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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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“, physical, existential, functional, spiritual, psychological, and social facets) that are commonly encountered by patients with terminal illnesses, as derived from the dignity model (Chochinov et al., 2002).”
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“” These are consistent with research on the perceptions of dignity among terminally ill individuals (Chochinov, Hack, McClement, Kristjanson, & Harlos, 2002 ; see also Chochinov, Hack, Hassard et al, 2002 ).”
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“For example, Chochinov et al. (2002) constructed a dignity model, and Chinese academics Wu et al. (2015) discussed the applicability of the dignity model in China.”
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“4 While there has been a body of research by Chochinov 29 and others on dignity therapy and legacy interventions, there are overall few intervention studies of those testing models of spiritual care delivery.”
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“Chochinov and colleagues, 14 using semistructured interviews and content analysis, identified categories, themes and subthemes for inventorying dignity among the dying.”
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“Indeed, an emerging empirical model of ‘‘dignity in terminal illness’’ is comprised of tight interaction of hedonic as well as nonhedonic elements (Chochinov et al. 2002).”
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“The PDI-CZ , the Czech version of the PDI developed by Chochinov et al., 32 is a self-assessment screening tool assessing the issues affecting patient dignity.”
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“Both questions were based on an adapted model of Chochinov, considering it as part of the context of preserving the repertoire of dignity (Chochinov et al. 2002), i.e., within the framework of the Social Dignity Inventory, which includes the perception of oneself as a burden (Chochinov et al. 2002).”
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Self-citationFactors Associated With Distress Related to Perceived Dignity in Patients With Rheumatic Diseases
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“Preserving patient dignity, or respect for personhood, during serious or terminal illness, such as advanced cancer, is a critical aspect of high-quality palliative care [1,2].”
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“…narration should foster role preservation, encourage a sense of self-continuity, facilitate a reflection on integrity across the lived life, allow expression of generativity toward important others, and a sense one’s influence will transcend death through others (Chochinov et al. 2002).”
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“…analyze the relationship between self-perceived burden and the level of dignity and the meaning of life for disabled patients, this study used Chochinov et al.’s (2002b) dignity model as the theoretical basis, taken the meaning of life as the independent variable, the level of dignity as the…”
White, M., Canick, J. E., Mowery, Y. M., Rocke, D. J., Ramos, K., & Osazuwa‐Peters, N. (2025) · Palliative & Supportive Care · doi:10.1017/s1478951524002049 · Cited by 4
“Physician-documented goals of care discussions – including conversations about prognosis, treatments, and palliation – have been shown to correlate with comfort care utilization (Vukkadala et al. 2021).”
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“’s model.(52) Thus participants will be able to express their ‘dignity in action,’(53) having control of their own narrative through values-based change-making, while also making a difference to the lives of others.”
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“The therapeutic process begins with a framework of questions (panel 1) that are based on an empirical model of dignity in the terminally ill patient.(4,5) These conversations, guided by a trained therapist, are flexible to accommodate the patients’ needs and choices about what they specifically wish to address.”
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Cancer cachexia and its impact on patient dignity: What nurses need to know
McClement, S. (2016) · Asia-Pacific Journal of Oncology Nursing · doi:10.4103/2347-5625.189808 · Cited by 4
Self-citationAging Meaningfully: The Ethics of Existential Suffering for Older Adults in Healthcare
Tsai, G. (2024) · Canadian Journal of Bioethics · doi:10.7202/1112285ar · Cited by 3
Demoralization and dignity loss in breast cancer: A network analysis and computer simulation study
Xiong, Y., Li, H., Cai, K., Yu, M., Zhou, J., Li, J., Knobf, M. T., & Ye, Z. (2025) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2025.100803 · Cited by 3
“30 Within this framework, dignity is conceptualized as a product of dynamic interactions among psychological, physical, and social variables.”
Human Flourishing Until the End: The Core Values of Palliative Care
Rodríguez‐Prat, A., & Monforte‐Royo, C. (2022) · Springer eBooks · doi:10.1007/978-3-031-09786-7_9 · Cited by 3
Choo, P. Y., Tan-Ho, G., Low, X. C., Patinadan, P. V., & Ho, A. H. Y. (2024) · Palliative & Supportive Care · doi:10.1017/s147895152300202x · Cited by 3
Gill, G. K., Pankratz, L., Pirzada, S., Papineau, K., Hensel, J. M., Bolton, J. M., Kredenster, M. S., El-Gabalawy, R. M., Rivière, C. L., Hiebert, T., et al. (2025) · Death Studies · doi:10.1080/07481187.2025.2514162 · Cited by 4
“…worthy of honor, respect and esteem, our studies of dignity in the terminally ill have determined multiple influences—ill-ness related, socially mediated, and psychologically and existentially determined—that uphold or undermine patients’ sense of dignity (Chochinov, 2002; Chochinov et al. 2002).”
