Adapting the Portuguese dignity question framework for adolescents: ages 10–18

Dignity in the Pediatric Population: A Systematic Review

CONTEXT

Children are a uniquely vulnerable patient population with restricted abilities for self-advocacy and autonomy, risking infringement upon their dignity. Yet the concept of dignity in pediatrics remains underexplored relative to the adult literature and other outcome measures.

OBJECTIVES

To characterize how dignity is defined, evaluated, and/or measured in pediatrics.

METHODS

We conducted a systematic review following PRISMA guidelines across the following databases: MEDLINE, Embase, Cumulative Index of Nursing and Allied Health, PsycINFO, Global Health, Social Science Premium Collection, and Dissertation and Theses. We included publications from database inception through April 2023, in English, involving children aged 0-18 years, and prioritizing dignity as a central theme with a focus on defining, evaluating, or measuring dignity. Study descriptions and pertinent characteristics were extracted and synthesized using a predefined form.

RESULTS

Forty-four articles met inclusion criteria; fewer than half comprised original research (20/44, 45%). Most studies (38/44, 86%) included description of the meaning of dignity, with emergence of salient themes around respect, communication, agency/autonomy, and privacy. Less than half (19/44, 43%) included a measurement or evaluation of dignity; approximately one-third described dignity therapy. More than one-third of publications focused on dignity at end of life (17/44, 39%) and included discussions of palliative care and hospice (15/44, 34%).

CONCLUSION

Relatively few published studies describe dignity in pediatrics. Opportunities exist to broaden scholarship on this topic in partnership with patients, families, and clinicians, with the goal of assessing and strengthening dignity-centered care across the illness course and at the end of life.

The dignity of terminally ill children in pediatric palliative care: perspectives of parents and healthcare providers

BACKGROUND

The Chochinov Dignity Model was developed based on a cohort of adult patients with advanced cancer, but its role among dying children is not clear. This study aims to develop a model of dignity for children receiving pediatric palliative care based on the Chochinov Dignity Model.

METHODS

This is a descriptive qualitative study. Participants included a total of 11 parents and 14 healthcare providers who were recruited from a tertiary children's hospital in Beijing and the Pediatric Palliative Care Subspecialty Group of the Pediatrics Society of the Chinese Medical Association using purposive sampling. Thematic framework analysis was used to analyze data.

RESULTS

The themes of the empirical Dignity Model were broadly supported in this study, but some themes were interpreted differently in the child population. Compared with the original model, some child-specific themes were identified including acknowledging regret, a sense of security, the company of important loved ones, realizing unfinished wishes, decent and dignified death, resolving family disputes, and fairness.

CONCLUSIONS

This is the first study on Dignity Model for terminal children. Knowledge of children's dignity can promote reflection of healthcare providers and caregivers regarding the values underlying their performance in pediatric palliative care, and develop certain practical interventions to strengthen children and their families' sense of dignity at end of life.

The European Portuguese Posthumous Dignity Therapy Schedule of Questions: Initial development and validation

OBJECTIVE

Dignity therapy (DT) is a brief psychotherapeutic intervention with beneficial effects in the end-of-life experience. Since it provides a continuing bond between the bereaved and their loved ones, we speculated that it could be offered as a novel bereavement intervention following the patient's death. We aimed to develop, translate, and validate the Posthumous DT Schedule of Questions (p-DT-SQ), for administration with bereaved relatives or friends.

METHOD

The original DT-SQ was adapted for application with bereaved relatives or friends. It was translated and back-translated to European Portuguese and revised by an expert committee. Content validity was assessed by the Content Validity Coefficient (CVC). The instrument was tested in a sample of 50 individuals from a large Senior Residence in Lisbon (10 elderly people and 40 healthcare professionals), who assessed face validity.

RESULTS

The p-DT-SQ showed very good CVC (0.94) and face validity: it was considered clear, easy to understand, reasonable in length, and not difficult to answer. Participants felt comfortable answering the p-DT-SQ and felt it could positively affect the way themselves or others would remember their loved ones, allowing an understanding of the deceased's concerns, interests, and values.

