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
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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