title: Enhancing legacy in palliative care: study protocol for a randomized controlled trial of Dignity Therapy focused on positive outcomes.
abstract: BACKGROUND
  Dignity Therapy is a brief psychotherapy that can enhance a sense of legacy while addressing the emotional and existential needs of patients receiving hospice or palliative care. In Dignity Therapy, patients create a formalized "legacy" document that records their most cherished memories, their lessons learned in life, as well as their hopes and dreams for loved ones in the future. To date, this treatment has been studied for its impact on mitigating distress within hospice and palliative care populations and has provided mixed results. This study will instead focus on whether Dignity Therapy enhances positive outcomes in this population.
  
  
  METHODS
  In this study, 90 patients with cancer receiving hospice or palliative care will complete a mixed-methods randomized controlled trial of Dignity Therapy (n = 45) versus Supportive Attention (n = 45). The patients will be enrolled in the study for 3 weeks, receiving a total of six study visits. The primary outcomes examine whether the treatment will quantitatively increase levels of positive affect and a sense of life closure. Secondary outcomes focus on gratitude, hope, life satisfaction, meaning in life, resilience, and self-efficacy. Using a fixed, embedded dataset design, this study will additionally use qualitative interviews to explore patients' perceptions regarding the use of positive outcome measures and whether these outcomes are appropriately matched to their experiences in therapy.
  
  
  CONCLUSIONS
  Dignity Therapy has shown mixed results when evaluating its impact on distress, although no other study to date has solely focused on the potential positive aspects of this treatment. This study is novel in its use of mixed methods assessments to focus on positive outcomes, and will provide valuable information about patients' direct experiences in this area.
  
  
  BACKGROUND
  ISRCTN91389194.
authors.affiliation: San Diego Moores Cancer Center, Psychiatry & Psychosocial Services; Patient & Family Support Services, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA. lpmontross@ucsd.edu.|San Diego Department of Psychiatry, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA. lpmontross@ucsd.edu.|San Diego Department of Family & Preventive Medicine, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA. lpmontross@ucsd.edu.
authors.forename: Lori P
authors.initials: LP
authors.lastname: Montross-Thomas
authors.affiliation: San Diego Moores Cancer Center, Psychiatry & Psychosocial Services; Patient & Family Support Services, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA. sirwin@ucsd.edu.|San Diego Department of Psychiatry, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA. sirwin@ucsd.edu.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Irwin
authors.affiliation: San Diego Moores Cancer Center, Psychiatry & Psychosocial Services; Patient & Family Support Services, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA. eameier@ucsd.edu.|San Diego Department of Psychiatry, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA. eameier@ucsd.edu.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Meier
authors.affiliation: San Diego Department of Family & Preventive Medicine, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA. jarredgallegos@gmail.com.|University of San Diego, San Diego, USA. jarredgallegos@gmail.com.
authors.forename: Jarred V
authors.initials: JV
authors.lastname: Gallegos
authors.affiliation: San Diego Department of Psychiatry, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA. sgolshan@ucsd.edu.
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Golshan
authors.affiliation: San Diego Moores Cancer Center, Doris A. Howell Palliative Care Service, University of California, San Diego, USA. eroeland@ucsd.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: Roeland
authors.affiliation: California State University Institute for Palliative Care, San Diego, USA. hmcneal@csusm.edu.
authors.forename: Helen
authors.initials: H
authors.lastname: McNeal
authors.affiliation: Family Health Centers of San Diego, San Diego, USA. dianem@fhcsd.org.
authors.forename: Diane
authors.initials: D
authors.lastname: Munson
authors.affiliation: Mission Hospice, San Diego, USA. lrodseth@missionhh.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Rodseth
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000523:psychology / Q000628:therapy; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D011614:Psychotherapy, Brief / Q000379:methods; D012297:Right to Die; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology*