"It makes you feel that somebody is out there caring": a qualitative study of intervention and control participants' perceptions of the benefits of taking part in an evaluation of dignity therapy for people with advanced cancer.

CONTEXT

Participants in a Phase II randomized controlled trial of Dignity Therapy felt that the intervention had helped them; however, the processes underlying this are not known.

OBJECTIVES

To explore intervention and control participants' perceptions of the benefits of taking part in an evaluation of Dignity Therapy within the frame of the underlying model of the intervention.

METHODS

We interviewed 29 patients at one-week follow-up and 20 at four-week follow-up. We also interviewed nine family members of patients in the intervention group. We used the Framework approach to qualitative analysis. This comprised five stages: familiarization, identifying a thematic framework, indexing, charting, and mapping and interpretation. The analysis was both deductive (a priori themes from the model informing the content and therapeutic tone of the intervention) and inductive (from participants' views).

RESULTS

There was support for five of the seven themes from the model underlying Dignity Therapy: "generativity," "continuity of self," "maintenance of pride," "hopefulness," and "care tenor." With the exception of generativity, all were evident in both groups. Prevalent emergent themes for the intervention group were "reminiscence" and "pseudo life review." "Making a contribution" was prevalent in the control group.

CONCLUSION

Patients with advanced cancer and their families found that Dignity Therapy had helped them in many ways; however, patients in the control group sometimes perceived similar benefits from taking part in the study, highlighting elements of Dignity Therapy that are common to dignity conserving care.