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Grassi L, Nanni MG, Riba M, Folesani F. Dignity in Medicine: Definition, Assessment and Therapy. Curr Psychiatry Rep 2024; 26:273-293. [PMID: 38809393 PMCID: PMC11147872 DOI: 10.1007/s11920-024-01506-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW Over the last 20 years, dignity and dignity-conserving care have become the center of investigation, in many areas of medicine, including palliative care, oncology, neurology, geriatrics, and psychiatry. We summarized peer-reviewed literature and examined the definition, conceptualization of dignity, potential problems, and suggested interventions. RECENT FINDINGS We performed a review utilizing several databases, including the most relevant studies in full journal articles, investigating the problems of dignity in medicine. It emerged that dignity is a multifactorial construct and that dignity-preserving care should be at the center of the health organization. Dignity should be also regularly assessed through the tools currently available in clinical practice. Among dignity intervention, besides dignity models of care, dignity intervention, such as dignity therapy (DT), life review and reminiscence therapy, have a role in maintaining both the extrinsic (preserved when health care professionals treat the patient with respect, meeting physical and emotional needs, honors the patient's wishes, and makes attempts to maintain privacy and confidentiality) and intrinsic dignity (preserved when the patient has appropriate self-esteem, is able to exercise autonomy and has a sense of hope and meaning). Unified trends across diverse medical contexts highlight the need for a holistic, patient-centered approach in healthcare settings. Challenges compromising dignity are pervasive, underscoring the importance of interventions and systematic efforts to address these issues. Future research and interventions should prioritize the multifaceted nature of dignity, striving to create healthcare environments that foster compassion, respect, and dignity across all medical settings.
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Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64°, 44121, Ferrara, Italy
- Integrated Department of Mental Health, University Hospital Psychiatry Unit, Ferrara, Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64°, 44121, Ferrara, Italy
- Integrated Department of Mental Health, University Hospital Psychiatry Unit, Ferrara, Italy
| | - Michelle Riba
- Department of Psychiatry, and PsychOncology Program, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Federica Folesani
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64°, 44121, Ferrara, Italy.
- Integrated Department of Mental Health, University Hospital Psychiatry Unit, Ferrara, Italy.
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Lim YX, Quah ELY, Chua KZY, Lin Ronggui CK, Govindasamy R, Ong SM, Ong EK, Phua GLG, Krishna LKR. A Systematic Scoping Review on Dignity Assessment Tools. J Pain Symptom Manage 2024; 67:e263-e284. [PMID: 38092260 DOI: 10.1016/j.jpainsymman.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 01/15/2024]
Abstract
CONTEXT The provision of person-centered dignity-conserving care is central to palliative care. It is important to reevaluate current methods of assessing dignity as the concept of dignity is multifaceted. OBJECTIVES The aim of this study is to understand the tools which are used to assess a patient's dignity and the elements of dignity evaluated in these tools. METHODS Two independent and concurrent Systematic Evidence-Based Approach guided systematic scoping reviews (SSR in SEBA) on existing dignity assessment tools and on accounts of assessments of dignity were carried out. The SSR in SEBA on dignity assessment tools involving PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Scopus, and CINAHL databases saw 22 full-text articles included from the 645 articles reviewed. The SSR in SEBA on accounts of assessments of dignity featured in the PubMed database identified 102 full-text articles which saw 46 articles included. RESULTS The domains identified were factors affecting patients' definition of dignity; elements of dignity-conserving care; and components of effective tools. CONCLUSION Current accounts to assess dignity and assessment tools fail to capture shifting self-concepts of dignity holistically. A portfolio-like appraisal of dignity is proposed to achieve assessments that are timely, longitudinal, and patient-specific. Portfolio-based assessments by members of the multidisciplinary team will better direct timely evaluations of relevant aspects of changing concepts of dignity, without losing the patient's holistic perception of dignity.
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Affiliation(s)
- Yun Xue Lim
- Yong Loo Lin School of Medicine (Y.X.L., E.L-Y.Q., K.Z-Y.C., S.M.O., L.K.R.R), National University of Singapore, Singapore; Division of Supportive and Palliative Care (Y.X.L., E.L-Y.Q., K.Z-Y.C., C.K.L.R., S.M.O., E.K.O., G.L.K.P., L.K.R.R), National Cancer Centre Singapore, Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine (Y.X.L., E.L-Y.Q., K.Z-Y.C., S.M.O., L.K.R.R), National University of Singapore, Singapore; Division of Supportive and Palliative Care (Y.X.L., E.L-Y.Q., K.Z-Y.C., C.K.L.R., S.M.O., E.K.O., G.L.K.P., L.K.R.R), National Cancer Centre Singapore, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine (Y.X.L., E.L-Y.Q., K.Z-Y.C., S.M.O., L.K.R.R), National University of Singapore, Singapore; Division of Supportive and Palliative Care (Y.X.L., E.L-Y.Q., K.Z-Y.C., C.K.L.R., S.M.O., E.K.O., G.L.K.P., L.K.R.R), National Cancer Centre Singapore, Singapore
| | - Casper Keegan Lin Ronggui
- Division of Supportive and Palliative Care (Y.X.L., E.L-Y.Q., K.Z-Y.C., C.K.L.R., S.M.O., E.K.O., G.L.K.P., L.K.R.R), National Cancer Centre Singapore, Singapore; Centre for Biomedical Ethics (C.K.L.R., L.K.R.R), National University of Singapore, Singapore; Department of Pharmacy (C.K.L.R.), National Cancer Center Singapore, Singapore; Division of Cancer Education (C.K.L.R., R.G., E.K.O., L.K.R.R.), National Cancer Centre Singapore, Singapore
| | - Ranitha Govindasamy
- Division of Supportive and Palliative Care (Y.X.L., E.L-Y.Q., K.Z-Y.C., C.K.L.R., S.M.O., E.K.O., G.L.K.P., L.K.R.R), National Cancer Centre Singapore, Singapore; Division of Cancer Education (C.K.L.R., R.G., E.K.O., L.K.R.R.), National Cancer Centre Singapore, Singapore; Department of Psychosocial Oncology (R.G.), National Cancer Center Singapore, Singapore
| | - Simone Meiqi Ong
- Yong Loo Lin School of Medicine (Y.X.L., E.L-Y.Q., K.Z-Y.C., S.M.O., L.K.R.R), National University of Singapore, Singapore; Division of Supportive and Palliative Care (Y.X.L., E.L-Y.Q., K.Z-Y.C., C.K.L.R., S.M.O., E.K.O., G.L.K.P., L.K.R.R), National Cancer Centre Singapore, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care (Y.X.L., E.L-Y.Q., K.Z-Y.C., C.K.L.R., S.M.O., E.K.O., G.L.K.P., L.K.R.R), National Cancer Centre Singapore, Singapore; Division of Cancer Education (C.K.L.R., R.G., E.K.O., L.K.R.R.), National Cancer Centre Singapore, Singapore; Duke-NUS Medical School (E.K.O., L.K.R.R.), Singapore; Assisi Hospice (E.K.O.), Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care (Y.X.L., E.L-Y.Q., K.Z-Y.C., C.K.L.R., S.M.O., E.K.O., G.L.K.P., L.K.R.R), National Cancer Centre Singapore, Singapore; Lien Centre for Palliative Care (G.L.G.P.), Duke-NUS Medical School, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine (Y.X.L., E.L-Y.Q., K.Z-Y.C., S.M.O., L.K.R.R), National University of Singapore, Singapore; Division of Supportive and Palliative Care (Y.X.L., E.L-Y.Q., K.Z-Y.C., C.K.L.R., S.M.O., E.K.O., G.L.K.P., L.K.R.R), National Cancer Centre Singapore, Singapore; Centre for Biomedical Ethics (C.K.L.R., L.K.R.R), National University of Singapore, Singapore; Division of Cancer Education (C.K.L.R., R.G., E.K.O., L.K.R.R.), National Cancer Centre Singapore, Singapore; Duke-NUS Medical School (E.K.O., L.K.R.R.), Singapore; Palliative Care Institute Liverpool (L.K.R.R.), Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom; PalC (L.K.R.R.), The Palliative Care Centre for Excellence in Research and Education, Singapore.
