Patient Dignity Research Articles

Malpractice Claims and Ethical Issues in Prison Health Care Related to Consent and Confidentiality.

Respecting the consent and confidentiality of a patient is an underlying element in establishing the patient’s trust in the physician and, implicitly, obtaining the patient’s compliance. In particular, cases of inmate patients require increased attention in order to fulfill this goal against a background of institutional interferences, which, in certain situations, may endanger the autonomy of the physician and their respect for the inmate’s dignity. The purpose of this article is to depict the characteristics of consent and confidentiality in a prison environment, in special cases, such as hunger strikes, violent acts, HIV testing, COVID-19 measures, and drug use, bringing into focus the physician and the inmate in the context of the particular situation where the target is disciplining someone in order for them to conform to social and juridical norms. Respecting the dignity of the inmate patient requires an adequate approach of informed consent and confidentiality, depending on each case, considering the potential unspoken aspects of the inmate’s account, which can be key elements in obtaining their compliance and avoiding malpractice claims.

Opt-in Vs. Opt-out of Organ Donation in Scotland: Bioethical analysis

This paper looks at the ethics of opt-in vs. opt-out of organ donation as Scotland has transitioned its systems to promote greater organ availability. We first analyse studies that compare the donation rates in other regions due to such a system switch and find that organ increase is inconclusive and modest at best. This is due to a lack of explicit opt-out choices resulting in greater resistance and family override unless there are infrastructures and greater awareness to support such change. The paper then looks at the difference between informed consent of the opt-in vs. presumed consent in the opt-out approaches. Patient autonomy and dignity are better reflected with informed consent. Eighteen months have passed since the new organ donation policy has come into effect, this paper recommends more research into organ donors’ psychological motivations to help governments and the healthcare profession obtain more organs for transplantation.

Undervalued and overlooked: the importance of private space in liaison psychiatry

SUMMARYAccess to private space for psychiatric assessments is crucial to facilitate the effective gathering of salient information while preserving the dignity of patients. In this article, we discuss the current availability of private space for liaison psychiatry services on in-patient wards in general hospitals and reflect on how this affects communication with patients. Additionally, we propose solutions for healthcare trusts in addressing this issue.

A scoping review protocol of non-verbal communication utilised in peri-interventive dental and medical procedures

Introduction: Dental operative procedures, by their interventive nature, impede the opportunity for peri-intervention verbal communication between patients and clinicians. This can impair trust, consent, and shared decision making with the potential of adversely affecting patient dignity, and potentially resulting in suboptimal clinical outcomes. This scoping review aims to interrogate the literature concerning non-verbal communication methods used in dental and medical practices during peri-interventive procedures, in aiding communication between clinician and patient. We will also ascertain how these align with the Limited Capacity Model of Motivated Mediated Message Processing (LC4MP) communication theory. Methods: The framework proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews, will be used to guide this scoping review and reporting methodology. Selected electronic databases (Medline, Embase, Cochrane Library and Scopus), PsychInfo, CINAHL and grey literature sources will be searched. Inclusion criteria are: articles written in the English language, publications between 2000 and 2020, peer-reviewed empirical studies, with either qualitative or quantitative data, mixed methods, reviews, book chapters and grey literature with a principal focus on non-verbal communication in the healthcare setting. A narrative synthesis will be conducted, with results reported according to elements of LCM4P theory: cognitive load, motivated messaging, message processing and memory. Conclusion: This scoping review will contribute to our methodological and theoretical understanding of the use of non-verbal communication strategies in clinical settings.

Threats to the dignity of COVID-19 patients: A qualititative study.

