Dignity therapy in palliative care: a bibliographic review

Abstract

Background: Palliative care and dignity at patients’ end-of-life are nursing competences. Many therapies and guides have been developed to assure the preservation of dignity in patients with life-threatening illnesses and in the last stages of these ones. In 2002, Harvey Max Chochinov developed the Dignity Therapy with the aim of promoting end-of-life dignity. Aim: Analyse the effectiveness of Dignity Therapy on the improvement of patients with advanced life-threatening diseases and establish if its use in the clinical practice should be recommended. The specific objectives are: analyse the effectiveness of Dignity Therapy to improve psychological distress, anxiety, depression and psychological fatigue; analyse its effectiveness in improving physical distress and symptomatology; know the effectiveness of Dignity Therapy to increase the palliative patient’s sense of dignity; analyse the benefits of Dignity therapy in the treatment of psychosocial and existential distress; and assess the feasibility of Dignity Therapy focusing on both patients and family relatives acceptability and satisfaction. Methodology: Conduction of a bibliographic review. PUBMED, COCHRANE, CINAHL and CUIDEN databases were queried during the first half month of March 2019. The selection of articles was limited to the use of Dignity Therapy in adult patients admitted to palliative care units with the sufficient physical and mental capacity to undergo the intervention. Data extracted was synthesised and analysed following the study objectives. Results: Fourteen papers encountered the selection criteria and were assessed for eligibility. The results obtained demonstrate that the Dignity Therapy is an effective instrument for the treatment and improvement of patients with life-limiting illnesses especially in the last stages of it. Therefore, its use in palliative care is recommended. Results on psychological distress lead to controversial conclusions. Four studies suggested benefits on physical distress. The overall light turns out to be positive in terms of sense of dignity, psychosocial distress and existential distress. Finally, in terms of feasibility, both patient and family’s opinion in relation to acceptability and satisfaction have been found to be positive. Conclusion: The results found throughout this review conclude firmly and affirm Dignity Therapy’s effectiveness in terms of patients’ dignity and consequently overall status. In palliative care settings, where de defence and preservation of patients’ dignity is an undeniable obligation, patients could clearly benefit from Dignity Therapy. Dignity Therapy has demonstrate to be a useful instrument for patients to solve, close or clear out their personal believes and questionable issues before leaving. This paper emerges a positive light for future research and the application of the Dignity Therapy in palliative care settings