Harvey Max Chochinov

Harvey Max Chochinov
CancerCare Manitoba · Psychiatry

OC OM MD PhD FRCPC FRSC FCHAS

About

324
Publications
145,628
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
15,406
Citations
Additional affiliations
January 2012 - present
Tom Baker Cancer Centre
January 2007 - present
University of Newcastle
January 2004 - present

Publications

Publications (324)
Article
Full-text available
Objective Dignity therapy (DT) is a brief psychotherapeutic intervention with beneficial effects in the end-of-life experience. Since it provides a continuing bond between the bereaved and their loved ones, we speculated that it could be offered as a novel bereavement intervention following the patient's death. We aimed to develop, translate, and v...
Article
Full-text available
How decisions are made and patients cared for are often guided by the Golden Rule, which would have us treat patients as we would want to be treated in similar circumstances. But when patients' lived experiences and outlooks deviate substantively from our own, we stop being a reliable barometer of their needs, values, and goals. Inaccurate percepti...
Article
Objective: To examine Dignity Therapy (DT) narratives in patients with severe mental illness (SMI) and a control group of cancer patients. Methods: 12 patients with SMI (schizophrenia, bipolar disorders, sever personality disorders) and 12 patients with non-advanced cancer individually participated to DT interviews. DT was tape-recorded, transcr...
Article
Full-text available
Objectives Intervention fidelity is imperative to ensure confidence in study results and intervention replication in research and clinical settings. Like many brief protocol psychotherapies, Dignity Therapy lacks sufficient evidence of intervention fidelity. To overcome this gap, our study purpose was to examine intervention fidelity among therapis...
Article
Full-text available
Purpose: Dementia is the major cause for disability and dependence in older people and associated with considerable psychological burden. The aim of this study was to determine the feasibility, acceptability and preliminary efficacy of Dignity Therapy, a brief psychotherapeutic intervention to enhance dignity and reduce psychological burden, in pat...
Article
Full-text available
Purpose: Intimate care procedures, such as bathing and toileting, are often regarded as simple, humble tasks. However, the provision of such care transforms a very private, personal activity into a social process. Understanding this complex process and the psychological impact it has on those providing and receiving care is critical in order to mit...
Article
Full-text available
Objective Dignity therapy (DT) is a guided process conducted by a health professional for reviewing one's life to promote dignity through the illness process. Empathic communication has been shown to be important in clinical interactions but has yet to be examined in the DT interview session. The Empathic Communication Coding System (ECCS) is a val...
Article
Context : Enhancing quality of life (QoL) is a goal of palliative care. Existential QoL is an important aspect of this. Objectives : This study sought to advance our understanding of existential QoL at the end of life through examining levels of Preparation and Completion, subscales of the QUAL-E, and their associated factors. Methods : We used d...
Article
Dignity therapy (DT) is a brief, individualized intervention, which provides terminally ill patients with an opportunity to convey memories, essential disclosures, and prepare a final generativity document. DT addresses psychosocial and existential issues, enhancing a sense of meaning and purpose. Several studies have considered the legacy topics m...
Article
Objectives Dignity therapy (DT) is a brief, individualized intervention, which provides terminally ill patients with an opportunity to convey memories, essential disclosures, and prepare a final generativity document. DT addresses psychosocial and existential issues, enhancing a sense of meaning and purpose. Several studies have considered the lega...
Article
Background Dignity Therapy (DT) has been implemented over the past 20 years, but a detailed training protocol is not available to facilitate consistency of its implementation. Consistent training positively impacts intervention reproducibility. Objective The objective of this article is to describe a detailed method for DT therapist training. Met...
Article
12116 Background: Pancreatic cancer (PDAC) is an aggressive, deadly disease. Chemotherapy (CT) can improve survival by months, but symptom burden is heavy and quality of life (QOL) is poor. Early palliative care (EPC) alongside standard oncologic care improves QOL and survival in other types of cancer; however, the impact on QOL and symptom burden...
Article
Lung cancer (LC) is the most frequent and deadly neoplasm in the world, and patients have shown a tendency to have more emotional distress than other cancer populations. Dignity Therapy (DT) is a brief intervention aimed to improve emotional well-being in patients facing life-threatening illness. Objective To analyze the effect of DT on anxiety, d...
