Using a technique called dignity therapy, psychologist Lori Montross interviewed Dralle five months before his death about meaningful life moments, lessons he'd learned and those he wished to pass on to loved ones. She transcribed their audio recordings, then read the transcript aloud to Dralle, who edited it to his liking. The resulting 14-page "legacy document" was bundled into a leather binder for him to bequeath to whomever he pleased.
Dralle's longtime partner, Lisa Amparan, remembers the sense of importance Dralle felt in being able to contribute something in his ailing state, and the relief he felt when it was finished, as though he'd gotten something off his plate.
"He got to tell his own story in his own words, and no one had to tell it for him," said Amparan, 48, who this month marks the first anniversary of Dralle's death. She keeps the binder, which she decorated with photos, on a bedroom bookshelf, and leafs through it when she misses him most.
Dignity therapy, an exercise that aims to give terminally ill patients a sense of meaning, closure and posterity in their final days, has experienced a surge of interest recently thanks to research showing it improves quality of life more effectively than other methods of end-of-life care.
A study published this summer in the journal Lancet Oncology found patients who underwent dignity therapy were significantly more likely to report enhanced sense of dignity, better spiritual well-being and feeling more helpful to their families than those who underwent standard palliative care or client-centered care, which is when clinicians work one-on-one with a patient on current issues.
Earlier studies have shown dignity therapy also provides comfort to grieving families.
Study author Dr. Harvey Chochinov, a Canadian psychiatrist who developed the technique a decade ago and holds annual training sessions in Winnipeg, Manitoba, said he added training sessions this year in San Diego and Australia to accommodate rising demand. In December he published "Dignity Therapy: Final Words for Final Days," the first book to lay out a blueprint for his technique.
Although hospices for decades have engaged patients in reflective "life review," what distinguishes dignity therapy is that it provides training and a framework for helping patients produce a tangible legacy document, and there's empirical evidence that it's beneficial, said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization.
"I think it's a very, very, very notable and useful technique, and I hope it does get adopted by many of the practitioners out there," Schumacher said.
Although published research on the effectiveness of dignity therapy has so far focused on patients with less than six months to live, a forthcoming study on the frail elderly shows similar outcomes, plus benefit to the health care workers who care for them, Chochinov said.
Chochinov, a psychiatry professor at the University of Manitoba, said he was inspired to learn more about the role of dignity in end-of-life care because Dutch studies had found "loss of dignity" to be the most frequently cited reason terminally ill patients pursued euthanasia to hasten death.
A host of factors can undermine dignity as people succumb to illness, including a loss of personhood, a loss of purpose and, prominently, perceiving themselves to not be appreciated by others, Chochinov said. Often there is fear that their lives won't have a ripple effect.
By asking probing questions — "When did you feel most alive?" "Are there specific things you want your family to know about you?" — trained dignity therapists aim to capture what really makes a person tick. They also focus on generativity, a psychological term that describes the desire to guide the next generation.
By Alexia Elejalde-Ruiz, Tribune Newspapers