Factors Associated with Empathic Self-Disclosure in Dignity Therapy with Cancer Patients

Background/Purpose: Dignity Therapy (DT) is designed to preserve patient dignity as they navigate illness. A trained provider elicits the patient's life story, asking interview questions that later form a Legacy Document to be shared with loved ones. Accordingly, a provider's empathic communication skills are critical. One way providers demonstrate empathy is through empathic selfdisclosure (ESD), which involves sharing something substantial and personal about themselves to relate to the patient. We evaluated how patient gender, provider gender, type of provider (nurse or chaplain), and DT modality (in‐person or virtual) related to ESD. Methods: We analyzed the recorded and transcribed DT sessions of 204 cancer outpatients aged 55 years or older. Data were part of a 6‐ site randomized clinical trial. Transcripts were segmented into units based on the DT questions. Two coders independently double‐coded transcripts using a modified version of the Empathic Communication Coding System and resolved discrepancies by consensus. Interrater reliability for the overall dataset was excellent (κ = 0.80, ICC = 0.80). We conducted t‐tests to compare mean ESD occurrence across target variables. Results: Overall, 37% of narratives had at least one instance of ESD. Chaplains (M = 0.88, SD = 1.517) used ESD more frequently than nurses (M = 0.22, SD = 0.415; p < 0.001). Female providers (M = 0.73, SD = 1.386) were more likely to use ESD than male providers (M = 0.26, SD = 0.538; p < 0.01). Providers were more likely to use ESD with male (M = 0.89, SD = 1.602) than female patients (M = 0.43, SD = 0.896; p < 0.01). Use of ESD trended more frequent for in‐person (M = 0.87, SD = 1.796) compared to virtual sessions (M = 0.50, SD = 0.956; p = .066). Conclusions and Implications: Patient‐provider interaction is integral to DT. Therefore, it is important to evaluate what factors are associated with ESD in order to improve implementation of DT. Findings suggest a communication exchange in which female providers are using ESD more often with male patients. Future research should examine the motivation for providers' use of ESD.