Development and evaluation of an intervention to improve psychological-existential distress in cancer patients at the end of life in Taiwan

End of life approaches in patients with cancer bodily deterioration and difficulties with everyday life can evoke psychological-existential distress. Dignity therapy (DT), a form of psychotherapeutic intervention, has been shown to alleviate psychological-existential distress in dying patients in Western culture. This thesis explores the potential application of DT in Taiwan. Three distinct, but linked phases of research, were conducted. Phase one elucidated the concept of dignity in Western culture through the technique of meta-ethnography. This revealed that psychological-existential adjustment strategies aimed at helping patients accept the inevitability of dying might preserve patients’ sense of dignity. In order to identify the conceptualisations of dignity in Taiwan, phase two comprised semi-structured interviews with Taiwanese dying patients (n=9) and palliative care professionals (n=10). These revealed that intrinsic to preserving a sense of dignity in this context were maintenance of moral life, having peace of mind, and a sense of existence. Findings supported the assertion that a modification of DT entitled dignity intervention (DI), making a life story legacy via a narrative approach, might help patients gain peace of mind and a sense of existence. Phase three consisted of a pre-test post-test single group evaluation with measurement of dignity, suffering, psychological symptoms, existential well-being and spiritual relationships, and interviews with terminally ill patients (n=14), their families (n=10) and palliative care professionals (n=9) in order to test the feasibility and acceptability of DI. No improvement in scores on outcome measures was recorded, but all participants reported DI to have been helpful. Patients used DI to convey messages regarding love, regret, gratitude and hope