Background: Dignity is a fundamental concept that has been threatened by the COVID-19 pandemic. Several factors threaten the dignity of COVID-19 patients, whether in palliative care departments, medical or surgery wards, intensive care units, or long-term care facilities. This threat is exacerbated by the increasing number of affected patients, the high transmission of the virus and problems such as limited resources, shortage of workforce, and ineffective communication. Recognizing the threats and challenges that currently affect the patients’ dignity and managing them can help maintain the patients’ dignity and increase their satisfaction. Research objective: This study seeks to explain the threats to the dignity of hospitalized COVID-19 patients. Research design: This qualitative study was conducted using conventional content analysis. Data were collected through in-depth, semi-structured, face-to-face interviews with 21 COVID-19 patients with maximum variation. Data were analyzed using Graneheim and Lundman’s conventional content analysis and encoded with MAXQDA-10 software. The participants had already recovered from COVID-19 when the interviews were held. Ethical considerations: The study protocol was approved by the Research Ethics Committee of medical universities in northwestern Iran (IR.UMSU.REC.1399.345). Ethical principles were observed during the study. Findings: The analysis of the interviews revealed three main categories and 11 subcategories for the threats to the dignity of COVID-19 patients. The main categories included facing imposed conditions (five subcategories), facing unprofessional performance (four subcategories), and ineffective communication (two subcategories). Conclusion: The findings of the present study can help health officials and policymakers in taking positive steps to maintain patients’ dignity by designing and implementing beneficial programs.

Katie Erikson's caring theories. Part 2. The theory of caritative caring ethics and the theory of evidence.

In this article, Katie Eriksson's theory of caritative caring ethics and the theory of evidence, are described. Both theories are anchored in caritas, that is love, mercy and compassion. The theory of caritative caring ethics was first described by Eriksson in 1995, where seven assumptions or basic categories were elaborated. These were: the human being's dignity, the care relationship, invitation, responsibility, virtue, obligation or duty, and good and evil. Eriksson's theoretical contribution is that she makes a distinction between caring and nursing ethics, between inner and external ethics, and between natural and clinical ethics. Concerning the theory of evidence, Eriksson claims that a multidimensional scientific view of evidence in caring that focuses on the patient's world is necessary and vital. To see, realise, know, attest and revise constitute the ontological definitions of the concepts of evidence and evident. The theories are united by the core concepts of testimony and witnessing the human being's suffering. Eriksson points out that it is in the ethical acts that deeds are formed, based on ethos. The anchorage in an ethos means to have firm value-loaded judgements of an inner motive. Moreover, the anchorage in ethos presupposes a personal and natural ethic. The good deeds are realised in the relationship between the patient and the carer, but the caring ethics is not a professional or external ethics. Caring ethics is an ontological inner ethics meaning fellowship and the right to exist, but it is the patient's world and reality that decides the foundation and starting point for caritative caring ethics in clinical practice. The ultimate purpose and goal of caring are to guarantee the patient's dignity and absolute value as a human being.

Intensive care unit dignified care: Development and validation of a questionnaire.

Patient dignity is sometimes neglected in intensive care unit (ICU) settings, which may potentially cause psychological harm to critically ill patients. However, no instrument has been specifically developed to evaluate the behaviors of dignified care among critical care nurses. This study aimed to develop and evaluate ICU Dignified Care Questionnaire (IDCQ) for measurement of self-assessed dignity-conserving behaviors of critical care nurses during care. The instrument was developed in 3 phases. Phase 1: item generation; phase 2: a two-round Delphi survey and a readability pilot study; phase 3: cross-sectional survey with model estimation. The questionnaire was evaluated by item analysis, exploratory and confirmatory factor analysis, assessment of internal consistency reliability, and test-retest reliability. The investigation was conducted using a convenience sample of 392 critical care nurses from 6 cities in Zhejiang Province, China, of which 30 participated in the test-retest reliability survey 2weeks later. The study was approved by ethics committee. All participants provided written informed consent before the survey. The questionnaire survey was anonymous. The results showed acceptable reliability and validity of the IDCQ. The 17-item final version questionnaire was divided into 2 dimensions: absolute dignity and relative dignity. These two factors accounted for 62.804% of the total variance, and model fitting results were acceptable. The Cronbach's alpha coefficient of the questionnaire was 0.94, and the test-retest intraclass correlation coefficient (ICC) was 0.88 after 2weeks. This study developed a brief and reliable instrument (IDCQ) to assess dignified care in ICU nursing. It can help critical care nurses identify their behaviors in maintaining patient dignity and discover their deficiencies. It may also serve as a clinical nursing management tool to help reduce patient disrespect experience in ICU.

