title: Exploring the therapeutic power of narrative at the end of life: a qualitative analysis of narratives emerging in dignity therapy.
abstract: OBJECTIVE
  To understand the therapeutic effect of a narrative intervention, specifically dignity therapy, in patients at the end-of-life. To examine the thematic dimensions and shared narrative features of the stories that emerge in dignity therapy and theorise their relationship to the intervention's clinical impact.
  
  
  METHODS
  Resident physicians, as part of an educational intervention, co-administered the dignity therapy protocol with the principal investigator. Interviews were transcribed, edited, and then, within a week, read back to the patient and provided as a document for the patient to keep. A constant comparative approach was taken to identify narratives and thematic patterns.
  
  
  METHODS
  12 Patients at the end-of-life were administered dignity interviews by 12 resident physicians, accompanied by the principal investigator.
  
  
  METHODS
  Palliative care settings in two University of Toronto academic hospitals.
  
  
  RESULTS
  Three narrative types emerged, each containing several themes. Evaluation narratives create a life lived before illness, with an overarching theme of overcoming adversity. Transition narratives describe a changing health situation and its meanings, including impact on family and on one's world view. Legacy narratives discuss the future without the patient and contain the parables and messages to be left for loved ones.
  
  
  CONCLUSIONS
  While the interview protocol guides patients' responses, the commonality of narrative structures across interviews suggests that patients draw on experiences with two familiar genres: the eulogy and the medical interview, to create a narrative order during the chaos of dying. The dignity interview's resonance with these genres appears to facilitate a powerful, and perhaps unexpected sense of agency.
authors.affiliation: Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Glendon R
authors.initials: GR
authors.lastname: Tait
authors.forename: Catherine
authors.initials: C
authors.lastname: Schryer
authors.forename: Allan
authors.initials: A
authors.lastname: McDougall
authors.forename: Lorelei
authors.initials: L
authors.lastname: Lingard
mesh_terms: D000046:Academic Medical Centers; D006801:Humans; D062525:Narrative Therapy; D028723:Personhood; D036301:Qualitative Research; D019452:Terminally Ill / Q000523:psychology*