'It makes me feel that I'm still relevant': A qualitative study of the views of nursing home residents on dignity therapy and taking part in a phase II randomised controlled trial of a palliative care psychotherapy

Background: Trials of dignity therapy (a palliative care psychotherapy) have shown self-reported benefits for participants from taking part, although more so in intervention than control groups. However, the sources of these benefits are unknown. Aim: The aim of this study was to explore and compare participants' views on taking part in a mixed methods phase II randomised controlled trial of dignity therapy. Design: This was a qualitative study, using the framework approach to the analysis. Setting/participants: It involved residents, aged 65+, with no major cognitive impairment, living in one of 15 nursing/care homes in London, UK (49 residents at 1-week follow-up, 36 residents at 8-week follow-up). Results: Residents' views were represented in nine themes, and three of these themes were evident only in the intervention group: views on the generativity document; generativity; and reminiscence. Six themes were evident in both groups: refocusing; making a contribution; interaction with the researcher or therapist; diversion; not helping with their problems; and cognitive impairment. Our findings support some of the proposed mechanisms of action for this palliative care intervention (pride, hopefulness, care tenor) but also draw attention to some of the potential problems of delivering the intervention. We show how residents could benefit from taking part in research, regardless of whether or not they receive the intended intervention. Conclusions: Dignity therapy is likely to be beneficial to some care home residents, albeit the small minority who have the desire and the capacity to engage in such an intervention. Whether or not dignity therapy helps distressed residents, and the most effective way of screening for those who might benefit from it, need to be determined.