Factors influencing mental health nurses in providing person-centered care.

Mental health nurses advocate for patients through a person-centered approach because they care for people experiencing mental distress who tend to be limited to exercising their human rights and autonomy through interpersonal relationships. Therefore, it is necessary to provide high-quality person-centered care for these patients by identifying the influencing factors. This study aims to identify the factors affecting mental health nurses in performing person-centered care for patients. This study had a cross-sectional, descriptive-correlational survey design. Nurses (N = 166) working at psychiatric wards in Korea completed an online questionnaire on moral sensitivity, attitudes toward people with mental illness, and person-centered care. The t-test and stepwise multiple regression analysis were used. Ethical approval for the study was obtained from the relevant ethics committee. Moral sensitivity was a significant factor correlating with the provision and perception of person-centered care. Attitudes toward patients had no effect on person-centered care. The predictor variables for the provision of person-centered care (R2 = 0.247) were moral sensitivity (β = 0.33), having a professional qualification (β = 0.19), marital status (β = 0.18), and closed ward (β = -0.15). The predictor variables for the perception of person-centered (R2 = 0.150) care were closed ward (β = -0.25), moral sensitivity (β = 0.23), and marital status (β = 0.18). Mental health nurses can strengthen person-centered care by improving moral sensitivity related to the ethical aspect of nursing and professional competence to address the complex needs of patients. Person-centered care needs to be applied more carefully in closed wards where human rights issues may arise. Through these efforts, the dignity of patients can be protected.

Exploring the characteristics of dignity loss in patients with cancer in North China.

e24132 Background: Patients with cancer experience different degrees of loss of dignity. Exploring the characteristics of dignity loss for patients with cancer is rare in China, but it is of great significance for patients and their families in the whole anti-cancer trajectory. Methods: Inpatients and outpatients with cancer from the Fourth Hospital of Hebei Medical University were enrolled in this study. The Patient Dignity Inventory(PDI) and EORTC Core Quality of Life questionnaire (EORTC QLQ-C30) was used for measuring patients’ dignity loss and quality of life. Spearman’s correlation analysis was conducted to analyze the correlation factors of dignity loss, and the correlation among dignity loss, quality of life and its dimensions. Results: A total of 403 patients with cancers were included in this study. In terms of loss of dignity, 20 patients (4.96%) didn’t report loss of dignity, 295 patients (73.20%) had mild loss of dignity, 78 (19.35%) had moderate and 10(2.48%) had severe loss of dignity. The three most prevalent PDI problems of patients were “experiencing physically distressing symptoms”(146, 36.23%), “Feeling that I am a burden to others” (126，31.27%) and “worrying about future” (114, 28.29%) . Companionship(r = 0.167, P = 0.001), PS(r = 0.392, P < 0.001), diagnosis to investigation time (r = 0.107, P = 0.031), stage of disease (r = 0.279, P < 0.001), stage of treatment (r = 0.333, P < 0.001), surgery and recurrence (r = 0.158, P = 0.001), anxiety (r = 0.612, P < 0.001), depression (r = 0.603, P < 0.001), psychological distress (r = 0.453, P < 0.001), symptom burden (r = 0.421, P < 0.001) and impact on life (r = 0.450, P < 0.001) were positive correlated with loss of dignity. Age (r = -0.134, P = 0.007), occupation (r = -0.124, P = 0.013) were negative correlated with loss of dignity. Loss of dignity and quality of life are significant correlated with each other. Dignity existential distress showed moderate negative correlation with emotional function (r = -0.513, P < 0.001). Dignity symptom distress showed moderate negative correlation with emotional function (r = -0.675, P < 0.001) and social function (r = -0.515，P < 0.001). Dignity symptom distress showed moderate positive correlation with fatigue symptoms (r = 0.541, P < 0.001). Conclusions: Most cancer patients’ dignity were impaired slightly or moderately in North China. Dignity of cancer patients showed significant association with quality of life. Anxiety and depression were more consistent with dignity than other factors. Improving the quality of life and dignity of patients is vital.

