The DOI matches its Crossref record; 43 of the 45 references it cites were found in a registry or an index.
Dignity in the terminally ill: a developing empirical model
Abstract
Despite use of the term dignity in arguments for and against a patient's self-governance in matters pertaining to death, there is little empirical research on how this term has been used by patients who are nearing death. The objective of this study was to determine how dying patients understand and define the term dignity, in order to develop a model of dignity in the terminally ill. A semi-structured interview was designed to explore how patients cope with their advanced cancer and to detail their perceptions of dignity. Interviews were audiotaped and transcribed verbatim. A consecutive sample of 50 consenting patients with advanced terminal cancer were recruited over a 15-month period of time from an urban extended care hospital housing a specialized unit for palliative care. This unit provides both inpatient services. and coordinates end-of-life care community based programming. Data were analysed using latent content analysis and constant comparison techniques. Four members of the research team independently coded the transcribed data, to develop conceptually meaningful categories of responses. Operational definitions were written for major categories, themes and sub-themes. Three major categories emerged from the qualitative analysis, including illness-related concerns; dignity conserving repertoire; and social dignity inventory. These broad categories and their carefully defined themes and sub-themes form the foundation for an emerging model of dignity amongst the dying. The concept of dignity and the dignity model offer a way of understanding how patients face advancing terminal illness. This will serve to promote dignity and the quality of life of patients nearing death.
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“Dignity therapy is based on a theoretical model of dignity in the terminally ill [3] and its purpose is to reduce dignity-related distress while enhancing hope and meaning [4].”
From Feasibility, acceptability and potential effectiveness of dignity therapy for family carers of people with motor neurone disease (2014) · cites this paper as [3]
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Items 101–200 of 733
Dignity Amidst Liminality: Healing Within Suffering Among Chinese Terminal Cancer Patients
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“They included problems in maintaining a sense of control, loss of dignity, diminished life satisfaction, concern for the future, hopelessness, and loss of meaning ~Dunkel-Schetter et al., 1992; Cohen et al., 1996, 1997; Chochinov et al., 1998, 2002; Street & Kissane, 2001!.”
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Dignity-based approaches in the care of terminally ill patients
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“These factors included functional capacity, cognitive acuity, symptom management, and alleviation of psychological distress.(18) Furthermore, anguish about medical uncertainty (i.”
BackgroundMaintaining patients’ dignity during clinical care: a qualitative interview study
Lin, Y., & Tsai, Y. (2010) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2010.05498.x · Cited by 60
Family Presence During Resuscitation: Canadian Critical Care Nurses’ Perspectives
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“30 See in particular Chochinov (2006), Chochinov et al. (2002, 2009).”
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“One particular aspect, the patient’s perception of dignity, has been shown to be influenced by the type of interaction that occurs between the ill person and others [40].”
BackgroundPatient dignity and its related factors in heart failure patients
Bagheri, H., Yaghmaei, F., Ashktorab, T., & Zayeri, F. (2012) · Nursing Ethics · doi:10.1177/0969733011425970 · Cited by 57
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“Although it may seem intangible, therapeutic presence markedly shapes and informs the tone of care.(8,35) It requires clinicians to draw on deeply held personal qualities, such as being compassionate and empathic, being respectful and nonjudgmental, being genuine and authentic, being trustworthy, and manifesting these…”
BackgroundSelf-citationWhite, P. T., White, S., Edmonds, P. M., Gysels, M., Moxham, J., Seed, P. T., & Shipman, C. (2011) · British Journal of General Practice · doi:10.3399/bjgp11x578043 · Cited by 59
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“developed an empirical model of dignity to understand how patients face an advancing terminal illness [13].”
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“Via interviews with older hospice patients in Canada, Chochinov and his colleagues [11, 12] developed an empirical model of dignity that identifies three major categories of physical, psychosocial and existential issues pertaining to one’s experience of dignity at life’s end.”
BackgroundSelf-citationTesting the feasibility of the Dignity Therapy interview: adaptation for the Danish culture
Houmann, L. J., Rydahl‐Hansen, S., Chochinov, H. M., Kristjanson, L. J., & Grøenvold, M. (2010) · BMC Palliative Care · doi:10.1186/1472-684x-9-21 · Cited by 58
“Dignity Therapy (DT) was developed by Chochinov and colleagues based on their previous research on the concept of dignity [2-4].”
Self-citationEngaging Homeless Persons in End of Life Preparations
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“In brief, the document includes elements necessary to construct a legal advance directive in Minnesota (29), addresses higher-level needs identified by Chochinov’s dignity-conserving care model (30, 31), and incorporates specific adaptations to meet the basic needs of homeless persons as identified by other empirical…”
BackgroundA comprehensive review of palliative care in patients with cancer
Jaiswal, R., Alici, Y., & BREITBART, W. S. (2014) · International Review of Psychiatry · doi:10.3109/09540261.2013.868788 · Cited by 53
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“Conversely, undignified care can have an unfavourable impact on the patient’s recovery such as leading to depression, loss of will to live (Chochinov et al., 2002) and feelings of worthlessness (Jacobson, 2009).”
BackgroundPeriyakoil, V. S., Noda, A. M., & KRAEMER, H. C. (2010) · Journal of Palliative Medicine · doi:10.1089/jpm.2009.0279 · Cited by 52
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“This measure has also been used in studies of palliative care patients [11–13] and care home residents [14].”
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“Social relationships and interactions between individuals and groups can promote or hinder a person’s sense of dignity [25, 30].”
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Johnston, B. M., Larkin, P. J., Connolly, M., Barry, C., Narayanasamy, M. J., Östlund, U., & McIlfatrick, S. (2015) · Journal of Clinical Nursing · doi:10.1111/jocn.12791 · Cited by 51
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“Dignity therapy is based on a theoretical model of dignity in the terminally ill [3] and its purpose is to reduce dignity-related distress while enhancing hope and meaning [4].”
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“pointed out that as advancing illness fluctuates in its clinical presentation, perceptions of dignity may be similarly dynamic and subject to change [17].”
Morir con dignidad. Estudio sobre voluntades anticipadas
Nebot, C., Ortega, B., Mira, J. J., & Ortíz, L. (2010) · Gaceta Sanitaria · doi:10.1016/j.gaceta.2010.09.006 · Cited by 50
“Excluidos solicitantes no pertenecientes a confesión religiosa expresamente declarada (n1⁄4244) Deseo de una muerte digna 244 (100) Consta deseo de limitar el esfuerzo terapéutico 242 (99,2) Solicitud de los fármacos necesarios para aliviar el dolor 240 (98,4) Dona órganos para trasplantes 126 (51,6)”
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Harstäde, C. W., Blomberg, K., Benzein, E., & Östlund, U. (2017) · Scandinavian Journal of Caring Sciences · doi:10.1111/scs.12433 · Cited by 50
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“The therapist conducts an interview, which is based on the dignity model[2].”
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Coenen, A., Doorenbos, A. Z., & Wilson, S. A. (2007) · Oncology nursing forum · doi:10.1188/07.onf.1151-1156 · Cited by 52
“Third, the researchers grouped the themes of nursing actions into the major conceptual construct categories of the Dignity-conserving care model (chochinov, 2002; chochinov et al., 2002).”
The Patient Dignity Inventory: Applications in the Oncology Setting
Chochinov, H. M., McClement, S., Hack, T. F., McKeen, N. A., Rach, A. M., Gagnon, P. R., Sinclair, S., & Taylor‐Brown, J. (2012) · Journal of Palliative Medicine · doi:10.1089/jpm.2012.0066 · Cited by 47
“The dignity model identifies a multitude of issues affiliated with life-threatening and life-limiting illness, 20–22, 24– 27 with The goal of this study was to place the PDI in the hands of psychosocial oncology professionals, to determine its role within actual clinical practice.”
Self-citationHALL, S. L., Goddard, C., Speck, P. W., Martin, P., & Higginson, I. J. (2012) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2012.03.009 · Cited by 47
HALL, S. L., Chochinov, H. M., Harding, R., Murray, S. A., Richardson, A. M., & Higginson, I. J. (2009) · BMC Geriatrics · doi:10.1186/1471-2318-9-9 · Cited by 47
“An empirically-based model of dignity has been developed from interviews with hospice patients [4], which forms the basis of a brief psychotherapy to help promote dignity and reduce distress at the end of life [5].”
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Self-citationHow patients with cancer experience dignity: An integrative review
Xiao, J., Ng, M. S. N., Yan, T., Chow, K. M., & Chan, C. W. H. (2021) · Psycho-Oncology · doi:10.1002/pon.5687 · Cited by 46
“Chochinov, Hack, McClement, et al.(26) Canada 3 Semi‐structured interviews and analyzed using latent content analysis and constant comparison techniques sample: 50 terminally ill cancer patients 3 categories with 9 themes and 15 subthemes: Illness‐related concerns; dignity conserving repertoires and social dignity inv…”
BackgroundMethodInfluentialYun, Y. H., Kim, S.-H., Lee, K. M., Park, S. M., Lee, C. G., Choi, Y. S., Lee, W. S., Kim, S.-Y., & Heo, D. S. (2006) · European Journal of Cancer · doi:10.1016/j.ejca.2006.04.010 · Cited by 45
Effects of dignity therapy on terminally ill patients: a systematic review
Donato, S. C. T., Matuoka, J. Y., Yamashita, C. C., Salvetti, M. D. G., & Instituto do Câncer do Estado de São Paulo, B. (2016) · Revista da Escola de Enfermagem da USP · doi:10.1590/s0080-623420160000700019 · Cited by 45
Dignity and Its Influencing Factors in Patients with Cancer in North China: A Cross-Sectional Study
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“Dignity is thus not only potentially affected by the disease but also by personal characteristics, experienced distress, relational and societal interactions, professional and social support [7,10,11].”
BackgroundÖstlund, U., Blomberg, K., Söderman, A., & Harstäde, C. W. (2019) · BMC Palliative Care · doi:10.1186/s12904-019-0393-x · Cited by 43
“A short explanation of the theme is given [19, 20], followed by the results of suggested care actions.”
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Alleviating existential distress of cancer patients: can relational ethics guide clinicians?
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“See Chochinov, Hack, Hassard, et al. (2002) and Chochinov (2002).”
InfluentialPatients’ Dignity and Its Relationship with Contextual Variables: A Cross-Sectional Study
Zirak, M., Ghafourifard, M., & Mamaghani, E. A. (2017) · Journal of Caring Sciences · doi:10.15171/jcs.2017.006 · Cited by 42
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“It was not until the emergence of Chochinov’s empirical model of dignity-conserving care that has brought greater clarity to the conceptual and practical knowledge of dignity in end-of-life contexts, as this body of work has served as the foundation to guide quality palliative care practices as well as subsequent dign…”
BackgroundDignity in end‐of‐life care at hospice: An Action Research Study
Viftrup, D. T., Hvidt, N. C., & Prinds, C. (2020) · Scandinavian Journal of Caring Sciences · doi:10.1111/scs.12872 · Cited by 42
Crafting Life Stories in Photocollage: An Online Creative Art-Based Intervention for Older Adults
Keisari, S., Piol, S., Elkarif, T., Mola, G., & Testoni, I. (2021) · Behavioral Sciences · doi:10.3390/bs12010001 · Cited by 42
“Dignity Therapy is a brief form of narrative psychotherapy used with clients approaching the end of life [58,59].”
BackgroundInfluentialDying, Death, and the Afterlife in Human-Computer Interaction. A Scoping Review.
Albers, R., Sadeghian, S., Laschke, M., & Hassenzahl, M. (2023) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3544548.3581199 · Cited by 48
“an integral part of dying in dignity [24].”
