Exploring the therapeutic power of narrative at the end of life: a qualitative analysis of narratives emerging in dignity therapy
- 1Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- 2Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- 3School of Professional Communication, Ryerson University, Toronto, Ontario, Canada
- 4Centre for Education Research and Innovation, University of Western Ontario, London, Ontario, Canada
- Correspondence to Dr Glendon R Tait, Department of Psychiatry, Dalhousie University, Suite 7113A, Abbey J Lane Building, 5909 Veterans Memorial Lane, Halifax, NS B3H 2E2, Canada;
Contributors GRT conceived and designed the study, secured the funding, administered the study, contributed to the interviews, collected all data, and contributed to the analysis, interpretation and writing of the paper. CS and LL led the analysis and theoretical framing of the analytic approach; both contributed to the analysis and the interpretation as well as writing of the paper. AMD conducted the primary analysis of the data and contributed to the interpretation and writing.
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.
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.
- Accepted 19 July 2011.
- Published Online First 29 August 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