Palliative care practitioners are increasingly able to respond to the pain and symptom distress experienced by those at the end of life. However, the concept of providing comfort as opposed to making a person comfortable has only recently begun to be re-examined. [3,5] What an individual values will determine what priorities they set and can help health care professionals understand care priorities in delivering dignified care. [6]
Research has identified 'The Dignity Model' where three major categories emerged from the qualitative analysis of dying patient’s perceptions of their sense of dignity, including:
- Illness-Related Concerns: These are issues that derive from the illness itself, and threaten to, or actually do impinge on the patient’s sense of dignity.
- Dignity Conserving Repertoire: This category was divided into two major themes:
- Dignity Conserving Perspectives are internally held qualities or a worldview
- Dignity Conserving Practices refer to a variety of personal approaches or techniques that patients used to increase or maintain their sense of dignity.
- Social Dignity Inventory: This refers to the quality of interactions with others that enhance or detract from one’s sense of dignity. This inventory refers to external sources or issues that impinge on a patient’s sense of dignity. [5,7]
A study using these themes found that 'not feeling treated with respect or understanding' and 'feeling a burden to others' were the most highly endorsed dignity-related concerns. [8]
Practice Implications
- Chochinov [8] has proposed a simple mnemonic to support dignity conserving care:
- Attitude: Suggests healthcare providers examine both their attitudes and assumptions towards patients, acknowledging that they may not be based on a patient’s reality
- Behaviour: Awareness of attitudes can lead to modified behaviour as a way of acknowledging patient need for dignity care
- Compassion: Refers to a deep awareness of the suffering of another combined with a wish to relieve that suffering
- Dialogue: Refers to communication that allows a healthcare provider to know a person beyond their illness which is critical to understanding them. [8]
- The Patient Dignity Inventory identifies dignity related distress and has been validated in older patients with cancer. [9]
- Basic tenets of palliative care under the goal of helping patients to die with dignity include: [1]
- Symptom control
- Psychological and spiritual support
- Care of the family.