Purpose
A 2015 systematic review found 14 interventions with palliative care patients and their caregivers that targeted therapeutic life review as a treatment to enhance positive emotions and existential/spiritual domains. These 14 interventions have good methodological bases but require more investigation to be judged “well-established.”
Strategy
Several of these interventions combine life review/reminiscence with creative activity resulting in a tangible memento representing accomplishments and meaningful lessons from the patient's life that the caregiver helps create and can keep after the patient's death.
Target Population
Individuals with advanced, chronic illness and likelihood of death or functional decline within two years and their caregivers are the focus of these interventions, but some approaches have trained retired senior volunteers to act as intervention coaches.
Research Outcomes
Results are promising for therapeutic life review interventions combined with creative activities in decreasing caregiving stress or increasing meaning while improving patient emotional and existential outcomes. Although eight of ten good quality studies have been judged probably efficacious, more research is needed for these approaches to be considered “well-established.”
Outcomes Research References
Allen, R. S., Harris, G.M., Burgio, L.D., Azuero, C.B., Miller, L. A., Shin, H., Eichorst, M.K., Csikai, E.L., DeCoster, J., Dunn, L.L., Kvale, E.A., & Parmelee, P. (2014). Can senior volunteers deliver reminiscence and creative activity interventions? Results of the Legacy Intervention Family Enactment randomized controlled trial. Journal of Pain and Symptom Management, 48(4), 590-601. doi: 10.1016/j.jpainsymman.2013.11.012.
Allen, R. S., Hilgeman, M. M., Ege, M. A., Shuster, J. L., Jr., & Burgio, L. D. (2008). Legacy activities as interventions approaching the end of life. Journal of Palliative Medicine, 11(7), 1029-1038 .doi: 10.1089/jpm.2007.0294.
Chochinov, H.M., Hack, T., Hassard, T., (2005). Dignity Therapy: A novel psychotherapeutic intervention for patients near the end of life. Journal of Clinical Oncology, 23, 5520-5525.
Chochinov, H.M., Kristjanson, L.J., Breitbart, W., McClement, S., Hack, T.F., Hassard, T., & Harlos, M. (2011). Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncololgy, 12(8), 753–762. doi:10.1016/S1470-2045(11)70153-X.
Keall, R.M., Clayton, J.M., & Butow, P. N. (2014). Therapeutic life review in palliative care: A systematic review of quantitative evaluations. Journal of Pain and Symptom Management, doi: 10.1016/jpainsymman.2014.08.015.
Clinical Approach References
Allen, R. S., Azuero, C.B., Csikai, E.L., Parmelee, P.A., Shin, H.J., Kvale, E., Durkin, D.W., & Burgio, L.D. (2016). “It was very rewarding for me …”: Senior volunteers' experiences with implementing a reminiscence and creative activity intervention. The Gerontologist, 56(2), 357-367. doi: 10.1093/geront/gnu167.
Allen, R.S. (2009). The Legacy Project Intervention to enhance meaningful family interactions: Case examples. Clinical Gerontologist, 32, 164-176. doi:10.1080/07317110802677005
Chochinov, H. (2012). Dignity Therapy: Final Words for Final Days. New York: Oxford.