BackgroundVulnerability, Disability, and Palliative End-of-Life Care
Stienstra, D., & Chochinov, H. M. (2006) · Journal of Palliative Care · doi:10.1177/082585970602200307 · Cited by 41
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UK Views toward Breastfeeding in Public
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Dignifying and undignifying aspects of care for people with dementia: a narrative review
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Managing Pain From Advanced Cancer in the Palliative Care Setting
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“Care also includes psychological, social, and spiritual well-being, and key elements of the assessment are presented with suggestions for intervention (Chochinov, Hack, McClement, Kristjanson, & Harlos, 2002; Covinsky et al., 1994; Daaleman & VandeCreek, 2000; Lo et al., 2002; Rando, 2000).”
Human Dignity in Paediatrics: The Effects of Health Care
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“These burdens are associated with loss of dignity [2, 3].”
BackgroundKittelson, S. M., Scarton, L. J., Barker, P. C., Hauser, J. M., O’Mahony, S., Rabow, M. W., Delgado-Guay, M. O., Quest, T. E., Emanuel, L. L., Fitchett, G. A., et al. (2018) · JMIR Research Protocols · doi:10.2196/12213 · Cited by 40
“We took the items from the DT Patient Feedback Questionnaire that has been used in a number of studies of DT [50].”
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Patient Control and End-of-Life Care Part II: The Patient Perspective
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Evaluation of the Dignity Care Pathway for community nurses caring for people at the end of life
Johnston, B. M., Östlund, U., & Brown, H. K. (2012) · International Journal of Palliative Nursing · doi:10.12968/ijpn.2012.18.10.483 · Cited by 39
Dignified dying: phenomenon and actions among nurses in India
Doorenbos, A. Z., Wilson, S. A., Coenen, A., & Borse, N. N. (2006) · International Nursing Review · doi:10.1111/j.1466-7657.2006.00458.x · Cited by 39
“In this sample, only 7.5% of the participants expressed that loss of dignity was of great concern; however, this finding should be interpreted with the understanding that all participants were receiving expert palliative care (Chochinov et al. 2002a).”
MethodResultInfluentialDefining dignity in end-of-life care in the emergency department
Fernández‐Sola, C., Cortés, M. M. D., Hernández‐Padilla, J. M., Torres, C. J. A., Terrón, J. M. M., & Granero‐Molina, J. (2015) · Nursing Ethics · doi:10.1177/0969733015604685 · Cited by 39
“This coincides with our theoretical framework, where continuity of oneself and autonomy for self-care are elements in the conservation of dignity.(27,28) In line with our theoretical framework,(29,31) our results highlight care environment, professional actions and socio-family context as attributes of dignity.”
ResultPeriyakoil, V. S., KRAEMER, H. C., & Noda, A. M. (2009) · Journal of Palliative Medicine · doi:10.1089/jpm.2009.0123 · Cited by 39
Existential distress in advanced cancer: A cohort study
Philipp, R., Walbaum, C., Koch, U., Oechsle, K., Daniels, T., Helmich, F., Horn, M., Junghans, J., Kissane, D. W., Lock, G., et al. (2025) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2025.02.023 · Cited by 39
Oosterveld‐Vlug, M., Pasman, H. R. W., van Gennip, I. E., de Vet, H. C. W., & Onwuteaka-Philipsen, B. D. (2014) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-12-17 · Cited by 38
“By now, there is a substantial amount of knowledge on how patients nearing death [15-17] and older people in nursing homes [18-22] understand the concept of dignity.”
