UF-led Study Shows Dignity Therapy Comforts Whether Guided by Nurse or Chaplain

Diana Wilkie Portrait

Dignity therapy provides significant spiritual and existential comfort to older, palliative care cancer patients, whether offered by a nurse or a chaplain, according to a study led by the University of Florida College of Nursing’s Diana Wilkie, PhD, RN, FAAN, and Northwestern University’s Linda Emanuel, PhD, MD.

Dignity therapy includes guided interview-style sessions designed to help a patient reflect on their lives and give meaning to their experiences. The interviews are transcribed and edited into legacy documents which can be shared with family. 

The five-year study included 579 patients at six sites across the country and was, to date, the largest study on dignity therapy. “Engaging Mortality: Effective Implementation of Dignity Therapy,” was published recently in the Journal of Palliative Medicine.

“One important finding was that patients — both with chaplains or nurses — achieved significant effects from the dignity therapy,” Wilkie said. “An individual’s sense of dignity is important to their existential well-being. You want to feel that life has had meaning. That there is a legacy that lives beyond you.”

The study looked at how patients responded to dignity therapy versus those receiving usual care on an outpatient palliative care basis. Those patients receiving dignity therapy received it from either chaplains or nurses. The usual care group did not receive dignity therapy but had access to as-needed chaplain visits. 

All participants took a seven-question survey to gauge their feelings before and after the study. The group receiving dignity therapy reported significantly higher positive feelings. The study results were similar for patients of all races.

“The study further confirmed the effectiveness of dignity therapy in improving patient’s sense of self-value,” Wilkie said.

Part of the study coincided with the COVID-19 pandemic, which forced lockdowns and the use of personal protection barriers that significantly reduced human touch and interaction between patients and caregivers.

“Dignity was assaulted by the COVID pandemic, unlike anything we have seen in our lifetimes. People were dying and not able to touch their loved ones. To not have human touch other than through lots and lots of protection was devastating,” Wilkie said, noting that the measures were necessary at the time.

Because most in-person meetings stopped, the researchers continued the study using virtual sessions. It turned out that those sessions were as effective as in-person sessions in improving the patient’s dignity index scale.

“We learned we could deliver dignity therapy virtually. That was an unintended outcome but an important one,” she said.

The study also looked at how the therapy impacted other areas of patients’ attitudes, including their preparation for death, sense of life completion, their level of peaceful awareness of illness, and their choice of life-prolonging or non-life-prolonging treatment. Dignity therapy showed no significant impact on those measures.

Palliative care is for patients facing a serious illness, including cancer. In palliative care, patients receive curative treatment for their illness and therapies for their physical, psychological and spiritual comfort. Many studies have shown palliative care provided with cancer care improves survival and quality of life. Wilkie directs the University of Florida Center for Palliative Care Research and Education.   

Wilkie said the biggest obstacle in offering dignity therapy is the cost. At about $500 per patient, it may be an obstacle to some. Still, she said, it is a worthwhile expense.

“Giving people meaning in their lives lets them die in peace or lets them live with a better quality of life as they live with their serious illness,” she said.

The research team included Yingwei Yao, PhD,  Marvin O. Delgado Guay, MD, Joshua Hauser, MD, Sheri Kittelson, MD, Sean O’Mahony, MD, Michael Rabow, MD, Tammie Quest, MD, Tasha Schoppee, PhD, RN, George Handzo, M.Div., MA, and  Harvey Max Chochinov, PhD, MD and many other team members to carry out the large study.