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Hadler RA, Dexter F, Epstein RH. Logistic Regression and Machine Learning Models for Predicting Whether Intensive Care Patients Who Are Alert and Without Delirium Remain As Such for at Least Two More Days. Cureus 2023; 15:e34913. [PMID: 36938184 PMCID: PMC10015509 DOI: 10.7759/cureus.34913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 02/15/2023] Open
Abstract
Background Some intensive care unit patients are alert and without delirium for at least two consecutive days. These patients, like other critically ill individuals, are at risk for dignity-related distress. An interval of at least two days would provide for a palliative care multidisciplinary team to be consulted in the late morning or afternoon of day one and visit the next day. An assessment would include the administration of the validated Patient Dignity Inventory in a reflective manner. To determine whether dignity-related distress can be identified and treated during patients' intensive care unit stay, we evaluated whether a substantive fraction of such patients (≥5%) have a substantial (>90%) probability of remaining alert and without delirium in the intensive care unit for at least four consecutive days. Methods The retrospective cohort study used data from one large teaching hospital in the United States of America, from 2012 to June 2022. The inclusion criteria were: a) adults, b) present in an intensive care unit at 12 PM one day and continually so for the next 48 hours, c) during those two days had every Riker sedation-agitation scale score "4, calm and cooperative," and d) during those two days had all Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scores negative (i.e., no delirium) and all Delirium Observation Screening Scale (DOS) scores less than three (i.e., no delirium). Results Among the 10,314 patients alert and without delirium in an intensive care unit over two-day periods that included three successive 12 PMs, 3,826 (37%) maintained this status for at least two successive 12 PMs. Six patient characteristics (e.g., hemodynamic infusion or ventilatory support) had value in predicting those 37% of patients. However, logistic regression and classification models each predicted a few (≈0.2%) patients with >90% probability of maintaining these criteria. Forecasts were inaccurate for nearly all patients remaining alert and without delirium in the intensive care unit (≈37%) because the models predicted no patient alert, without delirium, and in the intensive care unit for two days would remain so for at least four days. That ≈63% accuracy was improved upon by random forest machine learning, but only with ≈3% improvement. Conclusion Although many intensive care unit patients remain alert and without delirium for several consecutive days, each patient has a high daily probability of intensive care unit discharge or deterioration in medical condition. Therefore, the results of our prediction modeling show that care models for the assessment and treatment of patients with intensive care unit-associated dignity-related distress should not rely solely on the intensive care unit team but instead should be taken from the perspective of the entire hospitalization.
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Affiliation(s)
| | | | - Richard H Epstein
- Anesthesiology, University of Miami Miller School of Medicine, Miami, USA
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Nouri A, Esmaeili R, Ashk Torab T. Development and Psychometric Evaluation of the Elderly Dignity Questionnaire. J Caring Sci 2022; 11:148-153. [PMID: 36247040 PMCID: PMC9526795 DOI: 10.34172/jcs.2022.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/16/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Respect for dignity is the core of nursing. Dignity assessment improves nurses’ understanding of the level of people’s need for it. Yet, there is no valid and reliable culturally-appropriate instrument for dignity assessment among elderly people in Iran. This study aimed to develop and evaluate the psychometric properties of the Elderly Dignity Questionnaire (EDQ). Methods: The methodological study, EDQ items were generated based on the results of a qualitative study with conventional content analysis approach into dignity and the existing literature. For qualitative and quantitative face and content validity assessments, ten experts rated item then, item impact score and content validity ratio and index were calculated. Construct validity of EDQ was assessed via the exploratory factor analysis and using the data collected from 200 elderly people. Criterion validity was tested using the Rosenberg’s Self-Esteem Scale. Reliability testing was performed via the internal consistency and the test-retest stability assessments and data was collected from twenty elderly. Data were analyzed using SPSS software version 13. Results: Factor analysis loaded the forty items on six factors. factor six was combined with factor five due to its limited number of items. The five factors were labeled as roles and responsibilities (twelve items), familial and social relationships (seven items), self-dignity (ten items), authorization (four items), independence, and integrity (seven items). The Cronbach’s alpha and the intraclass correlation coefficient of EDQ were 0.91 and 0.86, respectively. Conclusion: This study confirms EDQ’s validity and reliability. Thus, this questionnaire can be used for dignity in the elderly.
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Affiliation(s)
- Azadeh Nouri
- Department of Medical Surgical Nursing, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roghayeh Esmaeili
- Department of Medical Surgical Nursing, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Ashk Torab
- Department of Medical Surgical Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Chua KZY, Quah ELY, Lim YX, Goh CK, Lim J, Wan DWJ, Ong SM, Chong CS, Yeo KZG, Goh LSH, See RM, Lee ASI, Ong YT, Chiam M, Ong EK, Zhou JX, Lim C, Ong SYK, Krishna L. A systematic scoping review on patients' perceptions of dignity. Palliat Care 2022; 21:118. [PMID: 35787278 PMCID: PMC9251939 DOI: 10.1186/s12904-022-01004-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background A socioculturally appropriate appreciation of dignity is pivotal to the effective provision of care for dying patients. Yet concepts of dignity remain poorly defined. To address this gap in understanding and enhance dignity conserving end-of-life care, a review of current concepts of dignity is proposed. Methods To address its primary research question “How do patients conceive the concept of dignity at the end of life?”, this review appraises regnant concepts and influences of dignity, and evaluates current dignity conserving practices. To enhance accountability, transparency and reproducibility, this review employs the Ring Theory of Personhood (RToP) as its theoretical lens to guide a Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) of patient perspectives of dignity. Three independent teams of reviewers independently analysed included articles from a structured search of PubMed, Embase, PsycINFO, Scopus, CINAHL and Cochrane Databases using thematic and content analyses. The themes and categories identified were compared and combined using the Funnelling Process to create domains that guide the discussion that follows. Results Seventy-eight thousand five hundred seventy-five abstracts were identified, 645 articles were reviewed, and 127 articles were included. The three domains identified were definitions of dignity, influences upon perceptions of dignity, and dignity conserving care. Conclusions This SSR in SEBA affirms the notion that dignity is intimately entwined with self-concepts of personhood and that effective dignity conserving measures at the end of life must be guided by the patient’s concept of dignity. This SSR in SEBA posits that such personalised culturally sensitive, and timely support of patients, their family and loved ones may be possible through the early and longitudinal application of a RToP based tool. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01004-4.
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Affiliation(s)
- Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Yun Xue Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Chloe Keyi Goh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Jieyu Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Darius Wei Jun Wan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Simone Meiqi Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Chi Sum Chong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Kennan Zhi Guang Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Laura Shih Hui Goh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Ray Meng See
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Min Chiam
- Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Jamie Xuelian Zhou
- Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Simon Yew Kuang Ong
- Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.,Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Lalit Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore. .,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore. .,Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore. .,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore. .,Academic Palliative Care Unit, United Kingdom Cancer Research Centre, University of Liverpool, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK. .,Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore. .,The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Moradoghli F, Darvishpoor Kakhki A, Esmaeili R. The association between frailty and dignity in community-dwelling older people. BMC Geriatr 2022; 22:344. [PMID: 35440071 PMCID: PMC9019952 DOI: 10.1186/s12877-022-03056-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The population of people aged 60 and older is rapidly increasing in developing countries such as Iran due to declining birth rates and increased life expectancy. Old age is associated with increased risk for frailty and reduced dignity. Frailty is a clinical syndrome characterized by depletion of physical reserves and multiple system disorders, reducing the individual's ability to cope with stressful events. Dignity is an inherent characteristic of human beings and respecting dignity is an ethical principle. This study investigated the association of frailty with dignity among older people in Tehran, Iran. METHODS This correlational study was conducted on 200 individuals aged 60 years and older. Data collection relied on the Demographic Questionnaire, Frailty Index for Elders (FIFE) and the Patient Dignity Inventory (PDI). Data were analyzed with SPSS 25. RESULTS The mean age of the participants was 68 ± 5.05 years; 62% of the participants were at risk for frailty, and 69% had few dignity-related problems. The multiple regression results showed that frailty was significantly associated with dignity (ß = 0.571, p < 0.001). The association was significant across all the dimensions of dignity measured by the PDI. The highest predictors of frailty included dependency (ß = 0.584, p < 0.001), followed by existential distress (ß = 0.560, p < 0.001), symptom distress (ß = 0.400, p = 0.400), social support (ß = 0.391, p < 0.001), and peace of mind (ß = 0.338, p < 0.001) in dignity. CONCLUSIONS The results show that higher levels of frailty in older people are associated with decreases in their dignity, and frailty was the leading predictor of dignity. Providers should develop programs to prevent and reduce frailty in those at risk and to enhance the dignity of the already frail.
