Table 1.

The literature reviews for Dignity Therapy.

Author(s)	Title	Design and methodology	Population/demographics	Therapy process	Primary outcomes	Notes
Akechi et al 7	Dignity therapy: preliminary cross-cultural findings regarding implementation among Japanese advanced cancer patients	Survey	n = 11	Chochinov	Terminally ill cancer patients who wish that they were unaware of their impending death may be less likely to participate in DT. Their aversion to participating in the study may not have been due to the DT per se, but rather, their having been confronted with information that they did not wish to hear.a	Although DT should not be routinely recommended to all terminally ill Japanese cancer patients, this therapy may be promising for patients who hope to leave a legacy.
Andreis et al 13	Dignity therapy: A new psychotherapeutic approach for people facing advanced disease	Case study	4 patients	The interview uses 10 core questions, and the responses are used to create a written legacy document.	DT showed to be a new promising therapeutic intervention for suffering and distress at the end of life. The literature review finds robust evidence for DT’s overwhelming acceptability, rare for any medical intervention, especially in psychosocial-spiritual care.	The DT is a multidimensional psychosocial intervention for patient-centered care, and it depends on experiences of generativity and the pursuit of purpose and meaning.
Aoun et al 9	Dignity therapy for people with motor neurone disease and their family caregivers: a feasibility study	Repeated-measures design preintervention and postintervention.	27 patients and 18 family and caregivers	Patients are invited to discuss issues that they would most want remembered about their life.	This is the first DT study to focus on MND and on home-based caregiving. The therapy needs to be offered earlier.	Results established the importance of narrative and generatively for patients with MND and may open the door for other neurodegenerative conditions.
Beck et al 20	Abbreviated dignity therapy for adults with advanced-stage cancer and their family caregivers: qualitative analysis of a pilot study	Qualitative	Interview with 11 participants	The legacy projects were coded for expression of core values.	Suggest that abbreviated DT effectively promotes 1 self-expression, 2 connection with loved ones, 3 sense of purpose, and 4 continuity of self.a	Direct content analysis was used to assess feedback from the interviews about benefits, barriers, and recommendations regarding abbreviated DT.
Bentley et al 5	Is dignity therapy feasible to enhance the end of life experience for people with motor neurone disease and their family carers?	Cross-sectional study utilizing a single-treatment group and a pre-/post-test design.	50 people diagnosed with MND and their nominated family carers.	Outcomes for participants include hopefulness, spirituality, and dignity.	Outcomes for family carers include perceived caregiver burden, hopefulness, and anxiety/depression.	Suggest the need to develop and utilize interventions that will support hopefulness, a sense of meaning, and dignity in order to alleviate psychosocial and existential distress in persons with MNDa
Bentley et al 10	Dignity therapy: a psychotherapeutic intervention to enhance the end of life experience for people with motor neurone disease and their family carers	A pre–post design	26 people with MND and 17 family carers	Mild cognitive decline and pseudobulbar affect were found to have minimal impact on the acceptability/feasibility of the psychotherapy.	DT was beneficial to people with MND, especially in the areas of encouraging acceptance (70%), strengthening identity (70%), helping to address unfinished business (65%), and helping to feel they could still play an important role (65%).a Acceptability was high, with 84% reporting the therapy was helpful to them and 92% reporting the therapy was satisfactory. Acceptability was also high with family carers, with 94% finding it helpful to their family member and 75% recommending it to others.a	Low base rates of distress precluded being able to demonstrate significant postintervention differences on measures of distress.
Bentley et al 11	Feasibility, acceptability and potential effectiveness of dignity therapy for family carers of people with motor neurone disease	Cross-sectional study utilizing a 1-group pretest and post-test design	18 family carers of people diagnosed with MND	Examining family carers’ involvement in the therapy.	There were no significant pretest and post-test changes on the group level, but there were decreases in anxiety and depression on the individual level.a.	DT is not likely to alleviate caregiver burden in MND family carers, but it may have the ability to decrease or moderate anxiety and depression in distressed MND family carers.
Bentley et al	Feasibility, acceptability, and potential effectiveness of dignity therapy for people with motor neurone disease	Cross-sectional feasibility study using a 1-group pretest and post-test design	29 people diagnosed with MND	Examining the length of time taken to complete DT	There were no significant pretest and post-test changes for hopefulness, spirituality, or dignity on the group level, but there were changes in hopefulness on the individual.a	DT for people with MND is feasible and acceptable. Further research is warranted to explore its ability to diminish distress.
Bernat et al 18	Piloting an abbreviated dignity therapy intervention using a legacy-building web portal for adults with terminal cancer: a feasibility and acceptability study	A pilot legacy-building intervention	16 participants enrolled in the study (12 females, 4 males).	This differed from traditional DT in 3 ways as mentioned.	Participant satisfaction was high with the intervention (mean = 8.82, SD = 1.08) and the final legacy project they created (mean = 8.55, SD = 1.13). Although the interventionist trained all participants in use of the web portal, fewer than half (45%) of the participants reported using it to complete their legacy project; the majority used a word processing program.a	Results suggest that our legacy-building intervention was both feasible and mostly acceptable.
