Objective To understand the therapeutic effect of a narrative intervention, specifically dignity therapy, in patients at the end-of-life. To examine the thematic dimensions and shared narrative features of the stories that emerge in dignity therapy and theorise their relationship to the intervention's clinical impact.
Design Resident physicians, as part of an educational intervention, co-administered the dignity therapy protocol with the principal investigator. Interviews were transcribed, edited, and then, within a week, read back to the patient and provided as a document for the patient to keep. A constant comparative approach was taken to identify narratives and thematic patterns.
Participants 12 Patients at the end-of-life were administered dignity interviews by 12 resident physicians, accompanied by the principal investigator.
Setting Palliative care settings in two University of Toronto academic hospitals.
Results Three narrative types emerged, each containing several themes. Evaluation narratives create a life lived before illness, with an overarching theme of overcoming adversity. Transition narratives describe a changing health situation and its meanings, including impact on family and on one's world view. Legacy narratives discuss the future without the patient and contain the parables and messages to be left for loved ones.
Conclusions While the interview protocol guides patients' responses, the commonality of narrative structures across interviews suggests that patients draw on experiences with two familiar genres: the eulogy and the medical interview, to create a narrative order during the chaos of dying. The dignity interview's resonance with these genres appears to facilitate a powerful, and perhaps unexpected sense of agency.
- Accepted 19 July 2011.
- Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
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Funding This study was supported by the Royal College of Physicians and Surgeons of Canada Medical Education Research Grant and the Sociobehavioral Cancer Research Network, with funds from the National Cancer Institute of Canada.
Competing interests None.
Ethics approval Ethics approval was obtained from the Health Sciences Research Ethics boards of University Health Network and Sunnybrook Health Sciences Centre, the two University of Toronto hospitals where the study took place.
Provenance and peer review Not commissioned; externally peer reviewed.
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