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Affiliation(s)
- Fereshteh Moradoghli
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Darvishpoor Kakhki
- Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Opposite to Rajaee Heart Hospital, Vali-Asr Avenue, Cross of Vali-Asr and Hashemi Rafsanjani Highway, 1996835119, Tehran, Iran.
| | - Roghayeh Esmaeili
- Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Opposite to Rajaee Heart Hospital, Vali-Asr Avenue, Cross of Vali-Asr and Hashemi Rafsanjani Highway, 1996835119, Tehran, Iran
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Bovero A, Tosi C, Botto R, Pidinchedda A, Gottardo F, Asta G, Torta R. A Qualitative Study to Explore Healthcare Providers' Perspectives on End-of-Life Patients' Dignity. How Can Dignity Be Defined, and Which Strategies Exist to Maintain Dignity? JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:280-287. [PMID: 32588351 DOI: 10.1007/s13187-020-01808-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dignity is a core topic within palliative care, and thus, it is important to get a detailed assessment of healthcare providers' (HCPs) perspectives on this subject. This study aimed to explore various HCPs' perspectives on end-of-life patients' dignity by collecting different testimonies about what dignity entails and which strategies HCPs use to maintain patients' dignity. A sample of 104 participants was interviewed using two open questions to collect qualitative data. Content analysis was performed to identify the central themes among answers. Regarding the first question ("What comes to your mind when I say "Dignity" in relation to your patients?"), nine themes emerged. The majority sampled stated that dignity means respecting the patient by considering him/her as a person in his/her entirety. Two other themes frequently emerged: "Respect the patient's will/wishes/needs" and "Self-determination/Self-expression." Concerning the second question ("Which strategies do you use to maintain patients' dignity?"), seven themes emerged. The "Caring skills" theme was most frequently identified, followed by "Empathic skills" and "Professional strategies." This study has enabled a better understanding of HCPs' perspectives on end-of-life patients' dignity. Through the interviews, HCPs were given an opportunity to reflect on dignity, possibly helping them improve their understanding of their patients' conditions and promote higher quality of care.
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Affiliation(s)
- Andrea Bovero
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, "Città della Salute e della Scienza" Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy.
| | - Chiara Tosi
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, "Città della Salute e della Scienza" Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Rossana Botto
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, "Città della Salute e della Scienza" Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Alexa Pidinchedda
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, "Città della Salute e della Scienza" Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Francesco Gottardo
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, "Città della Salute e della Scienza" Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Giacomo Asta
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, "Città della Salute e della Scienza" Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Riccardo Torta
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, "Città della Salute e della Scienza" Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy
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Huang Y, Zhou Y, Wong TKS, Luo D, Zhang G, Chen J, Smith GD. Inpatient Dignity Scale: Mandarin translation and psychometric characteristics evaluation. Nurs Open 2021; 9:500-512. [PMID: 34612614 PMCID: PMC8685866 DOI: 10.1002/nop2.1088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/30/2021] [Accepted: 09/08/2021] [Indexed: 11/12/2022] Open
Abstract
Aim The aim of this paper was to translate the English version of the Inpatient Dignity Scale into Mandarin and to test the psychometric properties of the Mandarin version of the Inpatient Dignity Scale. Design This research is a cross‐sectional survey, using convenience sampling. Methods The English version of the Inpatient Dignity Scale was translated into Mandarin Chinese. From June–August 2020, 736 inpatients from 50 tertiary hospitals in Guangzhou were recruited to assess the psychometric attributes of the Inpatient Dignity Scale. Results The Mandarin version of the Inpatient Dignity Scale consists of expectation and satisfaction subscales. It differs from the English language version, as the expectation subscale includes three dimensions and the satisfaction subscale includes two dimensions. The total Cronbach alpha coefficient of the expectation subscale and the satisfaction subscale were .820 and .965, respectively, and the split‐half reliability of the expectation subscale and the satisfaction subscale were 0.740 and 0.928, respectively, indicating good internal consistency and effectiveness. Known‐groups validity was established, as 70% of the hypotheses were supported.
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Affiliation(s)
- Yao Huang
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Ying Zhou
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | | | - Dongyi Luo
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Gangna Zhang
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Jiani Chen
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Graeme D Smith
- School of Health Sciences, Caritas Institute of Higher Education, Hong Kong SAR, China
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9
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Oh SN, Yun YH, Keam B, Kim YS, Koh SJ, Kim YJ, Kang JH, Lee K, Hwang IC, Oh HS, Song EK, Shim JY. Korean Version of the Patient Dignity Inventory: Translation and Validation in Patients With Advanced Cancer. J Pain Symptom Manage 2021; 62:416-424.e2. [PMID: 33484796 DOI: 10.1016/j.jpainsymman.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/13/2020] [Accepted: 01/10/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT The goal of palliative care is to maximize the quality of life and thus maintain the dignity of patients facing problems associated with a life-threatening illness. The Patient Dignity Inventory (PDI) is an instrument used to measure various sources of distress that can impact patients' sense of dignity at the end of life. OBJECTIVES We aimed to obtain a Korean translation of the PDI (PDI-K) and evaluate its psychometric properties in patients with advanced cancer. METHODS Translation and cultural adaptation of the PDI were performed to obtain the Korean version. In a sample of 131 inpatients and outpatients with advanced cancer, psychometric properties, including factor structure, internal consistency, and concurrent validity, were examined. Concurrent validity was evaluated using the Edmonton Symptom Assessment System, the Hospital Anxiety and Depression Scale, and the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being. RESULTS Cronbach's α for the PDI-K was 0.96. Four factors were identified by exploratory factor analysis, accounting for 68.7% of the overall variance: Dependency and Physical Symptoms, Psychological Distress, Existential Distress, and SocialSupport. Concurrent validity was confirmed by significant correlations between PDI-K and Edmonton Symptom Assessment System (r = 0.40 to 0.59, P < 0.001), Hospital Anxiety and Depression Scale (r = 0.78 to 0.81, P < 0.001), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (r = -0.32 to -0.57, P < 0.001). CONCLUSION Our findings indicate that the PDI-K is a valid and reliable instrument to measure dignity-related distress in patients with advanced cancer. This tool provides a four-factor Korean language alternative to the PDI.
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Affiliation(s)
- Si Nae Oh
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Medicine, Yonsei University Graduate School, Seoul, Korea; Department of Hospice and Palliative Service, National Cancer Center, Goyang, Korea
| | - Young Ho Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea; Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Bhumsuk Keam
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Sung Kim
- Department of Family Medicine, National Health Insurance Ilsan Hospital, Goyang, Republic of Korea
| | - Su-Jin Koh
- Division of Hematology and Oncology, Department of International Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jung Hun Kang
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Kangkook Lee
- Division of Hematology-Oncology, Department of Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - In Cheol Hwang
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Ho-Suk Oh
- Department of Internal Medicine, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Eun-Kee Song
- Division of Hematology/Oncology, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jae Yong Shim
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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10
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Dignity-conserving palliative care in a diverse population: A qualitative study of physicians' perspective. Palliat Support Care 2021; 20:196-202. [PMID: 33952366 DOI: 10.1017/s147895152100050x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Preserving personal dignity is an important aim of palliative care. Little is known about how physicians perceive and preserve dignity of patients from non-western migration backgrounds. Insight in this is important given the increased demand for culturally sensitive palliative care. AIM To gain insight in how Dutch physicians perceive and preserve dignity in the last phase of life for patients from non-western migration backgrounds. DESIGN Qualitative thematic analysis of semi-structured interviews. PARTICIPANTS Fifteen physicians experienced in palliative care. RESULTS Physicians experienced dilemmas in preserving dignity of non-western patients in three situations: (a) relief of suffering in the terminal phase, (b) termination of interventions and treatment, and (c) disclosure of diagnosis. Physicians wanted to grant the needs of patients in the last phase of their lives, which was central to physicians' view on dignity, but dilemmas arose when this conflicted with physicians' other personal and professional values. To make the dilemmas manageable, physicians assessed whether needs of patients were authentic, but due to linguistic, cultural, and communication barriers, this was difficult with non-western patients. To find a way out of the dilemmas, physicians had three strategies: accept and go along with patient's wishes, convince or overrule the patient or family, or seek solutions that were acceptable for all. CONCLUSIONS Physicians encounter dilemmas providing palliative care for people from non-western backgrounds. Future physicians can be trained in connective strategies and seeking middle grounds to optimally preserve patients' dignity while being in concordance with their personal and professional values.