Brozek et al 15 a	Dignity Therapy as an aid to coping for COPD patients at their end-of-life stage	Survey	10 patients with severe COPD	DT intervention was implemented according to the protocol established by Chochinov et al	Satisfaction questionnaire showed a positive effect of DT on the patient’ well-being.a The analyses of the patients’ original statements enabled an effective identification of the spiritual suffering and spiritual resources and faced by COPD patients.a	Conclusion: DT is an intervention well received by COPD patients, which may help them in recognizing and fulfilling their spiritual needs in the last phase of their life.
Chochinov et al 1	Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life	Correlational pretest and post-test design.	Terminally ill inpatients	DT invites patients to discuss issues that matter most or that they would most want remembered	91% of participants reported being satisfied with DT; 76% reported a heightened sense of dignity; 68% reported an increased sense of purpose; 67% reported a heightened sense of meaning; 47% reported an increased will to live; and 81% reported that it had been or would be of help to their family.a	DT shows promise as a novel therapeutic intervention for suffering and distress at the end of life.
Chochinov et al 4	Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial	RCT	165 of 441 patients were assigned to DT	DT is an individualized, short-term psychotherapy	No significant differences were noted in the distress levels before and after completion of the study in the 3 groups.a	Secondary outcomes of self-reported end-of-life experiences were assessed in a survey that was undertaken after the completion of the study.
Dose et al 22	Dignity therapy feasibility for cancer patients undergoing chemotherapy	Feasibility study	N = 10	DT is a brief psychotherapeutic intervention consisting of a focused LR.	Two-thirds were satisfied/very satisfied with DT/LP, and 78% found study participation worthwhile and DT/LP timing to be just right, and they would recommend DT/LP to others. QoL improved (baseline mean = 7.0; T2 = 7.25). Distress scores improved (baseline mean = 6.13; T2 = 5.63).a	Implications for research, policy, or practice. Conducting DT/LP in an outpatient oncology chemotherapy setting for newly diagnosed pancreatic cancer patients is both feasible and acceptable.
Dose et al	Outcomes of a dignity therapy/life plan intervention for patients with advanced cancer undergoing chemotherapy	Intervention study	N = 18 patients	DT entailed interviews during 3 outpatients	No variables were significantly different from baseline to postintervention and 3 months later, except for less distress between baseline and 3 months (P = .04).a	Participants documented life goals as their life plan.
Flad et al 26	Dignity therapy at an Austrian acute care hospital: feasibility and acceptance on wards that are not specialised in palliative care	Mixed-method study	N = 10	Conducting DT on wards	As patients usually spend only a very short time in hospital, professionals are put under pressure to conduct DT immediately and quickly.a	DT represents an appreciated and valuable contribution to a holistic care of patients with palliative care needs in an acute care hospital under the condition of open communication about the life-limiting character of the disease.
Gagnon et al 19	Dignity therapy: an intervention to diminish psychological distress in palliative care patients	Intervention study	N = 33	DT	Results confirmed the relevance of this intervention and showed that it is associated with a high level of satisfaction for participants and family members.
Goddard et al 23	Dignity therapy for older people in care homes: a qualitative study of the views of residents and recipients of ‘generativity’ documents	Qualitative exploration	N = 14	Framework approach	Four categories are reported: views on the document, impact on residents, impact on family, and potential impact on care homes.a	Family members felt DT had helped them. Findings suggest that DT may be useful for enhancing the end-of-life experience for residents and families
Hack et al 14	Learning from dying patients during their final days: life reflections gleaned from dignity therapy	Qualitative study Grounded theory approach	100 terminally ill patients	DT is a transcript of the edited therapy session(s).	The transcripts revealed that DT serves to provide a safe, therapeutic environment for patients to review the most meaningful aspects of their lives in such a manner that their core values become apparent.	The findings are discussed in terms of values theory, the role of DT, and consideration of values clarification in clinicians’ efforts to enhance the dignity of terminally ill patients.
Łabuś-Centek et al 16	Application of dignity therapy in an advanced cancer patient — wider therapeutic implication	Mixed methods	An advanced cancer patient within a Polish hospital setting	MH. Chochinov’s DT protocol was applied.	The survey questionnaire indicated that by far the greatest benefit consisted in an overall improvement of his mental well-being (4.67). Benefits for the family followed 4 , including his hope for recovering family ties 4 . An unexpected therapeutic effect consisted in re-establishing a broken relationship with his daughters.	The patient was also asked to complete a survey questionnaire designed to assess the therapeutic effectiveness of DT in the intervention.