Article
Context Religion and spirituality (r/s) are important resources in coping with cancer. However, there are aspects of r/s, such as religious and spiritual struggles, found to be associated with poorer outcomes. A new measure has been adapted from the Religious and Spiritual Struggles Scale (RSS) to assess r/s struggles: the RSS-14. This concise meas...
Article
Background Nearly 500,000 older Americans die a cancer-related death annually. Best practices for seriously ill patients include palliative care that aids in promoting personal dignity. Dignity Therapy is an internationally recognized therapeutic intervention designed to enhance dignity for the seriously ill. Theoretically, Dignity Therapy provides...
Article
Background: End-of-life discussions and documentation of preferences are especially important for older cancer patients who are at high risk of morbidity and mortality. Objective: To evaluate influence of demographic factors such as religiosity, education, income, race, and ethnicity on treatment preferences for end-of-life care. Methods: A retro...
Article
Introduction: The Patient Dignity Inventory (PDI) is a reliable screening instrument for a variety of problems (physical, existential, and social) that affect the dignity of patients during their end of life. The PDI has been translated into several different languages and has been validated in different settings. As such, it is important to valida...
Article
Objectives Dignity therapy (DT) is recognized as a valid form of support for terminally ill patients who have to manage trauma and loss. Given the positive evidence associated with DT, finding ways of adapting it for the older people warrants consideration. Methods The study examines if DT can be improved with the use of an album of family photogr...
Article
Objective. Telephone availability is integrated into our home-based palliative care team (HPCT) with the aim of helping terminally ill patients and their caregivers alleviate their physical and psychosocial suffering, in addition to the team’s home visits. We aimed to compare the differences between non-callers (patients with no phone calls during...
Article
A routine threat to palliative care research is participants not completing studies. The purpose of this analysis was to quantify attrition rates mid-way through a palliative care study on Dignity Therapy and describe the reasons cited for attrition. Enrolled in the study were a total of 365 outpatients with cancer who were receiving outpatient spe...
Chapter
Maintenance and promotion of patient and family dignity is a core tenet of palliative care and has significant implications for end-of-life experience, with loss of dignity associated with increased suffering and desire for death. This chapter provides an overview of empirical research on dignity at the end of life, including the model of dignity i...
Article
Context Generativity is a process whereby patients nearing the end of life invest in those they will soon leave behind. In recent years, the trajectory of cancer has changed, as new therapies have prolonged survival and patients often live with metastatic disease for several years. For these patients and for the healthcare professionals who care fo...
Article
Context Will-to-live (WtL) is a complex and multifactorial dimension of end-of-life experience. Health care decisions on assisted suicide and euthanasia are rarely based on WtL evidence-based discussions. Objectives To inform the debate, we aimed to evaluate the prevalence of WtL and its associations within a tertiary home-based palliative care un...
Article
Full-text available
Nearly 500,000 older Americans die a cancer-related death each year (National Vital Statistics Report, 2018). Following a diagnosis of a serious illness like cancer, maintaining a sense of dignity is central to a patient’s wellbeing. Dignity Therapy (DT) was recently introduced as an intervention to enhance dignity for terminally ill patients (Choc...
Article
Full-text available
Letter to the Editor regarding the paper: Schuelke T, Rubenstein J: Dignity therapy in pediatrics: A case series. Palliat Med Rep 2020;1.1:156–160.
Article
Dignity has gained increasing attention as a vital component of quality of life and quality of end-of-life care. This article reviews psychological, spiritual, existential, and physical issues facing patients at the end of life as well as practical considerations in providing therapy for this population. The authors reviewed several evidence-based...
Article
Objective Desire for death (DfD) is a complex and multifactorial dimension of end-of-life experience. We aimed to evaluate the prevalence of DfD and its associations, arising within the setting of a tertiary home-based palliative care (PC) unit. Method Retrospective analysis of all DfD entries registered in our anonymized database from October 201...
Article
Full-text available
Background: There is little concrete guidance on how to train current and future healthcare providers (HCPs) in the core competency of compassion. This study was undertaken using Straussian grounded theory to address the question: "What are healthcare providers' perspectives on training current and future HCPs in compassion?" Methods: Fifty-seve...
Article
Operationalizing dignity therapy for adolescents - Miguel Julião, Ana Santos, Sara Albuquerque, Bárbara Antunes, Margarida Crujo, Maria Ana Sobral, Cândida Cancelinha, Duarte da Silva Soares, Emília Fradique, Maria João Palaré, Harvey Max Chochinov
Article
Objective. Palliative care (PC) aims to improve patients’ and families’ quality of life through an approach that relieves physical, psychosocial, and spiritual suffering, although the latter continues to be under-assessed and under-treated. This study aimed to describe the prevalence of physical, psychosocial, and hope assessments documented by a P...
