C6 - A Multi-disciplinary Application of the Best Practice of Dignity Therapy in Any Healthcare Setting RAMONA BRUCKNER, BOARD CERTIFIED CLINICAL CHAPLAIN BILLINGS CLINIC BILLINGS, MONTANA Why Dignity? MAKING IT PERSONAL AN IDENTIFIED BEST PRACTICE IN THE FIELD OF PALLIATIVE CARE DIGNITY THERAPY A means of facilitating significance and meaning to the final words of patients in their final days. A birds eye view of PALLIATIVE CARE from a Chaplain s (Interdisciplinary) Perspective Definition of Palliative Care: The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of their disease or the need for other therapies. The National Consensus Project for Quality Palliative Care Ramona Bruckner 1
Founder of the contemporary Palliative Care movement: Dame Cicely Sanders BBC.CO.UK Scope of Access to Palliative Care WORLD HEALTH ORGANIZATION Worldwide, only about 14% of people who need palliative care currently receive it Canada 10% die suddenly 15% - 30% have good end-of-life care 70% do not have access to good quality Palliative Care "Palliative Care." USA "The Growth of Palliative Care in U.S. Hospitals Broad Characteristics of Palliative Care EXTRA LAYER OF SUPPORT TO HELP THE PATIENT TO LIVE AS WELL AS THEY CAN FOR AS LONG AS THEY CAN NOT JUST FOR THOSE AT END-OF-LIFE CAN BE USED ALONGSIDE TREATMENT TO IMPROVE QUALITY OF LIFE WORKS TO ADDRESS THE WHOLE PERSON: PHYSICAL, PSYCHOLOGICAL, SPIRITUAL, SOCIAL HELPS IDENTIFY WHAT IS IMPORTANT TO THE PERSON WHO IS DYING FOCUSES NOT JUST ON THE PATIENT, BUT ALSO THEIR IDENTIFIED FAMILY SEES DEATH AS A NATURAL PART OF LIFE Ramona Bruckner 2
(Life Is Short YouTube) Dignity Therapy Training Workshop Three day training Winnipeg - Canada Dr Harvey Chochinov Goal: to help bolster the dignity of dying patients and address their suffering Therapeutic intervention inviting individuals with lifelimiting illnesses to reflect on matters of importance to them The Importance of Understanding Dignity in Healthcare The thing that is most predictive of a patient s sense of dignity is how they perceive themselves to be seen and/or experienced by others Canadian Virtual Hospice Ramona Bruckner 3
Motivation for Dignity Therapy Chochinov et al. Social Science and Medicine 2002 Taking Dignity Therapy home with You Two Concepts to Contemplate: Two Practices to Consider: The A, B, C, D, s of Dignity Conserving Care The Dignity Therapy Legacy process Holding on to Personhood The Dignity Therapy Question Ramona Bruckner 4
A, B, C, D, s of Dignity Conserving Care (core efficiencies of the humanities of care) Attitude Behavior Compassion Dialogue Canadian Virtual Hospice Holding on to PERSONHOOD! Canadian Virtual Hospice Do patients have to relinquish WHO they are & WHAT they are to the prominence of their illness? How can patients hold on to their personhood? What can we do as health caregivers to make sure we are treating people in a way that they don t get lost? Dignity Therapy: Recording Ones Legacy Ramona Bruckner 5
Dignity Therapy Legacy Document Questions Tell me a little about your life history, particularly the parts that you either remember most, or think are the most important. When did you feel most alive? Are there specific things that you would want your family to know about you, and are there particular things you would want them to remember? What are the most important roles you have played in life (family roles, vocational roles, community service roles, etc.)? Why were they so important to you, and what do you think you accomplished in those roles? What are your most important accomplishments, and what do you feel most proud of? Are there particular things that you feel still need to be said to your loved ones, or things that you would want to take the time to say once again? What are your hopes and dreams for your loved ones? What have you learned about life that you would want to pass along to others? What advice or words of guidance would you wish to pass along to your (son, daughter, husband, wife, parents, others)? Are there words or perhaps even instructions you would like to offer your family to help prepare them for the future? In creating this permanent record, are there other things that you would like included? Dignity Therapy Toolkit Dignity Therapy Process: Step by Step Identify eligible patient Provide full explanation of Dignity Therapy Share Dignity Therapy question framework Obtain framing history for Dignity Therapy Arrange Dignity Therapy session Conduct Dignity Therapy session Follow editing protocol to create generativity document At follow-up session, read document to patient; address any final editing issues Provide patient final generativity document Dignity Therapy Toolkit Patient Dignity Question (PDQ) What should I know about you as a person to help me take the best care of you that I can? Ramona Bruckner 6
Maya Angelou wall art quote hanging above my computer, the essence of the heart of Dignity Therapy being seen and known for who we are, even in our suffering. RESOURCES on Dignity Therapy Become even better informed & equipped by reviewing resources, and much more, presented in today s presentation on the internet. All videos used in todays presentation are available to review by providing the URL provided Canadian Virtual Hospice: www.virtualhospice.ca Home Support The Gallery Dr. Harvey Chochinov Chochinov, Harvey Max, Dignity Therapy: Final Words for Final Days. NY: Oxford University Press, 2012. Dignity Therapy Toolkit dignityincare.ca/toolkit.html dignityincare.ca/toolkit.html Life Is Short video: https://www.youtube.com/watch?v=y1qvybvleas "Palliative Care." World Health Organization. Accessed September 03, 2018. http://www.who.int/news-room/fact-sheets/detail/palliative-care. Providence Vancouver. "Dr H 05 05 14." YouTube. May 09, 2014. Accessed September 03, 2018. https://www.youtube.com/watch?v=cvbydarrbmm. "The Growth of Palliative Care in U.S. Hospitals: A Status Report." A Definition for Wildness Ecopsychology. Accessed September 03, 2018. https://www.liebertpub.com/doi/full/10.1089/jpm.2015.0351. Ramona Bruckner 7