Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a progressive, life-limiting condition shown to result in psychological distress [1]. Community Respiratory Teams have a role in Anticipatory Care Planning. This approach aims to support individuals to think about their wishes for the future . This can include a ‘do not attempt cardiopulmonary resuscitation’ document [2]. These discussions can raise mortality concerns.
Dignity Therapy (DT) is a structured intervention developed to address psychosocial and existential distress as an individual nears the end of their life [3]. DT involves answering a list of suggested questions designed to explore the person’s life story and encourages individuals to discuss the aspects of their life that have most mattered to them, or that they would want remembered. Answers are audio recorded then transcribed and edited to produce a life review document. This pilot project aimed to explore if Dignity Therapy is an acceptable approach to individuals when introduced via a Community Respiratory Team.

Method: A Dignity Therapy life review approach was used with six patients with severe COPD. An anonymous post intervention questionnaire was completed.

Results: 100% of patients opting to participate rated the intervention as helpful. Key themes identified from qualitative feedback include participants valuing an opportunity to document and share key life moments and wisdom gained.

Conclusion: Early results from this pilot project suggest that DT is an acceptable intervention to COPD patients when introduced in a Community Respiratory Team. There are benefits in completing this approach at an earlier life stage and not waiting until the end of life is imminent. Further consideration of the optimal time to offer this intervention and ensure clinical utility is planned. Life review approaches may be a useful adjunct to Anticipatory Care Planning and play a role in ameliorating distress associated with the end of life.

References: 1.Maurer J,et al. Anxiety and depression in COPD: current understanding, unanswered questions, and research needs. Chest 2008;134:43S
2.Scottish Government Anticipatory Care Planning: Frequently Asked Questions,2010.ISBN9780755992133
3.Chochinov HM et al. Dignity Therapy: A novel psychotherapeutic intervention for patients near the end of life. JClinicalOncol 2005;23(24):5520-5525