Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care

Chochinov, Harvey Max

doi:10.1136/bmj.39244.650926.47

Cited by 436 publications

(292 citation statements)

References 23 publications

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“…Patients and relatives believed that lack of time and the high workload for health professionals was one explanation for these situations, but it was not accepted as an excuse for such behaviour. Kindness, humanity, and respect are identified as the core values of medical professionalism [37], but often overlooked in a time pressured health care. Health professionals have a crucial influence on how patients experience dignity.…”

Section: Discussionmentioning

confidence: 99%

Patients’ and relatives’ complaints about encounters and communication in health care: Evidence for quality improvement

Jangland

Gunningberg

Carlsson

2009

Patient Education and Counseling

134

141

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Results Three categories were identified: "Not receiving information or being given the option to participate", "Not being encountered in a professional manner" and "Not receiving nursing or practical support". Insufficient information, insufficient respect and insufficient empathy were described as the most common reasons for a negative professional encounter. ConclusionPatients and relatives experienced unnecessary anxiety and reduced confidence in health care after negative professional encounters. Practice implicationsThe complaints reported to the Patients' Advisory Committee could be used more effectively in health care and be regarded as important evidence when working with quality improvement. To systematically use patient stories, such as those obtained in this report, as a reflective tool in education and supervision could be one way to improve communication and bring new understanding about the patient's perspective in health care. KeywordsComplaints, communication, professional encounter and content analysis. Much research has been done on communication between patients and health professionals. For example, the power of the information communicated by the voice was studied among surgeons, and it was suggested that "how" a message is conveyed may be as important as "what" is said [8]. The physician-patient communication was studied among primary care physicians and surgeons. Physicians with no-claim seemed to conduct longer visits, educate patients more, check understanding more and use more humour during the visit than physicians with claims [9]. A study by Kuzel [10] showed that negative outcomes in the clinician-patient relationship, dominated by stories of disrespect or insensitivity, were reported as more common than technical errors in diagnosis and treatment.The Institute for Healthcare Improvement (IHI) emphasizes that the health care system needs to be more patient-centred and to involve the patients and families in the design of care. Patient-centred care requires respect for patients' values and expressed needs, information and communication, coordination of care, involvement of family, 4 and concordance between the patient and health professionals [11]. Eldh [12] concludes that health care professionals should support patient participation by recognizing the patient as an individual and as a resourceful partner. The benefits of patient-centred care could be that patients are more motivated to follow treatment advice [13] and are more satisfied with health care [14].Patient satisfaction is used as a common quality indicator in health care [15][16]. A problem using patient satisfaction as a quality indicator depends on the complexities where different factors could affect the outcome, and the reliability and validity questioned [17]. Factors such as gratitude, faith and loyalty to health care providers, could influence patient satisfaction [18] as well as background factors such as age, health status and expectations of care [19][20]. A patient's evaluation could be positive, even when care...

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Section: Discussionmentioning

confidence: 99%

Patients’ and relatives’ complaints about encounters and communication in health care: Evidence for quality improvement

Jangland

Gunningberg

Carlsson

2009

Patient Education and Counseling

134

141

View full text Add to dashboard Cite

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“…Chochinov's definition describes compassion as a deep awareness of the suffering of another coupled with the wish to relieve it. 52 Charlton, reflecting the conceptual confusion surrounding compassion concludes that it is almost indefinable. 53 Compassion, like sympathy, is evoked when something bad happens to another person, but compassion is generated by more serious states.…”

Section: Compassionmentioning

confidence: 99%

Empathy, sympathy and compassion in healthcare: Is there a problem? Is there a difference? Does it matter?

2016

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“…Psychological suffering for terminally ill patients is also often framed in terms of loss of dignity (Chochinov, 2007). Although dignity is a core element of palliative care, it was not well defined or operationalized until the work of Chochinov and colleagues.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of dignity therapy for depression and anxiety in terminally ill patients: Early results of a randomized controlled trial

et al. 2013

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Objective: Dignity therapy (DT) is a short-term psychotherapy developed for patients living with a life-limiting illness. Our aim was to determine the influence of DT on symptoms of depression and anxiety in people with a life-threatening disease with high level of distress, referred to an inpatient palliative care unit.Method:This was an open-label randomized controlled trial. Sixty terminally ill patients were randomly assigned to one of two groups: intervention group (DTþ standard palliative care [SPC]) or control group (SPC alone). The main outcomes were symptoms of depression and anxiety, measured with the Hospital Anxiety and Depression Scale, assessed at baseline, day 4, day 15, and day 30 of follow-up.Results: Of the 60 participants, 29 were randomized to DTand 31 to SPC. Baseline characteristics were similar between the two groups. DT was associated with a significant decrease in depressive symptoms at day 4 and day 15 (mean ¼ 24.46, 95% CI, 26.91-2.02, p ¼ 0.001; mean¼ 23.96, 95% CI, 27.33 to 20.61; p ¼ 0.022, respectively), but not at day 30 (mean ¼ 23.33, 95% CI, 27.32-0.65, p ¼ 0.097). DTwas also associated with a significant decrease in anxiety symptoms at each follow-up (mean¼ 23.96, 95% CI, 26.66 to 21.25, p ¼ 0.005; mean¼ 26.19, 95% CI, 210.49 to 21.88, p ¼ 0.006; mean ¼ 25.07, 95% CI, 210.22 to 20.09, p ¼ 0.054, respectively).Significance of results: DT appears to have a short-term beneficial effect on the depression and anxiety symptoms that often accompany patients at the end of their lives. Future research with larger samples compared with other treatments is needed to better understand the potential benefits of this psychotherapy.

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Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care

Cited by 436 publications

References 23 publications

Patients’ and relatives’ complaints about encounters and communication in health care: Evidence for quality improvement

Patients’ and relatives’ complaints about encounters and communication in health care: Evidence for quality improvement

Empathy, sympathy and compassion in healthcare: Is there a problem? Is there a difference? Does it matter?

Efficacy of dignity therapy for depression and anxiety in terminally ill patients: Early results of a randomized controlled trial

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