Abstract
Background
Dignity therapy (DT) is effective in addressing dignity-related existential distress in people with advanced cancer, but the traditional protocol assumes supportive family structures, uses heteronormative language, and requires synchronous clinician facilitation. These features may limit accessibility for LGBTQ+ individuals. This pilot study evaluated the feasibility and acceptability of a self-written, tele-delivered LGBTQ+-affirming DT adaptation.
Methods
LGBTQ+ women with advanced cancer completed the adapted protocol and a post-protocol survey asking both quantitative and qualitative data. Feasibility outcomes included completion rates and time from opening the survey to submission. Acceptability was assessed using items from the DT Patient Feedback Questionnaire, and user experience was explored with open-ended questions.
Results
Eight participants completed all study activities (100% completion). Mean time from opening to submitting the protocol was 34.3 h (SD = 57.3), with a median of 4.4 h. Most participants strongly agreed that the intervention was helpful (n = 6/8), satisfying (n = 7/8), and meaningful (n = 6/8), and all reported an increase in dignity; six were likely to recommend it to other LGBTQ+ individuals with cancer. Qualitative responses described the intervention as fostering reflection, emotional expression, decision-making, and a sense of being honored, while also eliciting complex emotions and highlighting preferences for affirming language (eg, “family of choice”) and interpersonal connection.
Conclusion
This pilot demonstrated that a self-written, tele-delivered LGBTQ+-affirming DT adaptation was feasible and acceptable for LGBTQ+ women with advanced cancer. Future research should refine language and relational elements and evaluate this approach in larger, more diverse LGBTQ+ samples.
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