An Audit of the DNACPR Policy at Malta's Mount Carmel Hospital

AimsA consideration for patient dignity in end-of-life care dictates that good clinical judgment should be exercised in advance resuscitation decisions. The COVID-19 pandemic, and its inherent risks to caregivers, only adds to this importance. Our aim was to audit the standards for the DNACPR policy at Mount Carmel Hospital (MCH), which is Malta's major inpatient psychiatric hospital, against those at Saint Vincent De Paule Residence (SVPR), which is a long-term care facility where DNACPR decisions are taken by geriatricians as opposed to psychiatrists.MethodsResuscitation status designation and rates of form completion were measured in the five chronic psychiatric inpatient wards at MCH. This 98-patient population was compared against an age-matched cohort from SVPR to evaluate differences in decision-making.Medical comorbidities and frailty scores (measured using the Clinical Frailty Scale) were compared between the two groups. As far as age-groups would allow, as many patients with a psychiatric comorbidity as possible were included from SVPR (36).Z-score testing for two population proportions was used to evaluate the differences in resuscitation status designation. The Independent Sample T-Test was used to compare means in medical comorbidity and frailty. A p-value of <0.05 was used to assume statistical significance.ResultsRates of resuscitation form completion were 73.47% and 94.90% in MCH and SVPR, respectively. In those patients with completed documentation, 9.72% of patients were designated as “Not for CPR” in MCH, compared to 61.29% in SVPR.Between these two age-matched cohorts, the mean frailty score was slightly greater in SVPR, which was not statistically significant (5.83 vs 5.48, p = 0.1456). The mean number of medical comorbidities was significantly greater in the SVPR cohort (3.50 vs 2.47, p = 0.0002).ConclusionThis striking difference in DNACPR designation suggests that geriatricians have a higher threshold for determining whether a patient would benefit from CPR compared to psychiatrists. Furthermore, rates of resuscitation form completion at MCH were disappointing. The greater likelihood for chronic psychiatric inpatients to be designated “For CPR” may be due to the perception that this entails a higher level care. In reality, in older, frailer patients, CPR may only prolong suffering, while a “Not for CPR” decision does not necessarily imply an omission of care.In Malta, we've tailored resuscitation training to the inpatient psychiatry setting, which includes stations on decision-making and COVID-19.

Perceived Dignity of Advanced Cancer Patients and Its Relationship to Sociodemographic, Clinical, and Psychological Factors.

ObjectiveLoss of dignity is one of the main reasons for wishing for an early death in patients with incurable diseases such as cancer and is strongly associated with psychological distress and loss of quality of life. The present study aims to analyze the perceived dignity of patients with advanced cancer undergoing systemic treatment and their relationship with sociodemographic, clinical, and psychological factors.MethodsA prospective, cross-sectional, multicenter study was conducted in 15 oncology departments in Spain. Patients with locally advanced, unresectable, or metastatic cancer who were candidates for systemic treatment were included. Participants completed demographic information and Palliative Patients’ Dignity Scale, Brief Symptom Inventory, Mental Adjustment to Cancer, Functional Social Support Questionnaire, and Illness Uncertainty.ResultsA total of 508 patients were recruited between February 2020 and October 2021. Most were male, aged > 65 years, with digestive tumors (41%), and metastatic disease at diagnosis. Subjects were classified as having low (56%, N = 283) or high (44%, N = 225) perceived dignity. Patients ≥ 65 years, with worse baseline status (ECOG ≥ 1), and worse estimated 18-month survival had lower levels of perceived dignity. People with lower perceived dignity scored higher for anxious preoccupation and hopelessness and lower for positive attitude. They also displayed higher levels of anxiety, depression, and somatic symptoms, greater uncertainty, and less social support.ConclusionSelf-perceived dignity in advancer cancer patients is significantly associated with psychological factors, psychological distress, uncertainty, less social support. Knowledge of these specific interactions is importance for adequate, comprehensive palliative care.

