Dignity Research

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Despite widespread use of the word “dignity” in health care, there was little empirical research on the subject until the mid-1990s, when a research team led by Dr. Harvey Max Chochinov began exploring the importance of this concept to patients’ quality of life. This research provided the basis for the Dignity Model and practical tools that can be used by workers in health care settings.

The team’s research began in palliative care, which provides an ideal vantage point for understanding the human experience through all phases of life. The findings and tools can be easily transferred to all areas and occupations in the health care system.

This section introduces:

The research trajectory
Dignity research papers
Related research

The research trajectory

Exploration: The origins of dignity research extend back to 1995. The Manitoba Palliative Care Research Unit began exploring the question of why some dying patients wish for death and develop suicidal thoughts, while others with similar symptoms can find some measure of serenity and enjoyment right up to the final days of life.

Theory generation: In 2002, the team conducted qualitative research with cancer patients to identify the various factors that sustain or erode a patient’s sense of dignity. These studies generated an empirically derived Dignity Model in the terminally ill, and direction regarding dignity-conserving care. The team also collected quantitative data to determine how various demographic and disease-specific variables were related to the issue of dignity in the terminally ill.

Intervention and screening tool testing: In 2004 the team began to test practical applications of the research. Interventions such as Dignity Therapy and the Patient Dignity Inventory were developed and piloted .

Knowledge translation: Since 2007 the team has been developing and testing tools to expand the use of dignity theory beyond palliative care. New tools such as the ABCD of Dignity in Care and Patient Dignity Question have been developed and are currently being piloted . The team is now developing learning modules that can be used by healthcare leaders to operationalize the Dignity in Care approach.

Dignity research articles

These articles present research and ideas that led to the Dignity Model, and related tools for more effective interventions in health care. Click on the title to read the summary and link to the full article.

Elements of Dignity

Dignity in the terminally ill: a developing empirical model.
Chochinov HM, Hack T, McClement S, Kristjanson L, Harlos M.
Soc Sci Med. 2002 Feb;54(3):433-43.

Thinking outside the box: depression, hope, and meaning at the end of life.
Chochinov HM.
J Palliat Med. 2003 Dec;6(6):973-7. No abstract available.

Dignity in the terminally ill: a cross-sectional, cohort study.
Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M.
Lancet. 2002 Dec 21-28;360(9350):2026-30.

Defining dignity in terminally ill cancer patients: a factor-analytic approach.
Hack TF, Chochinov HM, Hassard T, Kristjanson LJ, McClement S, Harlos M.
Psychooncology. 2004 Oct;13(10):700-8.

Dignity and the eye of the beholder.
Chochinov HM.
J Clin Oncol. 2004 Apr 1;22(7):1336-40. Review. No abstract available.

Dignity Therapy

Study Protocol for the dignity therapy randomized controlled trial.
Chochinov HM, Kristjanson LJ, Breitbart W, McClement S, Hack T,
Hassard Lancet Oncology. August 2011

Dignity-based approaches in the care of terminally ill patients.
Thompson GN, Chochinov HM.
Curr Opin Support Palliat Care. 2008 Mar;2(1):49-53. Review.

Dignity therapy: family member perspectives.
McClement S, Chochinov HM, Hack T, Hassard T, Kristjanson LJ, Harlos M.
J Palliat Med. 2007 Oct;10(5):1076-82.

Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life.
Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M.
J Clin Oncol. 2005 Aug 20;23(24):5520-5.

Practical Applications in Daily Care

The patient dignity inventory: a novel way of measuring dignity-related distress in palliative care.
Chochinov HM, Hassard T, McClement S, Hack T, Kristjanson LJ, Harlos M, Sinclair S, Murray A. J Pain Symptom Manage. 2008 Dec;36(6):559-71. Epub 2008 Jun 24.

Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care.
Chochinov HM.
BMJ. 2007 Jul 28;335(7612):184-7. No abstract available.

Dignity-conserving care: application of research findings to practice.
McClement SE, Chochinov HM, Hack TF, Kristjanson LJ, Harlos M.
Int J Palliat Nurs. 2004 Apr;10(4):173-9.

Dignity. Dignity? Dignity!
Chochinov HM.
J Palliat Med. 2008 Jun;11(5):674-5

Coping and End-of-Life Care

The landscape of distress in the terminally ill.
Chochinov HM, Hassard T, McClement S, Hack T, Kristjanson LJ, Harlos M, Sinclair S, Murray A.
J Pain Symptom Manage. 2009 Nov;38(5):641-9. Epub 2009 Aug 26.

Improving the quality of spiritual care as a dimension of palliative care: the report of the Consensus Conference.
Puchalski C, Ferrell B, Virani R, Otis-Green S, Baird P, Bull J, Chochinov H, Handzo G, Nelson-Becker H, Prince-Paul M, Pugliese K, Sulmasy D.
J Palliat Med. 2009 Oct;12(10):885-904.

Reducing the potential for suffering in older adults with advanced cancer.
Thompson GN, Chochinov HM.
Palliat Support Care. 2010 Mar;8(1):83-93. Epub 2010 Feb 18.

Prognostic acceptance and the well-being of patients receiving palliative care for cancer.
Thompson GN, Chochinov HM, Wilson KG, McPherson CJ, Chary S, O’Shea FM, Kuhl DR, Fainsinger RL, Gagnon PR, Macmillan KA.
J Clin Oncol. 2009 Dec 1;27(34):5757-62. Epub 2009 Oct 13.

Family satisfaction with care of a dying loved one in nursing homes: what makes the difference?
Thompson GN, Menec VH, Chochinov HM, McClement SE.
J Gerontol Nurs. 2008 Dec;34(12):37-44.

Burden to others and the terminally ill.
Chochinov HM, Kristjanson LJ, Hack TF, Hassard T, McClement S, Harlos M.
J Pain Symptom Manage. 2007 Nov;34(5):463-71. Epub 2007 Jul 5.

Dignity in the terminally ill: revisited.
Chochinov HM, Krisjanson LJ, Hack TF, Hassard T, McClement S, Harlos M.
J Palliat Med. 2006 Jun;9(3):666-72.

Dying, dignity, and new horizons in palliative end-of-life care.
Chochinov HM.
CA Cancer J Clin. 2006 Mar-Apr;56(2):84-103; quiz 104-5. Review.

Interventions to enhance the spiritual aspects of dying.
Chochinov HM, Cann BJ.
J Palliat Med. 2005;8 Suppl 1:S103-15. Review.

Dignity. Dignity? Dignity!
Chochinov HM.
J Palliat Med. 2008 Jun;11(5):674-5. No abstract available.

Understanding the will to live in patients nearing death.
Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M.
Psychosomatics. 2005 Jan-Feb;46(1):7-10.

Dignity and psychotherapeutic considerations in end-of-life care.
Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M.
J Palliat Care. 2004 Autumn;20(3):134-42. Review.

Dignity-conserving care–a new model for palliative care: helping the patient feel valued.
Chochinov HM.
JAMA. 2002 May 1;287(17):2253-60.