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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.
Table of Contents
|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|
|Moving Dignity into Care||p. 36|
|How the Dignity Model Informs Dignity Therapy||p. 37|
|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|
|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|
|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|
|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|
|Table of Contents provided by Ingram. All Rights Reserved.|