Caregivers' perception of teenagers' dignity in end of life stages: A phenomenological study.

Introduction: Maintaining patient dignity in a caregiving environment is one of the most important moral responsibilities for caregivers. Nonetheless, there are vulnerable groups, specifically teenagers, who in their final stages of life are prone to their dignity being threatened. Moreover, dignity is an abstract concept and there is no studies done on teenagers' dignity in the final stages of life available in Iran.Purpose: The purpose of this study is to describe the caregivers' experiences regarding teenagers' dignity in the final stages of life.Research design: This study is a descriptive phenomenological qualitative research project. The data was collected using deep individual and semi-structured interviews as well as taking notes. The Colaizzi analysis method was used to analyze the data.Participants and research context: 22 caregivers working with teenagers in the final stages of life in a public health centers in Iran who had the criteria to enter the study were selected using a purposeful sampling method and invited to join the study from August 2018 to June 2019. The sampling continued until data saturation.Findings: The findings of the present study were presented in the form of three main themes including "private," "respecting individual identity," and "attention to teenagers' needs" and an additional eight categories.Ethical Considerations: The study's protocol was approved by the Research Ethics Committee of the Shiraz University of Medical Sciences and all ethical principles were followed throughout the study.Discussion and conclusion: Based on the present study from the caregivers' point of view, teenagers in their final stages of life required to be cared for and taught in an environment that their privacy was maintained and their individual identity was respected as well as getting attention from the caregivers and companions. In such situations, the teenagers felt calm and their dignity was maintained; therefore, providing a cultural, professional, and organizational setting where all the components of maintaining dignity in teenagers are supported and prioritized is necessary.

Digital photography in the evaluation and management of female patients with congenital adrenal hyperplasia: A standardized protocol for quality improvement

Digital photography can be securely stored in the medical record and enhance documentation of physical exam findings and monitor wound healing. A standardized protocol that respects the dignity of the patient and maintains the fidelity of objective documentation is needed for patients with differences in sexual development (DSD) and congenital adrenal hyperplasia (CAH). The purpose of this study was to evaluate the feasibility, acceptability, and applications of a HIPAA-compliant digital photography protocol in the care of female patients with CAH. A protocol for standardized digital imaging including consent, permission, data capture, and storage in the electronic medical record (EMR) was implemented. Patients undergoing physical examination during multidisciplinary CAH clinic visits, preoperative evaluation, and postoperative follow-up from October 2020 through May 2021 were included. Male patients with CAH, patients with clitoromegaly or urogenital sinus not from CAH, and patients seen through telehealth were excluded. Consent was obtained from caregivers and permission from patients. Images of the exam were taken during clinic visits or at the time of surgery with no identifying features included. Images were directly uploaded into the patient's chart in the HIPAA-protected EMR separate from other clinical documentation and not stored on personal devices. There were 17 patients with CAH seen with median age 6 years (range 2 weeks-18 years). There was a median of 3 photos per patient during the study period with cooperation from both the patient and their caregiver. Amongst the patients seen, 6 patients underwent reconstruction with a median of 10 photos per patient. Images were available and used for preoperative planning and counseling. Patients with previous images did not require repeat examinations and were subjected to fewer genital examinations. Fewer providers were present during exams. Images taken by providers and caregivers during the postoperative period were used to monitor wound healing and surgical outcomes. Protocol implementation improved patient care by reducing the number of exams and number of providers present, enhancing clinical documentation, and providing a means of tracking the physical exam over time. This was in concordance with guidelines for limiting exams for patients with DSD and CAH. Implementation of best practices for medical photography was important in respecting patient dignity and confidentiality. Implementation of standardized digital photography was feasible and acceptable to patients and caregivers. Digital images reduced the need for repeat physical examination and provided a visual means of enhancing clinical documentation.

