Dignity Therapy Final Words for Final Days

Maintaining dignity for patients approaching death is a core principle of palliative care. Translating that principle into methods of guiding care at the end of life, however, can be a complicated and daunting task. Dignity therapy, a psychological intervention developed by Dr. Harvey Max Chochinov and his internationally lauded research group, has been designed specifically to address many of the psychological, existential, and spiritual challenges that patients and their families face as they grapple with the reality of life drawing to a close. Tested with patients with advanced illnesses in Canada, the United States, Australia, China, Scotland, England, and Denmark, dignity therapy has been shown to not only benefit patients, but their families as well. In the first book to lay out the blueprint for this unique and meaningful intervention, Chochinov addresses one of the most important dimensions of being human. Being alive means being vulnerable and mortal; he argues that dignity therapy offers a way to preserve meaning and hope for patients approaching death. Dignity Therapy: Final Words for Final Daysis a beautiful introduction to this pioneering and innovative work. With history and foundations of dignity in care, and step by step guidance for readers interested in implementing the program, this volume illuminates how dignity therapy can change end-of-life experience for those about to die - and for those who will grieve their passing.

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.

Dignity and the End of Life	p. 3
Why Study Dignity?	p. 3
Dignity and Empirical Research	p. 5
The Model of Dignity in the Terminally Ill	p. 8
Illness-Related Concerns	p. 9
Dignity-Conserving Repertoire	p. 13
Social Dignity Inventory	p. 27
References	p. 34
Moving Dignity into Care	p. 36
How the Dignity Model Informs Dignity Therapy	p. 37
Form	p. 37
Tone	p. 40
Content	p. 42
Dignity Therapy Revealed	p. 42
The First Clinical Trial Is Published	p. 43
What About Families?	p. 46
Gold Standard Evidence	p. 48
Time to Move On	p. 51
References	p. 52
Introducing Dignity Therapy to Patients and Families	p. 54
Patient Selection for Dignity Therapy	p. 54
Who Should Be Approached to Take Part in Dignity Therapy?	p. 56
Who Should Not Take Part in Dignity Therapy?	p. 58
A Typical Dignity Therapy Introduction	p. 61
Some Common Questions and Responses	p. 62
The Dignity Therapy Question Protocol	p. 70
References	p. 73
Doing Dignity Therapy	p. 74
Setting Up the Dignity Therapy Session	p. 75
Answering Remaining Questions	p. 75
Arranging the Therapeutic Setting	p. 75
Using an Audio Recorder	p. 76
Family or Friend Participant	p. 77
The Role of the Dignity Therapist	p. 77
References	p. 99
The Generativity Document	p. 100
The Rationale for Editing Dignity Therapy Transcripts	p. 101
Transcribing the Audio Recorded Interview	p. 102
Editing the Verbatim Transcript	p. 107
Cleaning Up the Transcript	p. 108
Clarifying the Transcript	p. 110
Correcting Time Sequences	p. 112
Finding a Suitable Ending	p. 113
The Patient Has the Final Say	p. 114
From Start to Finish	p. 118
Dave's Dignity Therapy	p. 119
Dave's Generativity Document	p. 138
Bill's Dignity Therapy	p. 145
Bill's Generativity Document	p. 164
Moving Forward	p. 173
Is There Currently Sufficient Evidence to Support the Application of Dignity Therapy?	p. 174
How Do I Become Skilled Enough to Implement and Improve My Abilities to Deliver Dignity Therapy?	p. 175
How Much Does Dignity Therapy Cost and How Can Resources to Support It Be Found?	p. 176
What If Family Members or Volunteers Want to Take on This Work? Is That an Option?	p. 177
Can Dignity Therapy Be Done by a Therapist Who Knows the Patient Well?	p. 179
Are There Still Things About Dignity Therapy Worth Studying? If So, How Might Researchers Take Up This Work?	p. 181
What About Other Modes of Generativity?	p. 183
What About Dying Children? Does Dignity Therapy Have a Role to Play?	p. 183
What About the Issue of Culture and
Dignity Therapy?	p. 184
How Should Dignity Therapy Be Evaluated?	p. 185
Closing Thoughts	p. 185
References	p. 187
Index	p. 189
Table of Contents provided by Ingram. All Rights Reserved.

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Dignity Therapy Final Words for Final Days

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