Table 2.
Themes, frequencies and example quotations of HCP views on the DTQP (M1/W1 = chaplain; M4 = psychologist; M3/M5/W0/W3/W6 = physician; M2/W5 = nurse)
| Main Category | Themes | Frequency M / W | Example Quotation (ID) |
|---|---|---|---|
| Negative aspects of DT | Complex for patients and therapists | 2 / 1 | The time-consuming process is a disadvantage. (M4); Do we need such a sophisticated concept or don’t you hit on it yourself when getting a serious diagnosis? (W0) |
| Psychological burden could arise | 3 / 5 | Negative memories could arise and create psychological burden. (M3); DT could have side effects if unconscious aspects arise. (W6) | |
| Patients fear negative consequences if they decline DT | 3 / - | Some patients tell me they’re afraid of being treated less well if they decline something, e.g. students’ teaching courses. (M1) | |
| The name of the intervention is inappropriate | 2 / 5 | You can’t say DT. This seems inappropriate. (M1); Therapy [in the name of the intervention] is something that people don’t want to have, because they had enough therapy during their illness. (W5) | |
| Application of DT is limited | - / 5 | DT is only appropriate for patients with the ability to communicate verbally, be self-reflective and discuss value-based issues. (W3) | |
| Positive aspects of DT |
DT encourages self-reflection | 6 / 4 | It triggers self-reflection, which is an advantage. (M5); DT is a process to realize what is important in my life, what is personally valuable for me. (W1) |
| Generating a legacy | 3 / - | The form (written words) creates the possibility to pass something on to your relatives that you couldn’t verbalize. (M2) | |
| DT creates space for a dignifying encounter | 3 / 4 | DT is about caring for the person. (M1); The concept of the dignifying attitude we find in DT is a good thing. (W3) | |
| Dignity Therapist | Challenges for the therapist posed by DT | 4 / 6 | The therapist must be very sensitive to decide which statement is meant for the document. (M5); You need to know how to handle negative issues when uncovering negative affect. (W0) |
| Consequences for the therapist after DT | 2 / - | The interviewer may take on some of the patient’s distress. (M4) | |
| Conducting DT | Application site / setting | 1 / 5 | The thousands of people in nursing homes or wards other than palliative care units should also be able to receive DT. (M1); The questions are great. I even used them during a dialogue about anamnesis. (W6) |
| DT Question Protocol | (Question) phrasing | 11 / 8 | Some questions sound awkward. (M1); Subjunctive phrases are irritating. (W2) |
| Open-ended questions are stimulating | 6 / 3 | The first question is a good opening as it is an open-ended question. (M3); For me, open-ended questions are important … they can be heart-opening. (W1) | |
| Focus on generating legacy | 1 / 2 | The advantage is to receive a treasure of life experience, e.g., question 11. (M3); [As a participant] I’d wish to know that it doesn’t have to be a permanent record for the next generation. (W6) | |
| Focus on accomplishments | 2 / 6 | Asking for accomplishments and roles is risky when interviewing a patient who is depressed. (M4); To name something as an accomplishment as an observer from the outside, that is social dignity. (W4) | |
| Application by DT Therapists | 6 / 6 | I understood that the therapist uses some but not all of the DT questions. (M1); The effect of the questions depends on asking these questions with a warm, calm and empathic tone. (W6) |