How to conserve dignity in palliative care: suggestions from older patients, significant others, and healthcare professionals in Swedish municipal care

Abstract

BackgroundAn essential aspect of palliative care nursing is to conserve the dignity of the patient. A Dignity Care Intervention (DCI) has been developed in Scotland to facilitate this role for nurses. The DCI is now being adapted to a Swedish context (DCI-SWE) and a central step is to identify culturally relevant, dignity-conserving care actions. These care actions will be incorporated into the DCI-SWE. Therefore, the aim of this study was to suggest care actions for conserving dignity in palliative care from the perspectives of the patients, significant others (SOs), and health care professionals (HPs) in municipality care in Sweden.MethodsThis study used a descriptive design with a qualitative approach. Data from 20 participants were collected through semi-structured individual interviews with patients (n = 3), SOs (n = 4), two focus groups with nurses (n = 9) and one focus group with physicians (n = 4) in two Swedish municipalities. These data were deductively analysed using qualitative content analysis with the Chochinov model of dignity as framework.ResultsWith the Chochinov model of dignity as a framework, care actions based on suggestions from the participants were identified and presented under three themes: Illness related concerns, Dignity conserving repertoire, and Social dignity inventory. The study found both specific concrete care actions and more general approaches. Such general approaches were found to be relevant for several dignity related issues as all-embracing attitudes and behaviours. However, these general approaches could also be relevant as specific care actions to conserve dignity in relation to certain issues. Care actions were also found to be linked to each other, showing the importance of a holistic perspective in conserving dignity.ConclusionsAs part of the adaption of the DCI from a Scottish to a Swedish context, this study added relevant care actions for collaborative planning of individualised care in mutual dialogues between nurses and those they care for. The adapted intervention, DCI-SWE, has the potential to help the nurses in providing palliative care of evidence-based quality.

The importance of living well now and relationships: A qualitative study of the barriers and enablers to engaging frail elders with advance care planning

“…While all frail elders were open to advance care planning conversations, they needed to understand advance care planning’s relevance for them, particularly as most were more interested in living well now, a coping strategy suggested as essential for those nearing the end of life. 31 – 33 These findings imply that for advance care planning to be relevant to frail elders it should encompass not just future planning, which can be difficult to imagine when living with uncertainty, 34 but also planning for now and how things may change. This tension between advance care planning the, often medicalised, documentation and advance care planning the process has been highlighted with the recent covid-19 pandemic.…”

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

“…In fact, DT background represents a solid basis of the rationale of broadening the use of this intervention in affiliated fields sharing similar dignity related, existential, and psychosocial implications among frail elderly with cognitive impairment. Palliation is a concept that should be not only intended as an intervention for terminally ill patients, but as a more general construct related to support and palliate the several dimensions of suffering in different clinical areas [67], including geriatrics, psychiatry, and others [68,69].…”

Translating the Patient Dignity Inventory

“…This underlines the importance of healthcare professionals who use the PDI being perceptive, using sensitive listening (Harstäde et al, , Östlund et al, 2019 and having an established relationship with the patient, as pointed out by Brown et al (2011) in a study of the DCI. In the same study, using the PDI was also seen as a way to create such a relationship (Brown et al, 2011).…”