Article
Background: The COVID-19 pandemic has created an environment in which existence is more fragile and existential fears or terror rises in people. Objective: Managing existential terror calls for being mature about mortality, something with which palliative care providers are familiar and in need of greater understanding. Methods: Using a case to i...
Article
Full-text available
Introduction: Dignity Therapy (DT) is a brief, individualized, narrative psychotherapy developed to reduce psychosocial and existential distress, and promote dignity, meaning, and hope in end of life patients. Previous studies have shown that DT was effective in reducing anxiety and depression, and improving dignity-related distress. However, less...
Article
Background: Research has identified inadequacies in the quality and quantity of dementia-related information, particularly end-of-life information provided to those living with dementia and their family caregivers. The purpose of this study was to identify what types of information family caregivers of persons living with dementia in nursing homes...
Article
Introduction. The Patient Dignity Question (PDQ) is a clinical tool developed with the aim of reinforcing the sense of personhood and dignity, enabling health care providers (HCPs) to see patients as people and not solely based on their illness. Objective. To study the acceptability and feasibility of the Portuguese version of the PDQ (PDQ-PT) in a...
Article
TPS777 Background: Pancreatic cancer is lethal. Chemotherapy can improve survival by months; however, many patients experience an overwhelming burden of cancer-associated symptoms and poor quality of life (QOL). Early palliative care (EPC) alongside standard oncologic care results in improved QOL and survival in patients with lung cancer. Although...
Article
Dr. Elisabeth Kübler-Ross is credited as one of the first clinicians to formalize recommendations for working with patients with advanced medical illnesses. In her seminal book, On Death and Dying, she identified a glaring gap in our understanding of how people cope with death, both on the part of the terminally ill patients that face death and as...
Article
Objective Dignity therapy (DT) is well established in adult populations, and it is likely that it could benefit younger people. This study aimed to adapt the adult Portuguese DT question framework for adolescents (DT-QF-Adol) (ages 10–18). Method Five stages were followed: (1) the Portuguese DT-QF for adults was adapted for adolescents with the or...
Article
Objectives This study aimed to explore the construct of dignity of the patient–family dyad in hospice palliative care, as well as its influencing factors from the perspective of hospice palliative care staff. Methods A qualitative descriptive study was conducted with 34 staff members from a residential hospice in Amherst, USA, and an inpatient pal...
Chapter
Dignity-conserving care is a multifactorial construct, consisting of three primary domains, i.e. illness-related concerns, such as symptom distress; dignity-conserving perspectives and practices, such as continuity of the self, maintenance of pride and hopefulness; and social dimensions of dignity, such as privacy concerns, burden to others and aft...
Preprint
Full-text available
BACKGROUND Our goal is to improve psychosocial and spiritual care outcomes for elderly patients with cancer by optimizing an intervention focused on dignity conservation tasks such as settling relationships, sharing words of love, and preparing a legacy document. These tasks are central needs for elderly patients with cancer. Dignity Therapy (DT) h...
Article
Full-text available
Background: Our goal is to improve psychosocial and spiritual care outcomes for elderly patients with cancer by optimizing an intervention focused on dignity conservation tasks such as settling relationships, sharing words of love, and preparing a legacy document. These tasks are central needs for elderly patients with cancer. Dignity therapy (DT)...
Article
The discourse of dying alone is negatively weighted and models of a good death identify not dying alone as a key outcome. Understanding why dying alone is viewed negatively and its effects on care is a priority. In separate focus groups with long-term care residents, family caregivers, and staff, we identified evidence for four different perspectiv...
Article
Context: It has become commonplace to use family caregivers as proxy responders where patients are unable to provide information about their symptoms and concerns to health care providers. Objective: To determine the degree of concordance between patients' and family members' reports of patient symptoms and concerns at end-of-life. Methods: Sa...
Article
Background: Feasibility of dignity therapy (DT) is well established in palliative care. Evidence of its efficacy, however, has been inconsistent and may stem from DT's primary effects differing from the outcomes measured in previous studies. We proposed that DT effects were in the spiritual domain and created a new outcome measure, Dignity Impact...