BackgroundLiving with dying: a hermeneutic phenomenological study of the work of hospice nurses
Evans, M. J., & Hallett, C. E. (2007) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2006.01620.x · Cited by 38
Respecting the privacy of hospitalized patients: An integrative review
Tehrani, T. H., Maddah, S. S. B., Fallahi‐Khoshknab, M., Ebadi, A., Shahboulaghi, F. M., & Gillespie, M. (2018) · Nursing Ethics · doi:10.1177/0969733018759832 · Cited by 38
A systematic scoping review on patients’ perceptions of dignity
Chua, K. Z. Y., Quah, E. L. Y., Lim, Y. X., Goh, C. K., Lim, J., Wan, D. W. J., Ong, S. M., Chong, C. S., Yeo, K. Z. G., Goh, L. S. H., et al. (2022) · BMC Palliative Care · doi:10.1186/s12904-022-01004-4 · Cited by 41
“Subdomain 2: The individual ring Dignity is conserved by sustaining their cognitive abilities [7, 83, 90–92, 96, 97, 102–105, 108, 118, 124, 132, 137, 139–143], autonomous function [6, 78, 79, 83, 88, 89, 92, 93, 96–99, 102, 103, 107, 108, 110, 111, 114, 122, 124, 138, 144–151] and independence in personal care [78, 8…”
BackgroundInfluentialA feasibility study of Dignity Psychotherapy delivered via telemedicine
Passik, S. D., Kirsh, K. L., LEIBEE, S., KAPLAN, L. S., Love, C. L., NAPIER, E., Burton, D. C., & Sprang, R. (2004) · Palliative & Supportive Care · doi:10.1017/s1478951504040209 · Cited by 38
“…that enhance or detract from one’s sense of dignity!. Dignity Psychotherapy is a newly developed intervention based on an empirical model of dignity in the dying, derived from research conducted by Dr. Harvey Chochinov’s group over the last 5 years ~Chochinov, 2002; Chochinov et al., 2002a, 2002b!.”
BackgroundMethodInfluentialThinking Outside the Box: Depression, Hope, and Meaning at the End of Life
Chochinov, H. M. (2003) · Journal of Palliative Medicine · doi:10.1089/109662103322654893 · Cited by 38
Self-citationSpecialist palliative care: patients’ experiences
Seymour, J. E., Ingleton, C., Payne, S. A., & Beddow, V. (2003) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.2003.02764.x · Cited by 38
Rullán, M., Carvajal, A., Núñez-Córdoba, J. M., Martínez, M., Carrasco, J. M., García, I. A., Arantzamendi, M., Belar, A., & Centeno, C. (2015) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2015.07.016 · Cited by 37
Integrative and complementary therapies for patients with advanced cancer.
Marchand, L. R. (2014) · PubMed · doi:10.3978/j.issn.2224-5820.2014.07.01 · Cited by 38
“Although acceptability of the intervention and perceived benefit are measured in non RCTs, effect on outcome measures is less than robust in randomized control trials of the intervention (68-71).”
BackgroundCrucial dimensions constituting dignity experience in persons living with dementia
Tranvåg, O., Petersen, K. A., & Nåden, D. (2014) · Dementia · doi:10.1177/1471301214529783 · Cited by 37
“Through reading various theoretical works concerning dignity, like Nordenfelt (2004), Jacobson (2009), and Chochinov and collegues (Chochinov et al., 2002, 2006; Chochinov, 2008), our preunderstandings on various perspectives of the phenomenon increased.”
Backgroundvan Gennip, I. E., Pasman, H. R. W., Oosterveld‐Vlug, M., Willems, D. L., & Onwuteaka-Philipsen, B. D. (2015) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2015.06.010 · Cited by 37
Chochinov, H. M., & McKeen, N. A. (2011) · doi:10.1002/9780470975176.ch8 · Cited by 37
Self-citationHastening Death Through Voluntary Cessation of Eating and Drinking
Chabot, B. E. (2012) · Cambridge University Press eBooks · doi:10.1017/cbo9780511843976.027 · Cited by 36
Altruism in terminal cancer patients and rapid tissue donation program: does the theory apply?
Quinn, G. P., Murphy, D., Pratt, C., Muñoz-Antonia, T., Guerra, L. G., Schabath, M. B., Leon, M. E., & Haura, E. B. (2013) · Medicine Health Care and Philosophy · doi:10.1007/s11019-013-9480-6 · Cited by 36
“Humans have an innate desire to perform actions that benefit the greater good of mankind, even if these actions will not be realized until after their death (Erikson 1959; Chochinov et al. 2002; Schwartz et al. 2003).”