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11
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de Voogd X, Willems DL, Onwuteaka-Philipsen B, Torensma M, Suurmond JL. Health care staff's strategies to preserve dignity of migrant patients in the palliative phase and their families. A qualitative study. J Adv Nurs 2021; 77:2819-2830. [PMID: 33755223 DOI: 10.1111/jan.14829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/13/2021] [Accepted: 03/05/2021] [Indexed: 11/28/2022]
Abstract
AIMS To determine registered nurses' and care assistants' difficulties and strategies for preserving dignity of migrant patients in the last phase of life and their families. BACKGROUND Preserving dignity of patients in a palliative phase entails paying attention to the uniqueness of patients. Migrant patients often have particular needs and wishes that care staff find difficult to address, or meet, and hence the patient's dignity might be at stake. METHODS We performed five focus group discussions with care staff and one with key figures with diverse ethnic backgrounds in the Netherlands (2018-2020). Thematic analysis was used. RESULTS Care staff creatively safeguarded the patient's dignity in daily care by attending to personal needs concerning intimate body care and providing non-verbal attention. Care staff had difficulties to preserve dignity, when the patient's family engaged themselves in the patient's choices or requests. According to care staff, the interference of family impeded the patient's quality of life or threatened the patient's dignity in the last days, or family member's choices (seemingly) prevailed over the patient's wishes. Care staff safeguarded dignity by catering to cultural or religious practices at the end of life and employing cultural knowledge during decision making. Key figures emphasized to make decisions with patient and family together and to listen more carefully to what patients mean. Bypassing family was experienced as harmful, and repetitively informing family, about, for example, the patient's disease or procedures in the nursing home, was experienced as ineffective. CONCLUSION To preserve the patient's dignity, attention is needed for relational aspects of dignity and needs of family, next to patients' individual needs. IMPACT Care staff should be supported to employ strategies to engage family of migrant patients, by, for example, acknowledging families' values, such as giving good care to the patient and the importance of religious practices for dignity.
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Affiliation(s)
- Xanthe de Voogd
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Dick L Willems
- Amsterdam UMC, Department of Ethics, Law and Humanities, Amsterdam UMC Expertise Center for Palliative Care and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Bregje Onwuteaka-Philipsen
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam UMC Expertise Center for Palliative Care and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marieke Torensma
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Jeanine L Suurmond
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
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12
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de Voogd X, Oosterveld-Vlug MG, Torensma M, Onwuteaka-Philipsen BD, Willems DL, Suurmond JL. A dignified last phase of life for patients with a migration background: A qualitative study. Palliat Med 2020; 34:1385-1392. [PMID: 32912088 PMCID: PMC7543003 DOI: 10.1177/0269216320948708] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preserving personal dignity is an important part of palliative care. Generally, autonomy, independency and not being a burden to others are emphasised for preserving dignity. Dignity has not been studied yet from the perspective of the growing group of patients with a migration background living in Western countries. AIM To gain insight into (1) what patients - and their relatives - with a Turkish, Moroccan or Surinamese background, living in the Netherlands, in their last phase of life find important aspects of dignity, and (2) how care professionals can preserve and strengthen the dignity of these patients. DESIGN Qualitative thematic analysis of semi-structured interviews. PARTICIPANTS A total of 23 patients and 21 relatives with a Turkish, Moroccan or Surinamese background were interviewed. RESULTS For respondents dignity encompassed surrender to God's or Allah's will and meaningful relationships with others, rather than preserving autonomy. Surrender to God or Allah meant accepting the illness, the situation and performing religious practice. A meaningful relationship meant being assisted or cared for by family members and maintaining a social role. Professionals could preserve dignity by showing respect and attention; guaranteeing physical integrity, hygiene and self-direction; and indirect communication about diagnoses and prognoses. CONCLUSIONS Religion and appropriate involvement of family members are important aspects of dignity in the last phase of life, in addition to autonomy and independency. Care professionals need to take these factors into account in order to provide person-centred care.
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Affiliation(s)
- X de Voogd
- Department of Public Health, Amsterdam UMC and Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - M G Oosterveld-Vlug
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - M Torensma
- Department of Public Health, Amsterdam UMC and Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - B D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC Expertise center for Palliative Care and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - D L Willems
- Department of General Practice, Amsterdam UMC Expertise center for Palliative Care and Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - J L Suurmond
- Department of Public Health, Amsterdam UMC and Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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13
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Hubbard RE, Bak M, Watts J, Shum D, Lynch A, Peel NM. Enhancing Dignity for Older Inpatients: The Photograph-Next-to-the-Bed Study. Clin Gerontol 2018; 41:468-473. [PMID: 29240531 DOI: 10.1080/07317115.2017.1398796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Older inpatients compromised by illness and cognitive decline may be stripped of physical and cultural identifiers, making them vulnerable to erosion of dignity. This study explored the experiences of patients, carers and clinical staff in response to a simple intervention that could enhance the dignity of care for older inpatients. METHODS All patients in a rehabilitation ward were encouraged to have a photograph of themselves next to their bed. Of those who participated, focus groups were recruited for patients, family members and staff to explore their reflections. Discussions were transcribed and analyzed using a deductive approach to capture evolving themes relating to patient care. RESULTS All groups reported that the photograph provided "connection" and means of communication between patients and staff. Staff spoke positively of gaining additional insights into patients' lives. Benefits included enrichment of inter-personal relationships between patients and staff, between staff and families and between patients themselves. CONCLUSIONS A bedside photograph improved connections between staff, patients and carers, promoting patients' dignity of identity. CLINICAL IMPLICATIONS Displaying a bedside photograph as a visual reminder of the patient in the pre‑illness state helps preservation of an individual's dignity, a core concept in patient‑centered care.
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Affiliation(s)
- Ruth E Hubbard
- a Centre for Research in Geriatric Medicine , The University of Queensland , Brisbane , Australia
| | - Melissa Bak
- a Centre for Research in Geriatric Medicine , The University of Queensland , Brisbane , Australia
| | - Jacqueline Watts
- a Centre for Research in Geriatric Medicine , The University of Queensland , Brisbane , Australia
| | - David Shum
- a Centre for Research in Geriatric Medicine , The University of Queensland , Brisbane , Australia
| | - Angelica Lynch
- a Centre for Research in Geriatric Medicine , The University of Queensland , Brisbane , Australia
| | - Nancye M Peel
- a Centre for Research in Geriatric Medicine , The University of Queensland , Brisbane , Australia
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14
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Kisvetrová H, Školoudík D, Danielová L, Langová K, Váverková R, Bretšnajdrová M, Yamada Y. Czech Version of the Patient Dignity Inventory: Translation and Validation in Incurable Patients. J Pain Symptom Manage 2018; 55:444-450. [PMID: 29128432 DOI: 10.1016/j.jpainsymman.2017.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT The Patient Dignity Inventory (PDI) is a valid, reliable screening tool to assess a range of issues that have been reported to affect the sense of dignity in patients with life-limiting conditions. OBJECTIVES We investigated the item characteristics, factor structure, and reliability of the Czech version of the PDI (PDI-CZ) among cancer and noncancer patients. METHODS The PDI was translated into the Czech language following state-of-the-art criteria (a five-stage proceeding method for the translation). Two hundred thirty-nine participants completed the study (136 cancer and 103 noncancer patients). Internal consistency, test-retest reliability, and factor analysis were used for validation of the PDI-CZ. RESULTS A Czech version of the PDI was obtained. The Cronbach's α for PDI-CZ was 0.92. Item 22 (not feeling supported by my health care providers) did not correlate with any other items, and it was skipped for factor analysis processing for this reason. Factor analysis resulted in a four-factor solution, accounting for 56.34% of the overall variance (factor loadings range, 0.37-0.92). The factor labels were as follows: loss of purpose of life; loss of autonomy; loss of confidence; and loss of social support (internal consistencies range, Cronbach's α 0.58-0.90). Test-retest reliability was assessed with 25 patients after two weeks. The resulting range of the Gwet's coefficient, AC1, was between 0.58 and 1.00. CONCLUSION The results from the study support the reliability of the PDI-CZ and its future use in patients with incurable cancer and noncancer patients.