Self-citationDeath and dying in residential care: a matter of concern
Smith, R. L. (2013) · Quality in Ageing and Older Adults · doi:10.1108/qaoa-01-2013-0001 · Cited by 3
End-of-Life Care: Issues Relevant to the Geriatric Psychiatrist
Lyness, J. M. (2007) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/foc.5.4.foc459 · Cited by 3
Noh, H. (2017) · Journal of Applied Gerontology · doi:10.1177/0733464817709531 · Cited by 3
Sinnbasierte Interventionen bei fortgeschritten erkrankten Patienten
Schulz‐Kindermann, F., & Vehling, S. (2017) · Der Onkologe · doi:10.1007/s00761-017-0281-z · Cited by 3
“Er befragte Schwerstkranke und Sterbende in zahlreichen Interviews und zeichnete in systematischer Weise deren Bedürfnisse auf, die insbesondere die Wertschätzung der eigenen Lebensgeschichte betrafen [5].”
Backgroundde Boer, A. F., de Voogd, X., Meershoek, A., & Suurmond, J. (2021) · Palliative & Supportive Care · doi:10.1017/s147895152100050x · Cited by 3
“physicians’ views on dignity as a more static model (Chochinov et al., 2002; Van Gennip et al., 2013) does not yet capture the interactive nature of dignity-conserving palliative care.”
BackgroundLin, J., Zhao, Y., & Guo, Q. (2022) · European Journal of Cancer Care · doi:10.1111/ecc.13670 · Cited by 3
Perceptions of bereaved family members of nursing care on an inpatient hospice palliative care unit
Maze, C., Wilkinson, C., Stajduhar, K., Daudt, H., & Tysick, S. (2022) · International Journal of Palliative Nursing · doi:10.12968/ijpn.2022.28.9.406 · Cited by 3
Palliative Care Support in People Experiencing Homelessness
Shulman, C. E., & Hudson, B. F. (2024) · Springer eBooks · doi:10.1007/978-3-319-31738-0_124-1 · Cited by 3
Chapter 6. Sociocultural Factors and Gender
Shear, K. M., Halmi, K. A., Widiger, T. A., & Boyce, C. A. (2007) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9780890427668.lg06 · Cited by 3
End of life decisions and practices : the experiences of doctors in Australia
Trankle, S. A. (2013) · Cited by 3
The ‘placement’ of people with profound impairments across the lifespan: re-thinking age criteria
Gibson, B. E., King, G. A., Kingsnorth, S., & McKeever, P. D. (2014) · BMC Medicine · doi:10.1186/1741-7015-12-83 · Cited by 3
“The latter two provisions are necessary but insufficient conditions that reduce persons to objects of care and fail to address their inherent dignity qua human beings [56].”
BackgroundCómo afrontar mejor las pérdidas en cuidados paliativos
Wilson Astudillo, A., Mendinueta, C., & Casado, A. (2007) · Hispana · Cited by 3
Vaghee, S., Javadi, A. R., Mazlom, S., Davoudi, N., & Gharavi, M. M. (2013) · Majallah-i dānishkadah-i parastārī va māmāyī-i Mashhad. · doi:10.22038/ebcj.2013.1083 · Cited by 3
Clinical counseling and applied psychotherapy in supportive oncology
Kissane, D. W., & Doolittle, M. N. (2011) · Elsevier eBooks · doi:10.1016/b978-1-4377-1015-1.00054-0 · Cited by 3
PATIENT DIGNITY AND RELATED FACTORS: A QUALITATIVE META-SYNTHESIS STUDY
Bagheri, H., Yaghmaei, F., & Tahereh, A. (2011) · Cited by 3
Responding to Requests for Euthanasia and Physician-Assisted Suicide
C, N. P. K. O. (2011) · Elsevier eBooks · doi:10.1016/b978-1-4377-1619-1.00021-4 · Cited by 3
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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