A systematic scoping review on patients’ perceptions of dignity

Abstract

Background A socioculturally appropriate appreciation of dignity is pivotal to the effective provision of care for dying patients. Yet concepts of dignity remain poorly defined. To address this gap in understanding and enhance dignity conserving end-of-life care, a review of current concepts of dignity is proposed. Methods To address its primary research question “How do patients conceive the concept of dignity at the end of life?”, this review appraises regnant concepts and influences of dignity, and evaluates current dignity conserving practices. To enhance accountability, transparency and reproducibility, this review employs the Ring Theory of Personhood (RToP) as its theoretical lens to guide a Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) of patient perspectives of dignity. Three independent teams of reviewers independently analysed included articles from a structured search of PubMed, Embase, PsycINFO, Scopus, CINAHL and Cochrane Databases using thematic and content analyses. The themes and categories identified were compared and combined using the Funnelling Process to create domains that guide the discussion that follows. Results Seventy-eight thousand five hundred seventy-five abstracts were identified, 645 articles were reviewed, and 127 articles were included. The three domains identified were definitions of dignity, influences upon perceptions of dignity, and dignity conserving care. Conclusions This SSR in SEBA affirms the notion that dignity is intimately entwined with self-concepts of personhood and that effective dignity conserving measures at the end of life must be guided by the patient’s concept of dignity. This SSR in SEBA posits that such personalised culturally sensitive, and timely support of patients, their family and loved ones may be possible through the early and longitudinal application of a RToP based tool.

Systematic scoping review on moral distress among physicians

“…The innermost ring or the microenvironment is influenced and influences the two outer rings. The microenvironment considers the physician’s narratives including their previous experiences,37 demographics, training, skills, personality, attitudes, resilience, current coping, and the values, beliefs,39 and principles10 62 within each of the 4 rings of the RToP 38. This ring also considers conflicts between and within the rings of the physician’s RToP.…”

“…In addition, recognising MD's complex sociocultural nature underscores the importance of appreciating the physician's narratives, competencies, experiences, reflections, abilities and available coping and support mechanisms that provide MD with its personalised and evolving nature. Two, with a physician's personal, moral, ethical and professional beliefs, values, and principles informed by their self-concepts of identity and personhood or 'what makes you, you', 36 the link between personalised concepts [37][38][39] of MD and self-concepts of personhood become clearer. Ho et al 38 Kuek et al 3 Chan and Chia 40 and Huang et al 41 provide clinical evidence of these ties between self-concepts of personhood and identity using the ring theory of personhood (RToP) to study the experiences of physicians, nurses and medical students caring for terminally ill patients and confronting the death of their patients.…”

“…Two, with a physician’s personal, moral, ethical and professional beliefs, values, and principles informed by their self-concepts of identity and personhood or ‘what makes you, you’,36 the link between personalised concepts37–39 of MD and self-concepts of personhood become clearer. Ho et al 38 Kuek et al 3 Chan and Chia40 and Huang et al 41 provide clinical evidence of these ties between self-concepts of personhood and identity using the ring theory of personhood (RToP) to study the experiences of physicians, nurses and medical students caring for terminally ill patients and confronting the death of their patients.…”

A systematic scoping review of reflective writing in medical education

“…To synthesise a coherent narrative from the multiple accounts of reflective writing, we adopt Krishna’s Systematic Evidence-Based Approach (SEBA) [ 10 , 15 , 21 , 46 – 53 ]. A SEBA-guided Systematic Scoping Review (SSR in SEBA) [ 13 – 24 , 50 , 53 – 55 ] facilitates reproducible, accountable and transparent analysis of patterns, relationships and disagreements from multiple angles [ 56 ].…”

“…The SEBA process (Fig. 1 ) comprises the following elements: 1) Systematic Approach, 2) Split Approach, 3) Jigsaw Perspective, 4) Funnelling Process, 5) Analysis of data and non-data driven literature, and 6) Synthesis of SSR in SEBA [ 10 , 15 , 21 , 46 – 53 , 57 – 60 ] . Every stage was overseen by a team of experts that included medical librarians from the Yong Loo Lin School of Medicine (YLLSoM) at the National University of Singapore, and local educational experts and clinicians at YLLSoM, Duke-NUS Medical School, Assisi Hospice, Singapore General Hospital, National Cancer Centre Singapore and Palliative Care Institute Liverpool.…”