Mechanisms of Dignity Therapy: Positive Outcomes in Older Cancer Patients.

Objective: To investigate two mechanisms, patient-level narrative richness and provider-patient empathy, of positive outcomes following Dignity Therapy, to focus provider training and intervention delivery. Background: Dignity Therapy is a brief reminiscence-based psychotherapeutic intervention designed to help seriously ill patients preserve dignity, reduce distress, and improve quality of life. Identifying mechanisms through which the therapy works can improve training and delivery of this increasingly popular intervention. Methods: Outpatients living with cancer (N = 203; M = 65.80 years; SD = 7.45 years; 66% women) from palliative care programs across the United States completed Dignity Therapy with a trained provider. Transcripts of their interview sessions were examined using interactional analyses to determine provider-level empathic communication. Transcripts were also content-analyzed for patient-level narrative richness. Changes in dignity, peaceful awareness of prognosis, and completion of existential tasks from pre- to postintervention were assessed. Results: The extent of narrative richness in patients' Dignity Therapy sessions was positively associated with post-test dignity (t = 3.09, p = 0.002) and completion of existential tasks (t = 2.65, p = 0.009) even when accounting for patient demographics. Providers' level of empathic communication did not affect patient outcomes at traditional significance levels. Results were not moderated by patients' symptom severity. Conclusions: Dignity Therapy benefits patients most when they richly engage in the process, narrating their life story and describing their legacy with elements of communion, meaning, and purpose. Future research might aim to follow up on forms of empathy or other provider behavior that elicit rich narratives during therapy.