NCRI Conference Abstracts
Plenary abstracts

Dying with dignity: a contemporary challenge in palliative cancer care

Harvey Max Chochinov

University of Manitoba and Manitoba Palliative Care Research Unit, Manitoba, Canada, USA

Over the past decade, our research group has conducted a number of studies addressing the issue of dying with dignity in patients with terminal cancer[1-5]. Dignity is a highly politicised term, which has been used to support various approaches for care of the dying. While most palliative care providers attending to patients would espouse dignity as an overarching value or goal of end-of-life care, few empirical studies have provided guidance or direction on how this might be operationalised or systematically achieved. Without such information, how are we to ensure that dying cancer patients maintain their sense of dignity until the very end?

To begin, one must appreciate how the terminally ill understand the notion of dignity, and what factors undermine or maintain dignity for those nearing death[1-2]. This talk will address these issues, using clinical illustrations and research data, highlighting therapeutic considerations for patients near the end of life. An empirical model of dignity will be presented, along with the rational for a ‘dignity model’ based therapy[3-5]. This novel, individual, brief psychotherapy coined Dignity Therapy has been designed specifically to maintain the dignity of dying patients and their families. Results from a study of Dignity Therapy will be presented, including information about the extent to which this intervention influenced their sense of dignity, hope, meaning, preparedness for death, and will to live[5]. Results will also be presented regarding the reactions this intervention has garnered from family participants.

Finally, the ABCDs of Dignity Conserving Care – attitude, behaviour, compassion, and dialogue – will be examined regarding how this can be used to guide healthcare practitioners towards maintaining patient dignity. Applying this framework requires an appreciation of the profound influence healthcare providers can have on patient experience of illness and sense of personhood. This framework can be applied to teaching, clinical practice, and standards at undergraduate and postgraduate levels and across all medical subspecialties, multidisciplinary teams, and allied health professions.

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