The association between frailty and dignity in community-dwelling older people

BackgroundThe population of people aged 60 and older is rapidly increasing in developing countries such as Iran due to declining birth rates and increased life expectancy. Old age is associated with increased risk for frailty and reduced dignity. Frailty is a clinical syndrome characterized by depletion of physical reserves and multiple system disorders, reducing the individual’s ability to cope with stressful events. Dignity is an inherent characteristic of human beings and respecting dignity is an ethical principle. This study investigated the association of frailty with dignity among older people in Tehran, Iran.MethodsThis correlational study was conducted on 200 individuals aged 60 years and older. Data collection relied on the Demographic Questionnaire, Frailty Index for Elders (FIFE) and the Patient Dignity Inventory (PDI). Data were analyzed with SPSS 25.ResultsThe mean age of the participants was 68 ± 5.05 years; 62% of the participants were at risk for frailty, and 69% had few dignity-related problems. The multiple regression results showed that frailty was significantly associated with dignity (ß = 0.571, p < 0.001). The association was significant across all the dimensions of dignity measured by the PDI. The highest predictors of frailty included dependency (ß = 0.584, p < 0.001), followed by existential distress (ß = 0.560, p < 0.001), symptom distress (ß = 0.400, p = 0.400), social support (ß = 0.391, p < 0.001), and peace of mind (ß = 0.338, p < 0.001) in dignity.ConclusionsThe results show that higher levels of frailty in older people are associated with decreases in their dignity, and frailty was the leading predictor of dignity. Providers should develop programs to prevent and reduce frailty in those at risk and to enhance the dignity of the already frail.

Dignity and time perspective: A pilot explorative study in cancer patients.

This study investigated the possible correlation between emotional distress linked to dignity and dysfunctional temporal orientations in the oncological context. We conducted an exploratory study between December 2020 and February 2021, referring to a sample of 107 patients in active treatment for solid tumors belonging to the Oncology Department of the Fondazione Poliambulanza (Brescia, Italy). We administered two self-report questionnaires: the Patient Dignity Inventory (PDI-IT) (Italian version, Grassi L, Costantini A, Caruso R, et al. (2017) Dignity and psychosocial-related variables in advanced and nonadvanced cancer patients by using the patient dignity inventory-Italian version. Journal of Pain and Symptom Management 53(2), 279-287), as a measure of perceived level of dignity, and the Italian version of the Zimbardo Time Perspective Inventory scale (ZTPI) (Zimbardo PG and Boyd JN (2009) Il paradosso del tempo. La nuova psicologia del tempo che cambierà la tua vita. Milano: Mondadori), as a measure of the experiential dimensions of time, such as past, present, and future. From the PDI-IT emerged that our sample reported high levels of physical and psychological distress. Furthermore, we founded higher distress in patients under 55 years (p = 0.04) and lower distress in retired patients (p = 0.01). The ZTPI showed in our patients prevailing orientations to the past-positive (39.3%) and the future (37.4%). We noticed a gender difference: men were mainly oriented to the future while women to the past-positive. Moreover, married subjects reported a prevalent orientation to past-positive and the future. Finally, data analysis found moderate positive correlation between the "Negative Past" dimension of ZTPI and high levels of physical (r = 0.203, p = 0.03) and psychological distress (r = 236, p = 0.01). In our experience in oncology, dignity and time perspective play a central role as indicators of the quality of care. Our study shows the importance of a treatment path that integrates the constructs of Dignity and Time Perspective to favor a better psychological adaptation.