Lee et al	Envoy service, a form of dignity therapy, to assist to express personal values and communication with family members and caregivers: a preliminary report	Case studies	The study has 10 patient’s experiences.	“Envoy service” was to deliver a detailed message to family members	“Envoy service” could be valuable for patients with incurable disease to help to express regarding their personal life values and communication in end-of-life options between the patients, family members and caregivers and might help to facilitate early palliative care.a	The assigned patients were helped by trained dialogist to express in narrative form regarding the personal values and end-of-life care options.
Li et al 27	Conceptualizations of dignity at the end of life: exploring theoretical and cultural congruence with dignity therapy	Qualitative exploration	N = 9	DT—a novel nurse-delivered psychotherapeutic intervention	Being a valuable person is the core meaning of patients’ dignity and this comprises intrinsic characteristics and extrinsic factors.a	The concept of dignity is culturally bound and understood differently in the Chinese and Western context; such differences should be considered when planning and delivering care.
Newman 24	Efficacy of dignity therapy for allogeneic bone marrow transplant patients: A qualitative pilot study	Mixed methods	5 patients	DT is a brief empirically validated psychotherapy.	The DT intervention appears to be a feasible, relevant, and meaningful intervention to this novel, nonterminally ill patient population.a	3 visits; consent documents were signed at the first; the DT interview was conducted at the second, which was then transcribed and edited.
Rodriguez 25	Assessing the benefit of dignity therapy for adolescents with advanced cancer: a prospective explorative mixed-method study	A small-scale open-label RCT	Adolescents with advanced cancer	Qualitative interviews with participants and family members	The findings of my research to date are suggestive that children have similar responses and worries about death and dying to adult populations, but they struggle to decide who to verbalize these worries to. Currently, there is no shared intervention for this purpose with children.a	Family members will also be asked to reflect on the benefits of the therapy 3 months after bereavement.
Tait et al	Meaning and legacy in the terminally-ill elderly: dignity therapy and its impact on patients and health professionals	Qualitative interviews	Dignity interviews were administered to 12 elderly patients by residents.	Medical residents were taught to utilize DT	From a developmental perspective, a dying elderly patient’s meaning and legacy making, often in the form of imparting wisdom, may solidify navigation through Erikson’s final and socially contextualized stage of Ego-Integrity vs Despair in a preparatory life-completion process.a	DT is a single 1-hour session intervention that provides patients an opportunity to make meaning out of life and impending death and to solidify a sense of integrity by using one’s individual agency to create a legacy that bears one’s addressees in mind.
Testoni et al 17	Dignity as wisdom at the end of life: sacrifice as value emerging from a qualitative analysis of generativity documents	Qualitative thematic analysis	5 patients in end-of-life and palliative care	Chochinov protocol using Schwartz’s matrix of values.	The results showed the role of values in the construction of wisdom and confirmed the importance of family relationships. The value of sacrifice, which is supported by various religious traditions, emerged as a perceived factor, indicating personal wisdom.a	The implications, not only for end-of-life counseling but also for other fields and disciplines focusing on spiritual care, in particular for pastoral psychology, are significant.
Vergo et al 12	A feasibility study of dignity therapy in patients with stage IV colorectal cancer actively receiving second-line chemotherapy	Pretest/post-test design.	15 of 17 patients	DT early in the disease trajectory	Most of the patients who completed DT reported being satisfied and felt it was helpful, that it increased their sense of meaning, that it would be helpful to their family, and that it increased their sense of dignity, their sense of purpose, and their will to live.a	Conclusion: DT is a highly feasible, satisfying, and meaningful intervention for advanced colorectal cancer patients who are receiving chemotherapy earlier in the course of their and may result in an understanding of disease and goals of care at the end of life.
Vuksanovic et al	Dignity therapy and life review for palliative care patients: a randomized controlled trial	Evaluation	70 adults with advanced terminal disease	DT shows evidence of acceptability and utility in palliative care setting	There were no significant changes for dignity-related distress or physical, social, emotional, and functional well-being among the 3 groups.a	Primary outcome measures were the Brief Generativity and Ego-Integrity Questionnaire, Patient Dignity Inventory, Functional Assessment of Cancer Therapy-General, version 4, and treatment evaluation questionnaires.
Vuksanovic et al 28	Dignity therapy and life review for palliative care patients: a qualitative study	Qualitative	56 participants	Context DT	Themes of spirituality, illness impacts, and unfinished business were relatively less common in WDT participants.a	Conclusion: This study provides further insight into what palliative care patients consider to be most important and meaningful to them when taking part in DT and LR.
Extracted studies: 28	Quantitative: 16 Qualitative: 9 Mixed methods: 3 Total 28

Abbreviations: COPD, chronic obstructive pulmonary disease; DT, digital therapy; MND, motor neurone disease; RCT, randomized controlled trial; LP, lumbar puncture; LR, life review; QoL, quality of life; WDT, waitlist DT.

^aThe number of reviewed literatures in Table 1 per research category.