Promoting dignified end-of-life care in the emergency department: A qualitative study
Díaz‐Cortés, M. D. M., Granero‐Molina, J., Hernández‐Padilla, J. M., Pérez‐Rodríguez, R., Correa‐Casado, M., & Fernández‐Sola, C. (2017) · International Emergency Nursing · doi:10.1016/j.ienj.2017.05.004 · Cited by 37
Personality, neuroticism, and coping towards the end of life.
Chochinov, H., Kristjanson, L., Hack, T., Hassard, T., Mcclement, S., & Harlos, M. (2006) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2006.05.011 · Cited by 29
Self-citationPalliative care for vulnerable populations
Stienstra, D., & Chochinov, H. M. (2012) · Palliative & Supportive Care · doi:10.1017/s1478951511000563 · Cited by 35
“One model that looks beyond the physical needs of the patient and includes their whole self and their humanity is dignity-conserving care (Chochinov, 2002; Chochinov et al., 2002).”
BackgroundSelf-citationLiu, X., Liu, Z., Cheng, Q., Xu, N., Liu, H., & Ying, W. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05732-2 · Cited by 35
The Development of an Instrument To Measure Factors that Influence Self-Perceived Dignity
Oosterveld‐Vlug, M., de Vet, H. C. W., Pasman, H. R. W., Rurup, M. L., & Onwuteaka-Philipsen, B. D. (2011) · Journal of Palliative Medicine · doi:10.1089/jpm.2010.0513 · Cited by 35
“In the dignity model, the ‘‘dignity-conserving repertoire’’ forms a buffer between ‘‘illness-related concerns’’ and ‘‘social dignity inventory’’ on the one hand and ‘‘dignity’’ on the other hand (19).”
InfluentialEvaluating the psychometric properties of the Jacelon Attributed Dignity Scale
Jacelon, C. S., & Choi, J. (2014) · Journal of Advanced Nursing · doi:10.1111/jan.12372 · Cited by 35
“Three instruments to measure dignity at the end of life were identified (Chochinov et al. 2002, Chochinov et al. 2008, Periyakoil et al. 2010, Albers et al. 2011, Vlug et al. 2011).”
BackgroundEnd of Life in Nursing Homes: Experiences and Policy Recommendations
Wetle, T. T., Teno, J. M., Shield, R. R., Welch, L. C., & Miller, S. C. (2004) · Cited by 35
Metadata
- Authors
- Chochinov, H. M., Hack, T., McClement, S., Kristjanson, L., & Harlos, M.
- Affiliations
- CancerCare Manitoba (CA)
- University of Manitoba (CA)
- Edith Cowan University (AU)
- St. Boniface Hospital (CA)
- Corresponding author
- Chochinov, Harvey Max
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2002-02
- Volume
- 54
- Issue
- 3
- Pages
- 433-443
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2015893364
- Cited by
- 733
- References
- 45
- Citations by year
- 2026: 34 · 2025: 37 · 2024: 31 · 2023: 30 · 2022: 34 · 2021: 38 · 2020: 34 · 2019: 25 · 2018: 28 · 2017: 40 · 2016: 35 · 2015: 30 · 2014: 30 · 2013: 39 · 2012: 30
- FWCI
- 19.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Online (Edith Cowan University) (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- eSpace (Curtin University) (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion)
- Funders
- University of Manitoba
- Topics
- Health Sciences › Nursing › Issues, ethics and legal aspects › Patient Dignity and Privacy
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- human dignity, dying patients, advanced cancer, end-of-life care, palliative care, patient perspectives, coping with terminal illness, social dignity, quality of life
- MeSH terms
- Activities of Daily Living, Adaptation, Psychological, Anecdotes as Topic, Attitude to Death, Family Relations, Humans, Interviews as Topic, Manitoba, Neoplasms, Professional-Patient Relations, Quality of Life, Right to Die, Skilled Nursing Facilities, Terminal Care, Cost of Illness, Terminally Ill
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