Patient dignity and dignified care: A qualitative description of hospitalised older adults perspectives.

The aim of this study was to explore older adults' perspectives about dignity and dignified nursing care during acute hospitalisation in Ghana. Maintaining hospitalised older adults' dignity is an essential component of nursing care and one of the most important determinants of wellbeing. To date, no study has been published on older adults' perspectives of dignified nursing care in the African context. A qualitative descriptive research design. Twenty hospitalised older adults were purposively selected from the medical and surgical wards of a teaching hospital in Ghana. Data were gathered through semi-structured interviews between April and August, 2021, and analysed using reflexive thematic analysis techniques. The SRQR checklist was used to document reporting of the study. The following four themes were identified: Effective nurse-patient communication, Maintaining patients' privacy, Respectful and compassionate care provision and Providing quality and safe care. Dignity was preserved when patients were treated with respect and compassion, provided privacy, and had close family members involved in physical care. Identified barriers to dignity included inadequate information about their health condition, poor communication by the nurses, lack of autonomy, poorly designed healthcare infrastructure and inadequate privacy. Several enablers and barriers to dignified nursing care have been identified that have been discussed in previous studies. The unique factors identified in the Ghanaian context were family members' involvement in physical care influenced by cultural and religious beliefs, environmental barriers to privacy and dignity and inadequate involvement in decision making. Nurses must treat older patients with respect, educate them about the health condition, involve them in care decisions, and identify their preferences regarding provision of hygiene needs, particularly in consideration of religious and cultural beliefs, including involvement of family members. Future planning of healthcare infrastructure needs to consider the importance of private cubicles with disability-accessible ensuite bathrooms for patients' comfort and privacy.

Current Status of Fear of Disease Progression in Patients with Advanced Cancer and Usefulness of Dignity Therapy Intervention.

With changes in lifestyle and an increase in bad health habits, cancer has become a noncommunicable and frequently occurring disease that poses a serious threat to human life. Cancer is associated with high rates of morbidity and mortality worldwide. As a major negative life event, advanced malignancies lead to strong mood swings in most patients. Furthermore, various internal and external factors can have a huge impact on patients' physical and mental health and put them in a stressful situation, causing a series of psychological stress responses. To explore the degree of fear of disease progression in patients with advanced cancer and the usefulness of dignity therapy. Overall, 120 patients with advanced malignant tumors admitted to Shijiazhuang No. 1 hospital between January 2019 and January 2020 were enrolled. The selected patients were divided into the test and control groups (60 people per group) using a random number table. All patients received basic treatment. Patients in the trial group also received dignity therapy. The intervention period was 4 weeks. Simplified scales were used for assessing disease progression (FoP-Q-SF) and quality of life (QLQ-C30) before and after the intervention, and the scores were compared between the groups. After the intervention, the degree of fear in the experimental group was lower than that of the control group. Cognitive function, emotional function, and the scores of the overall health status of the experimental group were higher than those of the control group. Additionally, the scores of fatigue, insomnia, loss of appetite, and diarrhea in the experimental group were lower than those of the control group (P < 0.05). The social support level scale scores, depression scores, hospital anxiety and depression scale scores, and patient dignity inventory scores of the experimental group were lower than those of the control group (P < 0.05). Patients with advanced malignant tumors have fear, anxiety, and depression related to disease progression. Dignity therapy is useful for improving the patients' quality of life, increasing dignity, and enhancing social support.

Development and Calibration of the PREMIUM Item Bank for Measuring Respect and Dignity for Patients with Severe Mental Illness.

