Dignity-Conserving Care in Medicine

Grassi, Luigi; Chochinov, Harvey Max; Moretto, Giuseppe; Nanni, Maria Giulia

doi:10.1007/978-3-319-74736-1_6

Cited by 8 publications

(7 citation statements)

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“…Available research in psychiatric settings indicates that stigma consists of both the auto perception of one‐self as stigmatized and different from others (self‐stigma, as the internalization of a negative stereotype that the person applies to oneself) 59 and the stigma imposed by society (social stigma, as the series of stereotyped beliefs, prejudices and discriminatory attitudes). Elsewhere 60 we have considered the dimension of stigma as the expression of the other side of dignity, where also it is possible to distinguish a self‐related sense of personal value and dignity (intrinsic dignity) and a reciprocal and interpersonal experience of dignity related to what others provide us in terms of value and dignity (extrinsic dignity). Being seen as an equal human being, with the potential to experience self‐worth, meaning and purpose are key factors to maintaining dignity, despite suffering the consequences of mental illness and having to fight for one's rights 61,62 .…”

Section: Possible Mechanisms Involved In the Problemmentioning

confidence: 99%

Cancer and severe mental illness: Bi‐directional problems and potential solutions

Grassi

Riba

2020

Psycho-Oncology

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Objective: Given the reported increased rates of physical morbidity and higher mortality rates among people with severe mental illness (SMI) (schizophrenia and severe mood disorders), with a life expectancy shorter of 15-20 years with respect to the general population, the aim of this paper was to call attention to the problem of cancer in SMI. Methods: We conducted a narrative review of the most significant papers published in the areas of cancer screening, incidence, mortality and palliative care in SMI. Results: Data from the literature confirm disparities in screening (eg, mammography; pap-smear test; colorectal cancer screening) and prevention (eg, clinical breast examination; smoking cessation). The incidence of cancer was found to be variable with a portion of the studies reporting a higher prevalence while others a similar or a lower prevalence of cancer compared to the general population. A lower percentage of patients with SMI received proper cancer treatment resulting in survival after cancer diagnosis significantly worse than people without SMI. Likewise, end-of-life care has been shown to be lacking with poorer levels of physical, psychological and spiritual care. Conclusions: The problems of stigma and discrimination, poorer dignity, poorer health behavior, lack of integration in health-care services for people with SMI needs to be addressed and solved in cancer care. Psycho-oncology has a very specific and mandatory role in integrating the recommendation of the World Health Organization to improve the links between oncology and mental health settings for more specific psycho-oncology programs addressed for this vulnerable segment of the population.

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Section: Possible Mechanisms Involved In the Problemmentioning

confidence: 99%

Cancer and severe mental illness: Bi‐directional problems and potential solutions

Grassi

Riba

2020

Psycho-Oncology

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“…With respect to this, a person-centered approach that seeks to maintain dignity in older persons with cognitive decline [17,18] is not possible without including their informal caregivers, usually their close relatives. It therefore follows that targeting dignity and meaning intervention in the affected elder alone, outside of the context of the dyadic relationship with the informal caregiver, cannot be expected to be sufficient to improve mental health and quality of life in those affected by cognitive decline [19].…”

Section: Introductionmentioning

confidence: 99%

Improving Dignity of Care in Community-Dwelling Elderly Patients with Cognitive Decline and Their Caregivers. The Role of Dignity Therapy

Ounalli

Mamo

Testoni

et al. 2020

Behavioral Sciences

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Demographic changes have placed age-related mental health disorders at the forefront of public health challenges over the next three decades worldwide. Within the context of cognitive impairment and neurocognitive disorders among elderly people, the fragmentation of the self is associated with existential suffering, loss of meaning and dignity for the patient, as well as with a significant burden for the caregiver. Psychosocial interventions are part of a person-centered approach to cognitive impairment (including early stage dementia and dementia). Dignity therapy (DT) is a therapeutic intervention that has been shown to be effective in reducing existential distress, mood, and anxiety symptoms and improving dignity in persons with cancer and other terminal conditions in palliative care settings. The aims of this paper were: (i) To briefly summarize key issues and challenges related to care in gerontology considering specifically frail elderly/elderly with cognitive decline and their caregivers; and (ii) to provide a narrative review of the recent knowledge and evidence on DT in the elderly population with cognitive impairment. We searched the electronic data base (CINAHL, SCOPUS, PSycInfo, and PubMed studies) for studies regarding the application of DT in the elderly. Additionally, given the caregiver’s role as a custodian of diachronic unity of the cared-for and the need to help caregivers to cope with their own existential distress and anticipatory grief, we also propose a DT-dyadic approach addressing the needs of the family as a whole.

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“…In fact, the need for ensuring the continuity of the self is at the core of the current person-centered care in medicine emphasized by CLP practice and experience (Grassi et al, 2017). This approach has been developed for conserving dignity, which is seen as a human right threatened by a dehumanized medicine (Grassi et al, 2019). Such person-centered care has been recently characterized as a “care that recognizes and cultivates the capabilities associated with the concept of persons” (Entwistle & Watt, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…The need to have such a safe space available for healthcare is also currently highlighted by a person-centered approach to recovery in medicine. Space particularly is seen as a primary element for achieving optimal communication, ensuring both the continuity of the self and dignity, a human right to be safeguarded in hospitals (Grassi et al, 2019).…”

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confidence: 99%

Potential Space in Hospitals: Insight From a Health Psychologist

Grignoli

2020

HERD

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Objective: Humanization is a challenge for the future of healthcare. Architecture may play a major role in designing spaces that enhance communication and help the patient to maintain mental health during physical illness. Health psychologists struggle to find adequate space for taking care of their patients. There is an urgent need to better define how relational space, defined here as potential, can be guaranteed in everyday hospital psychological consultations. Background: The author relates to his work as a health psychologist and psychotherapist in a consultation-liaison psychiatry (CLP) service operating in a general hospital in Lugano (Switzerland). Methods: An autoethnographic method is applied through calling on childhood memories on architecture and analyzing insights regarding the healthcare space in everyday work as a psychologist. Photographs and drawings are employed as evocative material. Results: Autoethnographical data show that building interiors can be a metaphor for an inner dimension. Spaces can be perceived as depersonalized in hospital. Through psychoanalytical theory, it is argued that space becomes ideal for CLP if it can ensure the continuity of the patient’s self during hospitalization. Proximity, confidentiality, and privacy are healthcare design requirements to be considered for favoring potential space and psychological intervention. Conclusion: Fostering potential space represents an outstanding challenge for the hospital of tomorrow in order to humanize healthcare spaces and promote a person-centered approach.

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Dignity-Conserving Care in Medicine

Cited by 8 publications

References 100 publications

Cancer and severe mental illness: Bi‐directional problems and potential solutions

Cancer and severe mental illness: Bi‐directional problems and potential solutions

Improving Dignity of Care in Community-Dwelling Elderly Patients with Cognitive Decline and Their Caregivers. The Role of Dignity Therapy

Potential Space in Hospitals: Insight From a Health Psychologist

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