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Affiliation(s)
- Helena Kisvetrová
- Centre for Research and Science, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic.
| | - David Školoudík
- Centre for Research and Science, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Libuše Danielová
- Centre for Research and Science, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic; Department of Geriatrics, University Hospital Olomouc, Olomouc, Czech Republic
| | - Kateřina Langová
- Centre for Research and Science, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Renáta Váverková
- Centre for Research and Science, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | | | - Yukari Yamada
- Centre for Research and Science, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic; Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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15
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Di Lorenzo R, Ferri P, Biffarella C, Cabri G, Carretti E, Pollutri G, Spattini L, Del Giovane C, Chochinov HM. Psychometric properties of the Patient Dignity Inventory in an acute psychiatric ward: an extension study of the preliminary validation. Neuropsychiatr Dis Treat 2018; 14:903-913. [PMID: 29636615 PMCID: PMC5880412 DOI: 10.2147/ndt.s153902] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the last decades, dignity has been an emerging issue in mental health since its ethical and therapeutic implications became known. This study is an extension of the preliminary validation of the Patient Dignity Inventory (PDI) in a psychiatric setting, originally designed for assessing perceived dignity in terminal cancer patients. METHODS From October 21, 2015 to December 31, 2016, we administered the Italian PDI to all patients hospitalized in an acute psychiatric ward, who provided their consent and completed it at discharge (n=165). We performed Cronbach's alpha coefficient and principal factor analysis. We administered other scales concomitantly to analyze the concurrent validity of PDI. We applied stepwise multiple linear regression to identify the patients' demographic and clinical variables related to the PDI score. RESULTS Our response rate was 93%, with excellent internal consistency (Cronbach's alpha coefficient=0.94). The factorial analysis showed three factors with eigenvalue >1, which explained >80% of total variance: 1) "loss of self-identity and anxiety for the future", 2) "concerns for social dignity and spiritual life", and 3) "loss of personal autonomy". The PDI and the three factor scores were positively and significantly correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Among patients' variables, "suicide risk" and "insufficient social and economic condition" were positively and significantly correlated with the PDI total score. CONCLUSION The PDI can be a reliable tool to assess patients' dignity perception in a psychiatric setting, which suggests that both social and clinical severe conditions are closely related to dignity loss.
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Affiliation(s)
- Rosaria Di Lorenzo
- Psychiatric Intensive Treatment Facility, Mental Health Department, Azienda USL, Modena, Italy
| | - Paola Ferri
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlotta Biffarella
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulio Cabri
- Service of Psychiatric Diagnosis and Treatment, Mental Health Department, Azienda USL, Modena, Italy
| | | | - Gabriella Pollutri
- School of Specialization in Pscyhiatry, Faculty of Medicine, University of Modena and Reggio Emilia, Italy
| | - Ludovica Spattini
- School of Specialization in Pscyhiatry, Faculty of Medicine, University of Modena and Reggio Emilia, Italy
| | - Cinzia Del Giovane
- Faculty of Medicine, Institute of Primary Care (BIHAM), University of Bern, Bern, Switzerland
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Barrington DJ, Sridharan S, Shields KF, Saunders SG, Souter RT, Bartram J. Sanitation marketing: A systematic review and theoretical critique using the capability approach. Soc Sci Med 2017; 194:128-134. [PMID: 29100137 DOI: 10.1016/j.socscimed.2017.10.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/03/2017] [Accepted: 10/17/2017] [Indexed: 11/17/2022]
Abstract
Sanitation is a human right that benefits health. As such, technical and behavioural interventions are widely implemented to increase the number of people using sanitation facilities. These include sanitation marketing interventions (SMIs), in which external support agencies (ESAs) use a hybrid of commercial and social marketing tools to increase supply of, and demand for, sanitation products and services. However, there is little critical discourse on SMIs, or independent rigorous analysis on whether they increase or reduce well-being. Most available information is from ESAs about their own SMI implementation. We systematically reviewed the grey and peer-reviewed literature on sanitation marketing, including qualitatively analysing and calculating descriptive statistics for the parameters measured, or intended to be measured, in publications reporting on 33 SMIs. Guided by the capability approach to development we identified that publications for most SMIs (n = 31, 94%) reported on commodities, whilst fewer reported on parameters related to impacts on well-being (i.e., functionings, n = 22, 67%, and capabilities, n = 20, 61%). When evaluating future SMIs, it may be useful to develop a list of contextualised well-being indicators for the particular SMI's location, taking into account local cultural norms, with this list ideally co-produced with local stakeholders. We identified two common practices in SMIs that can reduce well-being and widen well-being inequalities; namely, the promotion of conspicuous consumption and assaults on dignity, and we discuss the mechanisms by which such impacts occur. We recommend that ESAs understand sanitation marketing's potential to reduce well-being and design SMIs to minimize such detrimental impacts. Throughout the implementation phase ESAs should continuously monitor for well-being impacts and adapt practices to optimise well-being outcomes for all involved.
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Affiliation(s)
- D J Barrington
- Department of Marketing, Monash University, Australia; International WaterCentre, Australia; School of Civil Engineering, University of Leeds, United Kingdom.
| | - S Sridharan
- Department of Marketing, Monash University, Australia
| | - K F Shields
- The Water Institute, The University of North Carolina at Chapel Hill, USA
| | - S G Saunders
- Department of Marketing, Monash University, Australia
| | | | - J Bartram
- The Water Institute, The University of North Carolina at Chapel Hill, USA
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17
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Zirak M, Ghafourifard M, Aliafsari Mamaghani E. Patients' Dignity and Its Relationship with Contextual Variables: A Cross-Sectional Study. J Caring Sci 2017; 6:49-51. [PMID: 28299297 PMCID: PMC5348662 DOI: 10.15171/jcs.2017.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 08/07/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction: Dignity is considered as fundamental human
needs and recognized as one of the central concepts in nursing science. The aim of this
study was to assess the extent to which patients’ dignity is respected and to evalutae its
relationship with contextual variables. Methods: This cross-sectional study was conducted on 256
hospitalized patients in the two teaching hospitals affiliated to Zanjan University of
medical sciences, Iran. Data were collected by a questionnaire consist of two sections:
(a) demographic characteristics, and (b) patient dignity including 32 questions. Data were
analyzed by SPSS (ver.13) software using independent t-test, ANOVA and Pearson
correlation. Results: The result showed that the mean (standard
deviation) of total score of patient’s dignity was 108.17 (25.28). According to the
result, the majority of the respondents (76.2%) were not aware of patient’s rights. There
was a significant difference in mean scores of total dignity between single and married
persons, living in city or village, and hospitalization in Moosavi and Valiasr hospital. Conclusion: Health care systems should take the provision
of the patients' dignity into account through using a comprehensive educational program
for informing of patient, family members, and health professionals about patients’
dignity.
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Affiliation(s)
- Mohammad Zirak
- Department of Medical Surgical Nursing, Student Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mansour Ghafourifard
- Department of Medical Surgical Nursing, Student Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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18
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Grassi L, Costantini A, Caruso R, Brunetti S, Marchetti P, Sabato S, Nanni MG. Dignity and Psychosocial-Related Variables in Advanced and Nonadvanced Cancer Patients by Using the Patient Dignity Inventory-Italian Version. J Pain Symptom Manage 2017; 53:279-287. [PMID: 27810569 DOI: 10.1016/j.jpainsymman.2016.09.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/04/2016] [Accepted: 09/07/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT The Patient Dignity Inventory (PDI) is a valid and reliable instrument to measure dignity, as a state of physical, mental, social, and spiritual well-being in palliative care patients and an essential dimension for a comprehensive patient-centered approach. OBJECTIVES We examined the factor structure and correlation of the Italian version of the PDI (PDI-IT) with psychosocial variables among advanced and nonadvanced cancer outpatients in two Italian centers. METHODS In a sample of 194 patients, principal component analysis, reliability analysis (Cronbach's coefficient alpha), and correlation analysis of the PDI-IT were performed. Concurrent validity was evaluated with respect to the Italian versions of Patient Health Questionnaire-9 (PHQ-9), as a measure of depression, the Mini-Mental Adjustment to Cancer-Hopelessness Scale, as a measure of dysfunctional coping, and the Demoralization Scale (DS-IT), as a measure of demoralization. RESULTS Three factors were extracted by exploratory factor analysis, which accounted for 64.38% of the variance, namely existential distress (Cronbach's α = 0.95), psychological distress (Cronbach's α = 0.88), and physical distress (Cronbach's α = 0.81), with a Cronbach's α coefficient for the PDI-IT total score of 0.96. PDI-IT factors were significantly intercorrelated and shared between 42% and 53% of the variance. Higher scores on all the PDI-IT factors and PDI-IT total were found among patients who were clinically depressed (PHQ-9) and among those who were demoralized on the DS-IT. Significant correlations were also found between all PDI-IT and the DS-IT, PHQ-9, and the Mini-Mental Adjustment to Cancer-Hopelessness Scale. CONCLUSIONS The study confirmed that the PDI-IT is a valid instrument to be applied in oncology and measuring three factors, namely existential, psychological, and physical distress, as core dimensions of dignity, to be monitored and treated in clinical settings.
