering therapy and support to individuals as they face dying. The book Dignity Therapy offers unique insight into the process of psychological dying and the opportunity for growth. I recommend it to anyone who is working in the helping professions and has the unique opportunity to be present as individuals create their own last chapter." -- J. Donald Schumacher, President and CEO, National Hospice and Palliative Care Organization "Dying patients fear the loss of dignity at the end of their lives. Dr. Chochinov's book guides medical staff, patients, and families along a path where the patient is empowered, the family can be comforted, and the medical staff can truly provide for every aspect of its patient's needs." -- Sharon Carstairs, Senator for Manitoba, Canada "Dr. Chochinov is a pioneer of a new direction in psychiatry. Starting from first principles, he has defined dignity and developed an approach to its restoration in patients with far advanced disease. We have adopted it, clinically, in our own center. Our staff says it has added a new effective tool in caring for patients and their families. There's no better accolade for a physician than to have moved the field forward in the eyes of its clinicians." -- Charles F. von Gunten, Provost, Institute for Palliative Medicine at San Diego Hospice "Harvey Chochinov is a world leading clinician scientist who has spent the last 20 years improving our understanding of the concerns of patients and their families dealing with life limiting illnesses and facing the end of life. Dignity is at the heart of all we do in health care. This book is valuable to clinicians from all settings and fields, those involved in medical and nursing education, and those undertaking research to improve patient and family experience and care." -- Irene J. Higginson, Professor of Palliative Care, King's College, London "Dr. Chochinov's Dignity Therapy provides a practical way to implement one of the essential elements of any healthcare system and any relationship between a clinician or caregiver and patient who is seriously ill-- honoring the dignity of each and every individual. His book provides practical, evidence-based, yet sacred, interventions that allow for healing in the midst of suffering. Dr. Chochinov inspires all of us to transform our systems of care so that all people can find meaning, purpose, and value in their lives." -- Christina M. Puchalski, Professor of Medicine and Health Sciences, and Director, The George Washington Institute for Spirituality and Health (GWish) , The George Washington University School of Medicine and Health Sciences "Reading his latest book challenged me to look at his expanded work in Dignity Therapy to consider additional ways to engage with palliative care patients. Whether you are a professional who, like me, works in palliative care or in another setting, I recommend Chochinov's book as one to put on your reading list for the coming year." -- Plain Views "Dignity Therapy: Final Words for Final Days is an inspiring work that introduces the innovative work of Harvey Chochinov on maintaining dignity in individuals approaching death. It is an engaging read distinguished by its depth of insight and vibrant perspective.... On completing the book, I felt that I had grown in the ability to help others find meaning and solace in the final chapter of life." -- Andrew R. Barnosky, DO, MPH, JAMA "There is much of value in Chochinov's thoughtful and careful work... [O]ne of the unquestionable merits of this work is the sincerity, sensitivity, and authenticity with which the author grapples with the possible difficulties that might arrise in each step of the therapeutic process. Clearly, for palliative care agencies and workers who are considering the possibility of utilizing dignitiy therapy with their patients, this is an essential text." --The National Catholic Bioethics Quarterly "Dignity Therapy: Final Words for Final Days is a comprehensive, well-written, and engaging book, which provides a clear background and implementation guide for Dignity Therapy. It would probably be most useful for palliative care and hospice providers and for those of us in palliative care who are in a position to either implement or advocate for the implementation of a Dignity Therapy program." -- Mercedes Pacheco, Journal of Palliative Medicine "What I like about it particularly is that it presents a subtle and powerful argument against euthanasia without in any way being overtly religious." -- Francis Phillips, Catholic Herald

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