Dignity in the terminally ill: revisited.

BACKGROUND Several studies have been conducted examining the notion of dignity and how it is understood and experienced by people as they approach death. OBJECTIVE The purpose of this study was to use a quantitative approach to validate the Dignity Model, originally based on qualitative data. DESIGN Themes and subthemes from the Dignity Model were used to devise 22 items; patients were asked the extent to which they believed these specific issues were or could be related to their sense of dignity. RESULTS Of 211 patients receiving palliative care, "not being treated with respect or understanding" (87.1%) and "feeling a burden to others" (87.1%) were the issues most identified as having an influence on their sense of dignity. All but 1 of the 22 items were endorsed by more that half of the patients; 16 items were endorsed by more than 70% of the patients. Demographic variables such as gender, age, education, and religious affiliation had an influence on what items patients ascribed to their sense of dignity. "Feeling life no longer had meaning or purpose" was the only variable to enter a logistic regression model predicting overall sense of dignity. CONCLUSIONS This study provides further evidence supporting the validity of the Dignity Model. Items contained within this model provide a broad and inclusive range of issues and concerns that may influence a dying patient's sense of dignity. Sensitivity to these issues will draw care providers closer to being able to provide comprehensive, dignity conserving care.

[1]  Susan McClement,et al.  Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[2]  C. McPherson,et al.  A Burden to Others: A Common Source of Distress for the Terminally Ill , 2005, Cognitive behaviour therapy.

[3]  W. Breitbart,et al.  Desire for hastened death, cancer pain and depression: report of a longitudinal observational study. , 2005, Journal of pain and symptom management.

[4]  S. Wilkinson,et al.  A qualitative evaluation of the impact of palliative care day services: the experiences of patients, informal carers, day unit managers and volunteer staff , 2005, Palliative medicine.

[5]  T. Hassard,et al.  Defining dignity in terminally ill cancer patients: A factor‐analytic approach , 2004, Psycho-oncology.

[6]  J. Downie.  Unilateral Withholding and Withdrawal of Potentially Life-Sustaining Treatment: A Violation of Dignity under the Law in Canada , 2004, Journal of palliative care.

[7]  T. Hassard,et al.  Dignity and Psychotherapeutic Considerations in End-of-Life Care , 2004, Journal of palliative care.

[8]  P. Burnett,et al.  Association between clinician factors and a patient's wish to hasten death: terminally ill cancer patients and their doctors. , 2004, Psychosomatics.

[9]  K. Wilson,et al.  Structured Interview Assessment of Symptoms and Concerns in Palliative Care , 2004, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[10]  H. Chochinov.  Dignity and the eye of the beholder. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  W. Breitbart,et al.  Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients , 2003, The Lancet.

[12]  T. Hassard,et al.  Dignity in the terminally ill: a cross-sectional, cohort study , 2002, The Lancet.

[13]  H. Chochinov.  Dignity-conserving care--a new model for palliative care: helping the patient feel valued. , 2002, JAMA.

[14]  H. Chochinov,et al.  Dignity in the terminally ill: a developing empirical model. , 2002, Social science & medicine.

[15]  F. De Conno,et al.  Characteristics of terminal cancer patients who committed suicide during a home palliative care program. , 2001, Journal of pain and symptom management.