Conceptualizations of dignity at the end of life: exploring theoretical and cultural congruence with dignity therapy

Abstract

Aim. To explore the conceptualisation of patients' dignity within the context of end-of-life care in Taiwan Background. Dignity therapy (DT) -a novel psychotherapeutic intervention -has been demonstrated to have potential to alleviate terminally ill patients' psycho-existential distress in several western countries. In Taiwan, over half of terminally ill patients experience psychological-spiritual suffering and DT might prove helpful in improving this situation. Hence, a preliminary study to clarify Taiwanese conceptualisations of 'dignity' was conducted prior to planning a feasibility study in order to gauge the potential cultural fit of an intervention of this type. Design. Qualitative explorationMethods. Nine people with terminal cancer and ten health professionals were recruited from palliative care services in Taiwan in 2008. In-depth interviews were audiotaped and transcribed verbatim. A hermeneutic approach was employed to analyse and interpret data. Findings. Being a valuable person is the core meaning of patients' dignity in theTaiwanese context and this comprised intrinsic characteristics and extrinsic factors.Intrinsic characteristics of dignity encompassed living a moral life, having peace of mind and a sense of existence involving the perception of resignation to God's will.Extrinsic factors that influenced patients' dignity included illness-related distress, care Conclusion. The approaches of preserving dignity, living a moral life and resignation to God's will, in Taiwanese patients were distinguishable from western perspectives and the modification of DT in this context is warranted.Key words: Dignity therapy, palliative care, qualitative research, terminal illness 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 ◎ Dignity is of concern in healthcare as it relates to patients' physical, psychological and existential distress and also the support and care they receive. Page 2 of 32 Journal of Advanced Nursing◎ The translation of DT into other cultures might improve end-of-life care in different populations and assessment of whether it is cultural-appropriate to apply the intervention in different contexts is essential. • What are the key findings?◎ A sense of dignity was associated with whether a person is viewed by themselves or others as a valuable person.◎ The intrinsic characteristics of dignity were culturally influenced and involved a perception of living a moral life and resignation to God's will.◎ Extrinsic factors had both helpful and harmful influences on patients' sense of dignity, and approaches patients took to securing their dignity involved enhancing the intrinsic characteristics of dignity.• How should the findings be used to influence policy/practice/research/education? ◎ Modification of DT is warranted and culture-related perspectives of dignity should be addressed before implementation in the Tai...

A Narrative Review of Dignity Therapy Research

“…A study in Taiwan interviewed 10 palliative care professionals and nine people receiving palliative care about their perceptions of dignity (Li, Richardson, Speck, & Armes, ). The DT framework was generally supported although some divergent themes emerged, such as “living a moral life and acquiescing to God” instead of “maintenance of pride” and “generativity/legacy.” Findings suggested that modifications to DT should be made to ensure it is culturally congruent with Taiwanese beliefs.…”

“…Most DT research has taken place in the USA, UK, Canada, and Australia, but studies from Denmark, Sweden, and Taiwan found the question protocol required revision (Houmann et al, 2010;Li et al, 2014;Lindqvist et al, 2014) and a Japanese study found DT to be culturally incompatible (Akechi et al, 2012). These findings suggest that research surrounding the acceptability of DT should be conducted before DT is adopted for use with other cultural groups.…”

Perceptions of Iranian Cancer Patients Regarding Respecting their Dignity in Hospital Settings

“…Also, providing a private environment, social support and interactions with others, especially family and healthcare workers are social factors that affect patients' perception of dignity . Recognizing and focusing on these factors will help healthcare workers to preserve and promote patients' dignity (Thompson and Chochinov., 2008;Li et al, 2014).…”

Dojemanje dostojanstva pacientov z vidika zdravstvenih delavcev

“…osebnostno (individualno), duhovno, eksistencialno (Šmitek, 2006). Ideja o človeškem dostojanstvu ima pomembno vlogo v filozofiji, teologiji, politiki, zakonodaji kot tudi klinični praksi zdravstvene obravnave (Li, et al, 2014). Z zdravstveno nego je neločljivo povezano spoštovanje človekovih pravic, vključno s kulturnimi pravicami, pravico do življenja in izbire, do dostojanstva in spoštovanja (International Council of Nurses, 2012).…”