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Cancer Resources > Cancer News > Cancer News from Reuters > Reuters Cancer News > 2002 > December
Preservation of dignity needed in care of the terminally ill
Last Updated: 2002-12-19 18:30:29 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Among terminally ill patients, the loss of dignity is associated with certain types of distress, Canadian researchers report in the December 21/28 issue of The Lancet. They therefore suggest that preservation of patient dignity should be a goal for clinicians.
"The notion of dignity needs to be introduced into the clinical arena," lead author Dr. Harvey Max Chochinov told Reuters Health. "Maintaining dignity at the end of life needs to be set as the gold-standard in providing end-of-life care."
Dr. Chochinov from the University of Manitoba, Winnipeg, and colleagues asked 213 patients diagnosed with terminal cancer, whose life expectancy was less than 6 months, to rate their sense of dignity.
The researchers' main outcome measures included a seven-point sense of dignity item; the symptom distress sale; the McGill pain questionnaire; the index of independence in activities of daily living; and a quality of life scale. They also used a battery of self-reported measures that including screening for desire for death, anxiety, hopelessness, will to live, burden to others and requirement of social support.
Sixteen patients (7.5%) reported that loss of dignity was a great concern. Compared with the other patients, these patients were also more likely to report psychological distress, symptoms of distress, increased dependency needs, and loss of the will to live, Dr. Chochinov's team found.
The investigators suggest that "understanding the dignity concerns of patients near the end of life could raise our sensitivity to many important aspects of human pain, and provide the groundwork required to develop effective management strategies. Dignity-conserving care needs to become part of the palliative care lexicon, and an overarching therapeutic aim and standard of care for all patients close to death."
The study by Chochinov et al. provides a "major contribution to understanding loss of dignity and elucidating those factors necessary to promote dignity," Drs. Manish Agrawal and Ezekiel J. Emanuel from the National Institutes of Health, Bethesda, Maryland, comment in an accompanying editorial.
However, the findings "suggest that the dying process may not be as bad as many people fear--at least as regards dignity," they add. "The results...emphasize the importance of educating the public about the dying process, so that unrepresentative horror stories do not lead to misguided policy-making about death and dying."
Lancet 2002:360:1997-1998,2026-2030.
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