SIGNIFICANCE OF RESULTS

We created and validated an adapted version of the DT-SQ to be used posthumously by bereaved family and friends. The European Portuguese version of the p-DT-SQ is clear, comprehensible, and aligned with the fundamentals of DT. While our data suggest its beneficial effects for those who are bereft, future research is needed to examine the impact of p-DT-SQ for those who are grieving.

How dignity-related distress interact with quality of life in young adult patients with cancer during the active treatment stage: A network analysis

OBJECTIVE

Young adult patients with cancer are a growing concern. By means of network analysis, this study aimed to explore the interplay between dignity-related distress and quality of life (QoL) in young adult patients with cancer when they undergo active treatments.

METHODS

In this cross-sectional study, 309 young adults aged 18-39 and diagnosed with malignant tumors were recruited from an oncology center in China between September 2020 and August 2021. Participants completed the Patient Dignity Inventory and SF-36 questionnaires. Network analysis was applied to examine the network structure.

RESULTS

Overall, the core facets of dignity-related distress were negatively related to QoL and its corresponding domains, either directly or indirectly. Developmental distress played a central role among estimated networks and strongly interplayed with most QoL domains, especially the mental domains. Symptom distress was the only facet consistently interplayed with the physical domains of QoL (i.e., physical function and bodily pain). The social aspects were also revealed in the association between limited social support and vitality.

CONCLUSIONS

Early attention must be paid to guarantee the need of preserving dignity and enhancing QoL for young adult patients. This article is protected by copyright. All rights reserved.

Dignity Therapy - past, present and future journey: Beyond end of life cancer care. Responding to Grassi et al

This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Autoeficácia alimentar em crianças e adolescentes com sobrepeso ou obesidade: revisão integrativa de instrumentos

RESUMO Objetivo: Descrever as características dos instrumentos para avaliação da autoeficácia alimentar no sobrepeso e na obesidade em crianças e adolescentes. Métodos: Revisão integrativa da literatura, realizada em maio de 2020, em seis bases de dados (PubMed; Web of Science; Scopus; CINAHL, ADOLEC e PsycINFO) com a seguinte estratégia de busca: self-efficacy and (Overweight OR Obesity) and (Child* OR Adolescent). Resultados: Incluíram-se 35 artigos e 21 instrumentos aplicados às crianças de 6 a 9 anos (n=2), em adolescentes de 10 a 19 anos (n=9) e em crianças e adolescentes de 7 a 18 anos (n=10). Os instrumentos têm de 4 a 30 itens e variaram de duas a cinco dimensões, sendo as mais frequentes “alimentação saudável” e “atividade física”. Conclusão: Existem diferentes instrumentos confiáveis destinados à avaliação da autoeficácia alimentar do público adolescente e infantil, o que sinaliza a importância desse construto para prevenção e controle da obesidade e sobrepeso.

Eating self- efficacy in overweight and obese children and adolescents: integrative review of instruments

ABSTRACT Objective: To describe the characteristics of instruments to assess eating self-efficacy in overweight and obesity in children and adolescents. Methods: Integrative literature review, conducted in May 2020, in six databases (PubMed; Web of Science; Scopus; CINAHL, ADOLEC, and PsycINFO) with the following search strategy: Self-efficacy and (Overweight OR Obesity) and (Child* OR Adolescent). Results: The inclusion of thirty-five articles and twenty-one instruments was applied to children 6 to 9 years old (n=2), adolescents 10 to 19 years old (n=9), and children and adolescents 7 to 18 years old (n=10). The instruments have 4 to 30 items and vary from two to five dimensions, the most frequent being “healthy eating” and “physical activity.” Conclusion: There are different reliable instruments designed to assess eating self-efficacy in adolescents and children, indicating the importance of this construct for preventing and controlling obesity and overweight.