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Treating palliative care patients presents challenges that extend far beyond management of pain or other physical symptoms. Patients confronting death are susceptible to psychological distress, such as depression, anxiety, demoralization, and related constructs. In a study that explored attributes of a "good death," Steinhauser et al noted the emergence of two unexpected themes that support patients' perception of a "good death:" 1) "affirmation of the whole person," meaning that a patient feels affirmed as a "unique and whole person" and 2) "contributing to others," meaning that a patient believes that he or she can contribute to others' well-being.1
A growing body of literature on novel psychotherapies designed to address psychosocial distress in terminally ill patients echoes principles elucidated by Steinhauser. These therapies seek to relieve distress by honoring the patient's life story, by providing the patient an opportunity to experience his or herself as an integrated being with a meaningful, purposeful existence, and by creating a forum for him or her to share messages and life lessons with others.
This article will explore three novel therapies designed to relieve distress among palliative care patients by promoting themes of meaning, purpose, and spiritual peace. These therapies include dignity therapy, meaning-centered group therapy, and short-term life review. This article will also explore the role of other standard therapies, including cognitive-behavioral therapy and insight-oriented therapy, in treating distress experienced by palliative care patients.
Dignity Therapy
Dignity therapy, developed by psychiatrist Harvey Chochinov at the University of Manitoba, is a unique form of individualized brief therapy that aims to decrease psychosocial and existential distress that terminally ill patients may experience during their final days.2 Through his research on dignity and end-of-life care, Chochinov discovered "a strong association between an undermining of dignity and depression, anxiety, desire for death, hopelessness, feelings of being a burden on others, and overall poorer quality of life."2
Chochinov's hypothesis is that creation of a "generativity document," a written, narrative document highlighting a patient's sense of self and purpose, promotes a patient's sense of dignity and meaning, which in turn reduces his or her level of distress.2
In dignity therapy, a trained therapist meets with a terminally ill patient for one to two sessions, asking him or her questions from the...