Article
RESULTS: The original TIME authors fully endorsed the back translated version. A Portuguese version was created. Forty-three participants (response rate of 62%) were included, 53% of whom were male. The average age was 69 years old (range, 60-80 years old). The interviewed elderly strongly felt that the ESEU's summary captured their essence as a pe...
Article
Full-text available
Background Compassion is considered a component of quality healthcare that healthcare providers (HCPs) are increasingly expected to provide. While there have been some studies exploring facets of HCPs’ perspectives on the barriers and facilitators to providing compassion, a comprehensive understanding based on direct reports from HCPs is lacking....
Article
Full-text available
Background Healthcare providers are considered the primary conduit of compassion in healthcare. Although most healthcare providers desire to provide compassion, and patients and families expect to receive it, an evidence-based understanding of the construct and its associated dimensions from the perspective of healthcare providers is needed. Objec...
Article
Full-text available
Background During the last decades, dignity has been an emerging issue in mental health since its ethical and therapeutic implications became known. This study is an extension of the preliminary validation of the Patient Dignity Inventory (PDI) in a psychiatric setting, originally designed for assessing perceived dignity in terminal cancer patients...
Article
Full-text available
Background The lack of a holistic approach to palliative care can lead to a fractured sense of dignity at the end of life, resulting in depression, hopelessness, feelings of being a burden to others, and the loss of the will to live among terminally ill patients. Building on the clinical foundation of Dignity Therapy, together with the empirical un...
Article
Full-text available
Background: Effective patient-family communication can reduce patients' psychosocial distress and relieve family members' current suffering and their subsequent grief. However, terminally ill patients and their family members often experience great difficulty in communicating their true feelings, concerns, and needs to each other. Aim: To develo...
Article
Full-text available
Purpose: Women with breast cancer require information about their cancer and its treatment during the process of treatment decision-making, yet it is unclear if there are barriers to information support. This study explores the experience of making treatment decisions in breast cancer, paying particular attention to the barriers experienced to the...
Article
Background: Bill C-14 allows for medical assistance in dying (MAID) for patients who have intolerable physical or psychological suffering that occurs in the context of a reasonably foreseeable death. In Canada, psychiatrist support for MAID on the basis of mental illness and beliefs influencing level of support are unknown. The objectives of this...
Article
Full-text available
Background Confinement to an in-patient hospital ward impairs patients’ sense of social support and connectedness. Providing the means, through communication technology, for patients to maintain contact with friends and family can potentially improve well-being at the end of life by minimizing social isolation and facilitating social connection. Th...
Article
Background: Knowing someone with tuberculosis (TB) as a person, rather than defining them by their illness, is part of recognising their dignity and unique individuality, and a requirement for effective care. Objective: An adaptation of the Patient Dignity Question (PDQ) was formalised for persons receiving treatment for active TB or latent tube...
Article
Full-text available
Background: Compassion is considered an essential element in quality patient care. One of the conceptual challenges in healthcare literature is that compassion is often confused with sympathy and empathy. Studies comparing and contrasting patients’ perspectives of sympathy, empathy, and compassion are largely absent. Aim: The aim of this study was...
Article
Full-text available
Background Hospitalized palliative patients need to keep in touch with their loved ones. Regular social contact may be especially difficult for individuals on palliative care in-patient units due to the isolating nature of hospital settings. Technology can help mitigate isolation by facilitating social connection. This study aimed to explore the ac...
Article
Full-text available
Background The purpose of this qualitative study was to investigate advanced cancer patients’ perspectives on the importance, feasibility, teaching methods, and issues associated with training healthcare providers in compassionate care. Methods This study utilized grounded theory, a qualitative research method, to develop an empirical understandin...
Article
This study aimed at evaluating the effectiveness of the TIME (This Is ME) Questionnaire in eliciting personhood and enhancing dignity; specifically investigating the residents' and health care providers' perspectives in the nursing home setting. Residents (n = 41) from six nursing homes in a Canadian urban center completed both the TIME Questionnai...
Article
Full-text available
Context: Compassion is frequently referenced as a hallmark of quality care by patients, health care providers, health care administrators and policy makers. Despite its putative centrality, including its institution in recent health care reform, an empirical understanding based on the perspectives of patients, the recipients of compassion, is lack...
Article
Full-text available
Objective: The purpose of this study was to identify four non-cancer populations that might benefit from a palliative approach; and describe and compare the prevalence and patterns of dignity related distress across these diverse clinical populations. Design: A prospective, multi-site approach was used. Setting: Outpatient clinics, inpatient f...