Valuing the individual – evaluating the Dignity Care Intervention

Abstract

Background Palliative care needs in older persons can endanger their dignity. To provide dignity-conserving care to older persons, the Swedish Dignity Care Intervention (DCI-SWE) can be used. The DCI-SWE is built on Chochinov’s dignity model and the original version, developed and tested in UK and Scotland. Aim To describe older persons’ and their relatives’ experiences of dignity and dignity-conserving care when using the DCI-SWE in municipal health care. Research design A mixed method study with convergent parallel design. Participants and research context The DCI-SWE was used and evaluated in a Swedish municipality health care context. Older persons’ ( n=17) dignity-related distress and quality of life were assessed after the intervention. Interviews with older persons ( n=10) and their relatives ( n=8) were analysed using thematic analysis. Ethical considerations The study followed the World Medical Association Declaration of Helsinki. Ethical approval was obtained from the Regional Ethical Review Board in Uppsala, Sweden (Reg No. 2014/312) and the National Swedish Ethical Review Authority (Reg. No. Ö 10-2019). Informed consent was collected from older persons and their relatives. Findings The older persons’ dignity-related distress did not significantly change over time ( p = 0.44) neither was their overall quality of life ( p = .64). Only psychological quality of life was decreased significantly ( p = 0.01). The older persons and their relatives emphasized the importance of valuing the individual. Conclusions The DCI-SWE provides a forum to talk about dignity issues, but relevant competence, continuity and resources are needed. Psychological care actions and health care professionals’ communication skills training are important. To fully evaluate, the DCI-SWE a larger sample and validated instruments are necessary.

Effectiveness of integrated person‐centered interventions for older people's care: Review of Swedish experiences and experts’ perspective

“…The intervention Coordinated geriatric care with increased patient participation and goal‐setting for patients with hip fracture demonstrated a faster recovery in ADLs in the intervention group but failed to show significant differences between groups for the remaining outcomes, such as functional balance and physical performance measures [28]. The Swedish Dignity Care Intervention (DCI‐SWE) targeting palliative care patients did not show significant changes in quality of life (QoL) [29]. The intervention was reported to be acceptable by both patients and their relatives, as it provided the needed structure for palliative care.…”

“…• The intervention Coordinated geriatric care with increased patient participation and goal-setting for patients with hip fracture demonstrated a faster recovery in ADLs in the intervention group but failed to show significant differences between groups for the remaining outcomes, [22][23][24][25] PCC for patients undergoing total hip arthroplasty [26] A client-centered energy conservation program for people with CHF [27] Coordinated geriatric care with increased patient participation and goal setting [28] DCI-SWE: Swedish Dignity Care Intervention [29,30]…”

“…• The Swedish Dignity Care Intervention (DCI-SWE) targeting palliative care patients did not show significant changes in quality of life (QoL) [29]. The intervention was reported to be acceptable by both patients and their relatives, as it provided the needed structure for palliative care.…”

“…The intervention was reported to be acceptable by both patients and their relatives, as it provided the needed structure for palliative care. Facilitators included sufficient time, support from managers, and positive effects on patients; barriers included lack of staff, fear of change, and interruptions from family members [29,30].…”

Grasping a new approach to older persons' dignity: A process evaluation of the Swedish Dignity Care Intervention in municipal palliative care

“…It comprises three parts, the Patient Dignity Inventory (PDI), reflective questions, and evidence-based dignity care actions, and its purpose is to relieve dignity-related distress and enhance person-centered care (PCC). The DCI-SWE is evaluated within a project [26,27] which this study is a part of. It can be used with all persons having palliative care needs, however, in this project it is used by CNs together with older persons, and with their consent relatives can be involved [27].…”