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Affiliation(s)
- Luigi Grassi
- Department of Biomedical and Specialty Surgical Science, Institute of Psychiatry, University of Ferrara, Ferrara, Italy; University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Disorders, Health Authorities and University S. Anna Hospital, Ferrara, Italy.
| | - Anna Costantini
- Psychoncology Unit, Sant'Andrea Hospital La Sapienza, University of Rome, Rome, Italy
| | - Rosangela Caruso
- Department of Biomedical and Specialty Surgical Science, Institute of Psychiatry, University of Ferrara, Ferrara, Italy; University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Disorders, Health Authorities and University S. Anna Hospital, Ferrara, Italy
| | - Serena Brunetti
- Psychoncology Unit, Sant'Andrea Hospital La Sapienza, University of Rome, Rome, Italy
| | - Paolo Marchetti
- Medical Oncology, Sapienza University of Rome and IDI - IRCCS, Rome, Italy
| | - Silvana Sabato
- Department of Biomedical and Specialty Surgical Science, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Nanni
- Department of Biomedical and Specialty Surgical Science, Institute of Psychiatry, University of Ferrara, Ferrara, Italy; University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Disorders, Health Authorities and University S. Anna Hospital, Ferrara, Italy
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Estudio comparativo de la eficacia del counselling y de la terapia de la dignidad en pacientes paliativos. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.medipa.2014.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Di Lorenzo R, Cabri G, Carretti E, Galli G, Giambalvo N, Rioli G, Saraceni S, Spiga G, Del Giovane C, Ferri P. A preliminary study of Patient Dignity Inventory validation among patients hospitalized in an acute psychiatric ward. Neuropsychiatr Dis Treat 2017; 13:177-190. [PMID: 28182110 PMCID: PMC5279815 DOI: 10.2147/ndt.s122423] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the perception of dignity among patients hospitalized in a psychiatric setting using the Patient Dignity Inventory (PDI), which had been first validated in oncologic field among terminally ill patients. PATIENTS AND METHODS After having modified two items, we administered the Italian version of PDI to all patients hospitalized in a public psychiatric ward (Service of Psychiatric Diagnosis and Treatment of a northern Italian town), who provided their consent and completed it at discharge, from October 21, 2015 to May 31, 2016. We excluded minors and patients with moderate/severe dementia, with poor knowledge of Italian language, who completed PDI in previous hospitalizations and/or were hospitalized for <72 hours. We collected the demographic and clinical variables of our sample (n=135). We statistically analyzed PDI scores, performing Cronbach's alpha coefficient and principal factor analysis, followed by orthogonal and oblique rotation. We concomitantly administered to our sample other scales (Hamilton Rating Scales for Depression and Anxiety, Global Assessment of Functioning and Health of the Nation Outcome Scales) to analyze the PDI concurrent validity. RESULTS With a response rate of 93%, we obtained a mean PDI score of 48.27 (±19.59 SD) with excellent internal consistency (Cronbach's alpha coefficient =0.93). The factorial analysis showed the following three factors with eigenvalue >1 (Kaiser's criterion), which explained >80% of total variance with good internal consistency: 1) "Loss of self-identity and social role", 2) "Anxiety and uncertainty for future" and 3) "Loss of personal autonomy". The PDI and the three-factor scores were statistically significantly positively correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. CONCLUSION Our preliminary research suggests that PDI can be a reliable tool to assess patients' dignity perception in a psychiatric setting, until now little investigated, helping professionals to improve quality of care and patients to accept treatments.
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Affiliation(s)
- Rosaria Di Lorenzo
- Mental Health Department, Service of Psychiatric Diagnosis and Treatment in NOCSAE General Hospital
| | - Giulio Cabri
- Private Accredited Psychiatric Hospital villa Igea, Modena
| | | | - Giacomo Galli
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia
| | - Nina Giambalvo
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia
| | - Giulia Rioli
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia
| | - Serena Saraceni
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia
| | - Giulia Spiga
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia
| | - Cinzia Del Giovane
- PhD Statistics Unit, Department of Diagnostic, Clinical and Public Health Medicine
| | - Paola Ferri
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Shahhoseini S, Borhani F, Shoorideh FA, Kavousi A, Bagheri H, Almasi-Hashiani A. Different Sources of Dignity-Related Distress in Women Receiving Chemotherapy for Breast Cancer. Asian Pac J Cancer Prev 2017; 18:2953-2958. [PMID: 29172264 PMCID: PMC5773776 DOI: 10.22034/apjcp.2017.18.11.2953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Identification of different sources of dignity-related distress experienced by people nearing the end of
life may help nurses to provide better care services. This study was conducted to determine sources of dignity-related
distress from the perspective of women with breast cancer undergoing chemotherapy. Materials and Methods: In
this cross sectional study, the participants comprised 207 women with breast cancer undergoing chemotherapy in
chemotherapy clinics in hospitals of Tehran, Iran. The Cronbach’s coefficient alpha for the PDI was 0.76. Validity
of PDI by confirmatory factor analysis shows that the comparative Fit Index of this instrument is 0.96 and so it is
appropriate for application in different setting. Data were analyzed by Stata version 13. Results: Patients were mostly
concerned about the distress caused by disease symptoms (mean; 2.4061, S.D.; 0.96), followed by existential distress
(mean; 1.8784, S.D.; 0.75), peace of mind (mean; 1.871, S.D.; 0.77), dependence (mean; 1.8647, S.D.; 0.98), and
social support (mean; 1.4097, S.D.; 0.99), respectively, in order of highest scores. Conclusion: Considering that the
patients were mostly concerned about the distress caused by disease symptoms, followed by existential distress, peace
of mind, dependency, and social support, it seems necessary to take further measures toward addressing these issues.
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Affiliation(s)
- Somaye Shahhoseini
- Nursing and Midwifery School, Shahid Beheshti University of Medical Science, ACECR, Tehran, Iran
| | - Fariba Borhani
- Medical Ethics and Law Research Center, Medical Surgical Department, Shahid Beheshti University of Medical Science, ACECR, Tehran, Iran,For Correspondence:
| | | | - Amir Kavousi
- School of Health, Safety and Environment Nursing and Midwifery School, Shahid Beheshti University of Medical Science, ACECR, Tehran, Iran
| | - Hossein Bagheri
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Barrington D, Sridharan S, Saunders S, Souter R, Bartram J, Shields K, Meo S, Kearton A, Hughes R. Improving community health through marketing exchanges: A participatory action research study on water, sanitation, and hygiene in three Melanesian countries. Soc Sci Med 2016; 171:84-93. [DOI: 10.1016/j.socscimed.2016.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/26/2016] [Accepted: 11/02/2016] [Indexed: 11/28/2022]
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Rodríguez-Prat A, Monforte-Royo C, Porta-Sales J, Escribano X, Balaguer A. Patient Perspectives of Dignity, Autonomy and Control at the End of Life: Systematic Review and Meta-Ethnography. PLoS One 2016; 11:e0151435. [PMID: 27010323 PMCID: PMC4806874 DOI: 10.1371/journal.pone.0151435] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/28/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Research in the end-of-life context has explored the sense of dignity experienced by patients with advanced disease, examining the factors associated with it. Whereas certain perspectives regard dignity as an intrinsic quality, independent of external factors, in the clinical setting it is generally equated with the person's sense of autonomy and control, and it appears to be related to patients' quality of life. This study aims to explore the relationship between perceived dignity, autonomy and sense of control in patients at the end of life. METHODS We conducted a systematic review and meta-ethnography using reciprocal translation and line-of-argument synthesis. The search strategy used MeSH terms in combination with free-text searching of the Pubmed, Web of Science, CINAHL, PsycINFO and Cochrane databases, from their inception until 2015. This identified 186 articles, after excluding duplicates. The inclusion criterion was primary qualitative studies in which dignity, autonomy and control at the end of life were explored. Studies were evaluated using the CASP guidelines. RESULTS Twenty-one studies recording the experiences of 400 participants were identified. Three themes emerged: a) dignity mediated by the loss of functionality, linked to the loss of control; b) dignity as identity; and c) autonomy as a determining factor of perceived dignity, understood as the desire for control over the dying process and the desire for self-determination. We propose an explanatory model which highlights that those patients with an intrinsic sense of dignity maintained a positive view of themselves in the face of their illness. CONCLUSION This synthesis illustrates how dignity and autonomy are intertwined and can be perceived as a multidimensional concept, one that is close to the notion of personal identity. The ability to regard dignity as an intrinsic quality has a positive impact on patients, and the design of care strategies should take this into account.