Most patient-reported experience measures (PREMs) are paper-based, leading to a high burden for patients and care providers. The aim of this study was to (1) calibrate an item bank to measure patients’ experience of respect and dignity for adult patients with serious mental illnesses and (2) develop computerized adaptive testing (CAT) to improve the use of this PREM in routine practice. Patients with schizophrenia, bipolar disorder, and major depressive disorder were enrolled in this multicenter and cross-sectional study. Psychometric analyses were based on classical test and item response theories and included evaluations of unidimensionality, local independence, and monotonicity; calibration and evaluation of model fit; analyses of differential item functioning (DIF); testing of external validity; and finally, CAT development. A total of 458 patients participated in the study. Of the 24 items, 2 highly inter-correlated items were deleted. Factor analysis showed that the remaining items met the unidimensional assumption (RMSEA = 0.054, CFI = 0.988, TLI = 0.986). DIF analyses revealed no biases by sex, age, care setting, or diagnosis. External validity testing has generally supported our assumptions. CAT showed satisfactory accuracy and precision. This work provides a more accurate and flexible measure of patients’ experience of respect and dignity than that obtained from standard questionnaires.

How staying in a single room affects the experiences of haematology inpatients in an Australian cancer hospital.

It has been suggested that single rooms for patients improve patient dignity and privacy and reduce infection transmission, but they can be socially isolating. It is not well understood how single rooms affect long-stay patients. To understand the experience of being an inpatient in a ward with single-room design. A qualitative, phenomenological study was conducted using semi-structured interviews with patients (n=10) in a newly built cancer hospital with a 100% single-room haematology ward. Interviews were analysed using Colaizzi's (1978) seven-step analysis. Patients described their experiences of their acute stay using the concepts of privacy, isolation and independence, as well as enabling sleep. Privacy enabled patients to have their own toilet, was perceived to aid infection control and provided silence. Privacy came at a cost of isolation, but patients re-framed this as expected and necessary for self-preservation. Furthermore, they were unsure as to whether other patients would reciprocate social contact and instead relied on the healthcare team. Patients sought independence during their acute stay as it enabled them to control the environment and create a space for healing. The ability to sleep and be rested was also a critical feature of patients' stay. The research highlighted that haematology patients prefer single rooms. However, because they experienced isolation, it also highlighted the importance of facilitating and enabling peer support within the haematology setting.

"What do I need to know about you?": the Patient Dignity Question, age, and proximity to death among patients with cancer.

PurposeThe Patient Dignity Question (PDQ), “What do I need to know about you as a person to give you the best care possible?” is a validated instrument designed to assess patient priorities and stressors. Administration of the PDQ has been demonstrated to improve patient-provider relationships. The PDQ has been evaluated in multiple settings, but never as a standard component of palliative care consultation. The primary objectives of this study were to determine the feasibility of PDQ screening in palliative care consultation and to characterize responses. The secondary objective was to determine patient and disease factors associated with PDQ response among patients diagnosed with cancer.MethodsPDQ responses were collected from 2015 to 2017, and patient survival data collected through 2018. A codebook was developed to categorize responses using literature review and template analysis; coding was performed until thematic saturation was achieved. We descriptively analyzed thematic distribution among responders and performed multivariable multinomial regression to determine the association between patient characteristics and PDQ response.ResultsResponse to the PDQ was documented in 2053/5002 consultations (41.1%); 1877 patient responses were included in final analysis. A total of 544 (29.5%) patients referenced illness-related concerns, 879 (46.8%) shared personal insights, and 283 (15.1%) cited interpersonal relationships. Younger patients frequently reported illness-related concerns; older respondents (age > 65) often responded with insights into their identity. Patients’ responses evaluated less than 1 year before death were more likely to focus upon identity and interpersonal relationships than illness-related concerns.ConclusionThe PDQ can be used as a means of eliciting values among patients with cancer. Variations in response pattern suggest that approaches to distress may be tailored to age and proximity to death.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-022-06938-2.