Empathic communication in dignity therapy: Feasibility of measurement and descriptive findings

Carma L. Bylund*, Greenberry Taylor, Emily Mroz, Diana J. Wilkie, Yingwei Yao, Linda Emanuel, George Fitchett, George Handzo, Harvey Max Chochinov, Susan Bluck

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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 validated, reliable coding system used in clinical interactions. The aims of this study were (1) to assess the feasibility of the ECCS in DT sessions and (2) to describe the process of empathic communication during DT sessions. Methods We conducted a secondary analysis of 25 transcripts of DT sessions with older cancer patients. These DT sessions were collected as part of larger randomized controlled trial. We revised the ECCS and then coded the transcripts using the new ECCS-DT. Two coders achieved inter-rater reliability (κ = 0.84) on 20% of the transcripts and then independently coded the remaining transcripts. Results Participants were individuals with cancer between the ages of 55 and 75. We developed the ECCS-DT with four empathic response categories: acknowledgment, reflection, validation, and shared experience. We found that of the 235 idea units, 198 had at least one of the four empathic responses present. Of the total 25 DT sessions, 17 had at least one empathic response present in all idea units. Significance of results This feasibility study is an essential first step in our larger program of research to understand how empathic communication may play a role in DT outcomes. We aim to replicate findings in a larger sample and also investigate the linkage empathic communication may have in the DT session to positive patient outcomes. These findings, in turn, may lead to further refinement of training for dignity therapists, development of research into empathy as a mediator of outcomes, and generation of new interventions.

Original languageEnglish (US)
Pages (from-to)321-327
Number of pages7
JournalPalliative and Supportive Care
Issue number3
StatePublished - Jun 13 2022


  • Dignity therapy
  • Empathy
  • End of life

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology
  • General Nursing


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