Dignity Intervention for
Terminally Ill Patients
Professor Linda Kristjanson
Prof Harvey Chochinov
Dr Tom Hack
Dr Sue McClement
Dr Mike Harlos
Dr Tom Hassard
Dr William Brietbart
Clinical Challenge
How to address suffering of dying patients
Suffering that derives from psychosocial,
spiritual or existential domains of the
patient ’s experience
Over past 15 years – international
collaboration to develop, pilot test and
complete an RCT to test an intervention
aimed at decreasing suffering and
increasing sense of dignity
Sense of Dignity Responses (n=213)
Responses Prevalence
0 No sense of lost dignity 114 (53%)
1 Minimal sense of lost dignity 64 (30%)
2 Mild; sense of lost dignity occasionally; 19 (9%)
regarded as minor problem
3 Moderate sense of lost dignity; regards 11 (5%)
as significant problem
4 Strong; feels clear sense of lost dignity 5 (2%)
most of time
5 Severe; clear sense of lost dignity almost 0 (0%)
always present
6 Extreme; sense of lost dignity virtually 0 (0%)
constant
Intact versus Fractured Dignity:
Psychological Variables
Desire for death (p 3 years
108 (33%) assigned to Standard
Care
107 (33%) assigned to Client
Centred Care
11 (34%) assigned to Dignity Care
Results
Baseline measures for all pre-study
psychometrics were calculated and
reported
Sample did not demonstrate a high
prevalence of major or overwhelming
problems with most sources of
distress as measured by Patient
Dignity Inventory
No significant differences found
across study arms
Results
Dignity Therapy outperformed Client
Centred Care and Standard Care on
all 25 PDI items
Dignity Therapy outperformed the
other study arms on the following:
• having found the study helpful,
• improving quality of life,
• depression
• sense of dignity
Results
Dignity Therapy also significantly
outperformed Standard Care and
Client Centred Care on:
• changing how family sees and
appreciates them
• indicating that the study has or will be
of help to their family
Results
Dignity Therapy also significantly
outperformed one of the two other
study arms on the following:
• having been as helpful as any other
aspect of care
• improving spiritual well being
• feeling that it enabled being able to
carry out an important task or role
• feeling satisfied with the study arm
• causing life to feel more meaningful
• and a heightened sense of purpose
Qualitative Feedback
I’m very happy to have participated in
this project. It’s helped bring my
memories, thoughts and feelings into
perspective instead of all jumbled
emotions running through my head.
The most important thing has been that
I’m able to leave a sort of “ insight “ of
myself for my husband and children,
and all my family and friends.
36 year old mother and wife with metastatic breast cancer
I believe dignity therapy will be a lot
of help to many people. [I] thought it
was brilliant. It has lightened my
spirits- because I wouldn ’t have had
the emotional courage to put it
down.
63 year old woman with ovarian cancer
Dignity therapy was a lovely
experience.... Getting down on paper
what I thought was a dull boring life
really opened my eye’s to how much
I really have done. This could be
nothing but helpful to many ill
people. I thoroughly recommend it
for everyone…..
49 year old woman with advance breast cancer
Last Word
You matter because you are you,
and you matter until the last
moment of your life. We will do all
we can, not only to help you die
peacefully, but also to live until
you die (Dame Cicely Saunders,
1993).