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Affiliation(s)
| | - Cristina Monforte-Royo
- Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Josep Porta-Sales
- Palliative Care Service, Institut Català d’Oncologia, Barcelona, Spain
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Xavier Escribano
- Faculty of Humanities, Universitat Internacional de Catalunya. Barcelona. Spain
| | - Albert Balaguer
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Johnston B, Lawton S, McCaw C, Law E, Murray J, Gibb J, Pringle J, Munro G, Rodriguez C. Living well with dementia: enhancing dignity and quality of life, using a novel intervention, Dignity Therapy. Int J Older People Nurs 2015; 11:107-20. [PMID: 26710890 DOI: 10.1111/opn.12103] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
AIMS AND OBJECTIVES To assess the feasibility, acceptability and potential effectiveness of Dignity Therapy to improve the quality of life and reduce psychological and spiritual distress in older people with early stage dementia. BACKGROUND Dementia is a syndrome with several causes that leads to a progressive decline in multiple areas of functioning. The maintenance of dignity and enhancement of quality of life are key elements of care. Meaningful communication may become more difficult with condition progression. Improvements in communication may have positive effects on the person's quality of life. Dignity Therapy is a short psychotherapeutic intervention that uses a trained therapist to take the person with dementia through a guided interview process, producing a 'generativity' document that creates a lasting, written legacy during a time when they are still able to communicate well. DESIGN AND METHOD This was a feasibility mixed method study. Dignity Therapy was undertaken with patients diagnosed as having early stage dementia. Data were gathe-red from pre- and post-Dignity Therapy interviews, a focus group, interviews with key stakeholders, and three outcome measures: The Herth Hope Index; The Patient Dignity Inventory; Perceived Quality of Life/Satisfaction with Quality Life Ratings. FINDINGS This study demonstrated that Dignity Therapy is feasible, acceptable and potentially effective for older people with dementia. Three overarching themes emerged: A life in context, A key to connect and Personal legacy. CONCLUSIONS We recommend that this feasibility study forms the basis for further study, advocating the prospective benefits to patients with dementia, families and nursing practice. IMPLICATIONS FOR PRACTICE Dignity Therapy, as a psychosocial intervention, has the potential to improve the quality of life and enhance person centred care for people with dementia.
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Affiliation(s)
- Bridget Johnston
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, The University of Nottingham, Nottingham, UK
| | - Sally Lawton
- NHS Grampian and Robert Gordon University, Aberdeen, UK
| | - Catriona McCaw
- Scottish Dementia Clinical Research Network, Murray Royal Hospital, Perth, UK
| | - Emma Law
- Scottish Dementia Clinical Research Network, Murray Royal Hospital, Perth, UK
| | | | - John Gibb
- Community Mental Health Team, NHS Tayside, Angus, UK
| | - Jan Pringle
- School of Nursing and Midwifery, University of Dundee, Dundee, UK.,University of Nottingham, Nottingham, UK
| | - Gillian Munro
- Wellbeing Centre, NHS Tayside, Royal Victoria Hospital, Dundee, UK
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Affiliation(s)
- Sarah H Kagan
- School of Nursing, University of Pennsylvania, Clarie M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA.
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Sturm BA, Dellert JC. Exploring nurses' personal dignity, global self-esteem and work satisfaction. Nurs Ethics 2015; 23:384-400. [PMID: 25670174 DOI: 10.1177/0969733014567024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study examines nurses' perceptions of dignity in themselves and their work. Nurses commonly assert concern for human dignity as a component of the patients' experience rather than as necessary in the nurses' own lives or in the lives of others in the workplace. This study is exploratory and generates potential relationships for further study and theory generation in nursing. RESEARCH QUESTIONS What is the relationship between the construct nurses' sense of dignity and global self-esteem, work satisfaction, and identified personal traits? PARTICIPANTS AND RESEARCH CONTEXT This cross-sectional correlation study used a stratified random sample of nurses which was obtained from a US University alumni list from 1965 to 2009 (N = 133). ETHICAL CONSIDERATIONS University Institutional Review Board approval was achieved prior to mailing research questionnaire packets to participants. Participation was optional and numerical codes preserved confidentiality. FINDINGS Statistical results indicated a moderately strong association between the nurse's sense of personal dignity and self-esteem (rx = .62, p = .000) with areas of difference clarified and discussed. A positive but moderate association between nurses' personal dignity and nurses' work satisfaction (rx = .37, p = .000) and a similar association between self-esteem and nurses' work satisfaction (rs = .29, p = .001) were found. A statistically significant difference was found (F = 3.49 (df = 4), p = .01) for dignity and categories of spiritual commitment and for nurses' personal dignity when ratings of health status were compared (F = 21.24 (df = 4), p = .000). DISCUSSION Personal sense of dignity is discussed in relation to conceptual understandings of dignity (such as professional dignity) and suggests continued research in multiple cultural contexts. CONCLUSION The relationships measured show that nurses' sense of dignity has commonalities with self-esteem, workplace satisfaction, spiritual commitment, and health status; the meaning of the findings has ramifications for the welfare of nurses internationally.
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Abstract
BACKGROUND Dying with dignity is regarded as a goal of quality end-of-life care. However, the meaning of dying with dignity is ambiguous, and no comprehensive synthesis of the existing literature has been published. AIM To synthesize the meaning of dying with dignity and to identify common aspects of dignity in end-of-life care. DESIGN This is an integrative review article. Methodological strategies specific to the integrative review method proposed by Whittemore and Knafl were followed to conduct data analysis. The matrix method was used to summarize characteristics of included articles. DATA SOURCES Five electronic databases were searched in October 2012, with no date restriction: PubMed, CINAHL, PsycINFO, Academic Search Premier, and Social Sciences Abstracts. Theoretical reports, and both qualitative and quantitative empirical reports, focused on dignity in end-of-life care were included. RESULTS Themes of dying with dignity are as follows: a human right, autonomy and independence, relieved symptom distress, respect, being human and being self, meaningful relationships, dignified treatment and care, existential satisfaction, privacy, and calm environment. Factors influencing dignity include demographic, illness-related, and treatment-/care-related factors, as well as communication. Models of dignity in end-of-life care and instruments to measure dignity were reported. Interventions to support dignity stressed physical, psychological, and spiritual supports not only to dying patients but also to family members. CONCLUSION This review clarified the meaning of dying with dignity and synthesized common aspects of dignity in end-of-life care. Further research is needed to evaluate the meaning of dying with dignity across cultures and to explore individualized dignity-based care.
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Affiliation(s)
- Qiaohong Guo
- College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA
| | - Cynthia S Jacelon
- College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA
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Oosterveld-Vlug MG, Pasman HRW, van Gennip IE, de Vet HCW, Onwuteaka-Philipsen BD. Assessing the validity and intra-observer agreement of the MIDAM-LTC; an instrument measuring factors that influence personal dignity in long-term care facilities. Health Qual Life Outcomes 2014; 12:17. [PMID: 24512296 PMCID: PMC3930004 DOI: 10.1186/1477-7525-12-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 02/06/2014] [Indexed: 12/02/2022] Open
Abstract
Background Patients who are cared for in long-term care facilities are vulnerable to lose personal dignity. An instrument measuring factors that influence dignity can be used to better target dignity-conserving care to an individual patient, but no such instrument is yet available for the long-term care setting. The aim of this study was to create the Measurement Instrument for Dignity AMsterdam - for Long-Term Care facilities (MIDAM-LTC) and to assess its validity and intra-observer agreement. Methods Thirteen items specific for the LTC setting were added to the earlier developed, more general MIDAM. The MIDAM-LTC consisted of 39 symptoms or experiences for which presence as well as influence on dignity were asked, and a single item score for overall personal dignity. Questionnaires containing the MIDAM-LTC were administered face-to-face at two moments (with a 1-week interval) to 95 nursing home residents residing on general medical wards of six nursing homes in the Netherlands. Constructs related to dignity (WHO Well-Being Five Index, quality of life and physical health status) were also measured. Ten residents answered the questions while thinking aloud. Content validity, construct validity and intra-observer agreement were examined. Results Nine of the 39 items barely exerted influence on dignity. Eight of them could be omitted from the MIDAM-LTC, because the thinking aloud method revealed sensible explanations for their small influence on dignity. Residents reported that they missed no important items. Hypotheses to support construct validity, about the strength of correlations between on the one hand personal dignity and on the other hand well-being, quality of life or physical health status, were confirmed. On average, 83% of the scores given for each item’s influence on dignity were practically consistent over 1 week, and more than 80% of the residents gave consistent scores for the single item score for overall dignity. Conclusion The MIDAM-LTC has good content validity, construct validity and intra-observer agreement. By omitting 8 items from the instrument, a good balance between comprehensiveness and feasibility is realised. The MIDAM-LTC allows researchers to examine the concept of dignity more closely in the LTC setting, and can assist caregivers in providing dignity-conserving care.
