Overview
High quality care places an emphasis on the uniqueness of each individual and seeks to preserve their own sense of dignity. How patients perceive themselves to be seen is a powerful mediator of their dignity.[1] The more that health providers affirm a patient’s value by seeing the person as they are or as they were, rather than just within the illness they have, the more likely a person’s sense of dignity will be upheld.
Spiritual pain includes “… a sense of diffuse emotional / existential / intellectual pain directly related to the meaninglessness created as a result of a break with the expected / normal network of relationships that function to connect one to life. A key ingredient in that pain is the sense that the… experience with life is failing to meet the individual’s needs, and thus the expected satisfaction and meaning-making from life are not forth-coming.” [2]
What is known
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]
Recent research identifies three categories of dignity-related concerns: illness, social factors, and psychological and spiritual considerations – The Dignity Conserving Repertoire. [4] A recent 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.
Implications for practice
Chochinov [2007] 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. [5]
Finding out more
Chochinov HM. Dignity and the essence of medicine: the A, B, C, & D of dignity conserving care. BMJ 2007;335:184-187 (28 July), doi:10.1136/bmj.39244.650926.47
Related CareSearch pages
Suffering
Existential Distress
References
- Chochinov HM, Hack T, McClement S, Kristjanson L, Harlos M. Dignity in the terminally ill: a developing empirical model. Social Science & Medicine 2002 Feb;54(3):433-43.
- McGrath P. Creating a language for ‘spiritual pain’ through research: a beginning. Supportive Care in Cancer 2002 Nov;10(8):637-46.
- Chochinov HM. Dying, Dignity, and New Horizons in Palliative End-of-Life Care. CA: a Cancer Journal for Clinicians 2006 Mar-Apr;56(2):84-103.
- Chochinov HM, Kristjanson LJ, Hack TF, Hassard T, McClement S, Harlos M. Dignity in the terminally ill: revisited. Journal of Palliative Medicine 2006 Jun;9(3):666-72
- Chochinov HM. Dignity and the essence of medicine: the A, B, C, & D of dignity conserving care. BMJ 2007 Jul 28;335(7612):184-7.
This page was created on 14 May 2008 and is due for review in May 2010