How-to guide

Dignity therapy questions and how to ask them at home

What dignity therapy is, the nine questions in its protocol, and how to ask them at home with a parent or loved one.

Dignity therapy is a brief, structured conversation for a person facing a serious or life-limiting illness. A trained clinician asks a fixed set of open questions about the person's life, records the answers, and shapes them into a written document the person can pass to whomever they choose. The person reviews the draft before it is final, and the finished document belongs to them.

This guide explains what dignity therapy is, walks through the nine questions in its protocol, and describes how a family can borrow the same questions for a conversation at home. It also marks, in plain terms, where the family version ends and the clinical one begins.

What dignity therapy is

Dignity therapy was introduced by Dr. Harvey Max Chochinov, a psychiatrist at the University of Manitoba, in a 2005 Journal of Clinical Oncology paper. It produces what Chochinov calls a generativity document: something made now that continues to matter to the people left behind, a written legacy the person has read, corrected, and chosen to pass on.

The early work measured whether the approach was feasible and whether it eased distress. In the 2005 study of 100 patients with terminal illness in Winnipeg and Perth, most people said the process helped them and their families. A larger randomized controlled trial in 2011, published in The Lancet Oncology, added a more specific finding: dignity therapy did not reduce measured distress any more than ordinary palliative care, but patients consistently said it helped them, changed how their family saw them, and helped their family. Our guide to life story work research covers that evidence in more detail.

The question protocol

The protocol rests on nine questions, and their order is deliberate. The first question opens with what the person already knows best, which is usually the easiest place to begin. The next questions widen to relationships and roles, then accomplishments, which let a person name what mattered to them. The middle questions turn to what still needs to be said and what the person hopes for the people they love. The last questions gather the lessons and final words for the family, then leave the door open for anything the list missed.

Use only the questions that fit. Skip anything that feels too private, and follow the details they want to share. In the protocol, "family" and "loved ones" mean whoever is closest to the person; substitute the people who matter to them.

  1. Tell me a little about your life history, particularly the parts you remember most or think are most important. When did you feel most alive?
  2. Are there specific things you would want your family to know about you, or particular things you would want them to remember?
  3. What are the most important roles you have played in life, such as in your family, your work, or your community? Why were they important to you, and what do you think you accomplished in them?
  4. What are your most important accomplishments, and what do you feel most proud of?
  5. Are there particular things that still need to be said to your loved ones, or things you would want to take the time to say once again?
  6. What are your hopes and dreams for your loved ones?
  7. What have you learned about life that you would want to pass along to others? What advice or words of guidance would you want to offer the people who matter most to you?
  8. Are there words, or even instructions, you would like to leave with your family to help prepare them for the future?
  9. In creating this record, are there other things you would like included?

Keep sessions short

A clinical interview can run 30 to 60 minutes, but a first conversation at home can be much shorter and should be. One or two questions at a time is enough; rushing past all nine leaves most of them unanswered.

Record rather than take notes

A phone recording lets the conversation move at the person's pace and keeps you present. Ask permission each time, and stop the moment the person wants to stop.

Let the person skip and follow the story

If a question feels too private, or the person changes the subject, follow them. The order is a guide, not a script. If a date is off or two events blur together, leave it; what matters is what the person chooses to say, not an accurate timeline. When they circle back to a question later, follow them then.

The questions are a starting point, and the person decides which ones matter.

Know when to pause

Tiredness, discomfort, or an answer that arrives with visible emotion is a signal to stop and offer to continue another day. There is no schedule to keep.

If the person has memory loss

If the person is living with memory loss or dementia, the questions change shape. Aim earlier in the life, keep sessions shorter, and avoid testing what they remember. Our guide to recording life stories with a parent who has memory loss covers this.

Where the family version ends and the clinical one begins

Dignity therapy is a brief therapy delivered by a trained clinician. The recording is transcribed and carefully edited: clarifications are added, tangents are removed, and anything likely to cause harm to a family member is set aside after discussion with the person. The clinician then reads the draft back for the person's changes before it is final.

A family conversation using the same questions is different, and it is worth saying so plainly. If the person is in hospice or palliative care, ask whether the team offers dignity therapy. If they do, the family conversation sits alongside it rather than replacing it. Reading the questions aloud at home can produce something worth keeping, but it is not the same intervention.

From conversation to a document your family can keep

The clinical process ends with a written document. At home, the recording is the starting point for the same idea.

Do something with it. Transcribe it yourselves, listen to it together, or use the answers to draft a written letter. Our guide to writing a legacy letter covers the written form, and the questions above overlap with it in a useful way.

For a written form with less drafting, Loristry turns a spoken conversation into a written record the family can read together.

Sources

Frequently asked questions

Dignity therapy is a brief, interview-based intervention for people facing a serious or life-limiting illness. A trained clinician asks a fixed set of questions about the person's life, records and edits the answers, and returns a written document the person can share with anyone they choose. Dr. Harvey Max Chochinov introduced it in a 2005 study.
A family member can ask the same questions in a conversation, and that conversation can produce something worth keeping. The clinical version, with its structured editing and a trained clinician, is a different thing. The two can sit alongside each other, but a family conversation is not the therapy.
The clinical version usually takes two or three sessions, with each interview running about 30 to 60 minutes. A conversation at home can be much shorter. One or two questions at a time is enough, and the project can continue across many visits.
Both are ordinary. The questions touch on what a life has meant, and emotion is a reasonable response, not something to fix. If a question is refused, skip it and move on. The purpose is the person's comfort and their willingness, not completing a list.
It was developed for people facing a terminal illness, but it has since been offered more broadly, including to people with serious illness, memory loss, and those who are grieving. The questions work in any family conversation, whatever the person's situation or age.
No, though they overlap. A legacy letter is a document a person writes or records, often covering values, lessons, gratitude, and hopes. Dignity therapy is a structured interview with a fixed set of questions that ends in a written document. The questions above can feed a legacy letter, but the two are not the same thing.
The clinical version is delivered by a trained clinician, such as a psychologist, social worker, nurse, or chaplain, who has been trained in the method. A family member does not need that training to have a good conversation, but the clinical intervention is a trained role.
At home, that is up to the person and the family. Transcribe it, keep the audio, or work the answers into a written letter. In the clinical version, the clinician transcribes and edits the conversation and returns a written document for the person to review and keep.