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Affiliation(s)
- Mariska G Oosterveld-Vlug
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
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Lind JD, Powell-Cope G, Chavez MA, Fraser M, Harrow J. NEGOTIATING DOMAINS OF PATIENT DIGNITY IN VA SPINAL CORD INJURY UNITS: PERSPECTIVES FROM INTERDISCIPLINARY CARE TEAMS AND VETERANS. ANNALS OF ANTHROPOLOGICAL PRACTICE 2013. [DOI: 10.1111/napa.12027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jason D. Lind
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital; Tampa FL
| | - Gail Powell-Cope
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital; Tampa FL
| | - Margeaux A. Chavez
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital; Tampa FL
| | - Marsha Fraser
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital; Tampa FL
| | - Jeffrey Harrow
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital; Tampa FL
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Addington-Hall J, Hunt K, Rowsell A, Heal R, Hansford P, Monroe B, Sykes N. Development and initial validation of a new outcome measure for hospice and palliative care: the St Christopher's Index of Patient Priorities (SKIPP). BMJ Support Palliat Care 2013; 4:175-181. [PMID: 24644169 DOI: 10.1136/bmjspcare-2012-000352] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 06/27/2013] [Accepted: 08/16/2013] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop and conduct a preliminary psychometric analysis of a hospice and palliative care patient-reported outcome measure to detect patients' perceptions of change in quality of life (QoL) and issues of concern, and views of service benefit. METHODS Following pilot testing and cognitive interviewing, St Christopher's Index of Patient Priorities (SKIPP) was administered twice to hospice inpatients and homecare patients. QoL was rated 'now', and retrospectively 'before starting hospice care' or 'at the time of the first interview'. Patients nominated and rated progress with main concerns, rated the difference the service was making, and completed palliative care outcome scale. Patients completed SKIPP again within 24 h to measure test-retest reliability. RESULTS QoL scores 'now' differed significantly from retrospective scores made at same time: QoL increased with hospice care when patients 'looked back' on previous QoL. Four-fifths reported that their first concern had got 'a little'/ 'much' better since initial service contact: this declined subsequently. Four-fifths at both time points said the hospice had made 'a lot of difference' to them. No significant differences were noted between time points on palliative care outcome scale items. Test-retest analyses were prevented by low numbers. CONCLUSIONS SKIPP can detect patients' perception of change in QoL and main concerns, and the difference patients think the service has made to them. Its design with current and retrospective components addresses response shift and means it can be used for quality improvement or clinical purposes with only one administration, an advantage in frail populations. It is therefore a useful addition to hospice and palliative care patient-reported outcome measures.
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Affiliation(s)
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Ali Rowsell
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Albers G, Pasman HRW, Deliens L, de Vet HCW, Onwuteaka-Philipsen BD. Does health status affect perceptions of factors influencing dignity at the end of life? J Pain Symptom Manage 2013; 45:1030-8. [PMID: 23141880 DOI: 10.1016/j.jpainsymman.2012.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 05/15/2012] [Accepted: 06/14/2012] [Indexed: 10/27/2022]
Abstract
CONTEXT More people are surviving into old age, and chronic diseases tend to become more common with age. Ill health and disability can lead to concerns about loss of personal dignity. OBJECTIVES To investigate whether health status affects the perceptions of factors influencing personal dignity at the end of life, and the relationship between those perceptions and sociodemographic characteristics. METHODS A subsample (n=2282) of a large advance directives cohort study was used. Three different health status groups (good, moderate, and poor) were defined based on the Euroqol-5D and a question on whether they had an illness. For each health status group, we calculated the percentage of respondents who indicated the extent to which the items of the Patient Dignity Inventory would influence their dignity as (very) large. Logistic regression analyses were used to investigate the associations between the perceptions of factors influencing personal dignity and sociodemographics. RESULTS The percentage of respondents who indicated the factors as having a (very) large influence on dignity at the end of life were not significantly different for the three health status groups, except for three physical items on symptoms, roles, and routines. Those items were significantly more influential on dignity for people with a poor health status. Gender, old age, having a partner, and having a belief or religion that is important to one's life were associated with an understanding of factors influential to dignity. CONCLUSION Health status seems only to affect the perceptions of physical factors maintaining dignity at the end of life. This might suggest that the understanding of dignity will not substantially change as health status changes and may support starting advance care planning early.
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Affiliation(s)
- Gwenda Albers
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Mah L, Grossman D, Grief C, Rootenberg M. Association between patient dignity and anxiety in geriatric palliative care. Palliat Med 2013; 27:478-9. [PMID: 23630188 DOI: 10.1177/0269216312463111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Linda Mah
- Rotman Research Institute, Baycrest; Department of Psychiatry, Baycrest; Department of Psychiatry, Division of Geriatric Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daphna Grossman
- Department of Family and Community Medicine, Baycrest; Department of Family and Community Medicine, Division of Palliative Care, University of Toronto, Toronto, ON, Canada
| | - Cindy Grief
- Department of Psychiatry, Baycrest; Department of Psychiatry, Division of Geriatric Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mark Rootenberg
- Honours BSc Candidate, York University
- Department of Family and Community Medicine, Baycrest, Toronto, ON, Canada
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Sizoo EM, Taphoorn MJB, Uitdehaag B, Heimans JJ, Deliens L, Reijneveld JC, Pasman HRW. The end-of-life phase of high-grade glioma patients: dying with dignity? Oncologist 2013; 18:198-203. [PMID: 23335620 DOI: 10.1634/theoncologist.2012-0247] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the end-of-life (EOL) phase, high-grade glioma (HGG) patients have a high symptom burden and often lose independence because of physical and cognitive dysfunction. This might affect the patient's personal dignity. We aimed to (a) assess the proportion of HGG patients dying with dignity as perceived by their relatives and (b) identify disease and care factors correlated with dying with dignity in HGG patients. METHODS We approached relatives of a cohort of 155 deceased HGG patients for the study. Participants completed a questionnaire concerning the EOL phase of the patient, covering several subthemes: (a) symptoms and signs, (b) health-related quality of life, (c) decision making, (d) place and quality of EOL care, and (e) dying with dignity. RESULTS Relatives of 81 patients participated and 75% indicated that the patient died with dignity. These patients had fewer communication deficits, experienced fewer transitions between health care settings in the EOL phase, and more frequently died at their preferred place of death. Relatives were more satisfied with the physician providing EOL care and reported that the physician adequately explained treatment options. Multivariate analysis identified satisfaction with the physician, the ability to communicate, and the absence of transitions between settings as most predictive of a dignified death. CONCLUSIONS Physicians caring for HGG patients in the EOL phase should timely focus on explaining possible treatment options, because patients experience communication deficits toward death. Physicians should strive to allow patients to die at their preferred place and avoid transitions during the last month of life.
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Affiliation(s)
- Eefje M Sizoo
- Department of Neurology, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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Mah L, Grief C, Grossman D, Rootenberg M. Assessment of Patient Dignity in Geriatric Palliative Care. J Am Geriatr Soc 2012; 60:2178-80. [DOI: 10.1111/j.1532-5415.2012.04235.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Linda Mah
- Rotman Research Institute; Baycrest; Toronto Ontario Canada
- Department of Psychiatry; Baycrest; Toronto Ontario Canada
- Division of Geriatric Psychiatry; Department of Psychiatry; University of Toronto; Toronto Ontario Canada
| | - Cindy Grief
- Department of Psychiatry; Baycrest; Toronto Ontario Canada
- Division of Geriatric Psychiatry; Department of Psychiatry; University of Toronto; Toronto Ontario Canada
| | - Daphna Grossman
- Department of Family and Community Medicine; Baycrest; Toronto Ontario Canada
- Division of Palliative Care; Department of Family and Community Medicine; University of Toronto; Toronto Ontario Canada
| | - Mark Rootenberg
- Department of Family and Community Medicine; Baycrest; Toronto Ontario Canada
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Pereira SM, Fradique E, Fialho R, Cerqueira M, Pereira A, Sampaio F. Advance directives: Portuguese Palliative Care Professionals' views. Int J Palliat Nurs 2011; 17:373-80. [DOI: 10.12968/ijpn.2011.17.8.373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sandra M. Pereira
- Azores University, Nursing School of Angra do Heroísmo, Canada dos Melancólicos, 9700-878 Angra do Heroísmo, Portugal
| | | | - Renata Fialho
- North Lisbon Hospital Centre, Saint Mary Hospital, Portugal
| | | | | | - Florbela Sampaio
- Health School, Polythecnic Institute of Viana do Castelo, Portugal
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