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Dignity and Quality of Life

Key Messages

  • Quality of life (QoL) is an important component of the social, psychological, psychiatric, and spiritual aspects of palliative care. [1,2] QoL in palliative care includes the concepts of compassionate care and of dying with dignity. [2-4]
  • Anxiety, depression, and pain can erode QoL [2,5] and palliative care has been shown to be associated with improvements in QoL. [6,7]
  • Certain comprehensive geriatric assessments (CGAs) help identify the needs and preferences of older people receiving palliative care in residential aged care facilities. [8]
  • Evidence suggests that dignity therapy is beneficial for older people at end-of-life and for their family and carers. [9]
  • Companion animals may have a positive impact on the well-being and QoL of people receiving palliative care. [10]

Background

Quality of life (QoL) is implicit in the definition of palliative care as recognised by The World Health Organization (2018): "Palliative care is an approach that improves the quality of life for patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual." [2,11]

QoL in palliative care includes the concepts of compassionate care and of dying with dignity. [2-4] Dignity is related to personal identity and feelings of value and self-worth. [1] Compassion and compassionate care have particular relevance to the psychological and spiritual issues at the end-of-life and can be important in the appeasement of suffering. [3]
 

Evidence Summary

Dignity and QoL are complex and subjective and will each mean different things to different people. They include physical, social, psychological and spiritual well-being, and feelings of value and self-worth. Quality of life (QoL) in palliative care includes the concepts of compassionate care and of dying with dignity. [1,5]

Palliative care has been shown to be associated with improvements in QoL and symptom burden of people receiving palliative care. However, outcomes for carers are inconclusive and poorly represented in high-quality literature. [6,7]

Care planning and clear, respectful and empathetic communication can contribute positively to the sense of dignity and the quality of life of people receiving palliative care. [4,7,12,13] Also important are correct and timely assessment and management of physical symptoms (particularly pain), psychological symptoms (particularly anxiety and depression) and spiritual needs. [5-7]

The sense of dignity is readily influenced by a number of external factors. Care plans which address the areas of life on which a person’s dignity is based can readily contribute to an improved quality of life. [1] Dignity therapy is a brief individualised psychotherapy which offers people an opportunity to reflect on issues that are important to them or other things that they would like to recall or transmit to others. [9,14,15] Dignity therapy, developed in 2002, has been shown to be well-accepted by older adults at the end of their life and for their family and carers. [9,14,15] Evidence suggests that dignity therapy can raise levels of meaning of life, quality of life and spiritual well-being of residents in aged care. However, an effect on lowering depression or distress has not been clearly demonstrated. [9,14,15]

In the assessment of palliative care for residents of aged care facilities, five comprehensive geriatric assessments (CGAs) were reviewed in a meta-analysis. [8] The McMaster Quality of Life Scale (MQLS) was shown to have strong validity and reliability. The interRAI Palliative Care instrument covers all domains of the Guidelines for A Palliative Approach to Residential Aged Care and demonstrated high inter-rater reliability and suitability as a care planning tool. The Palliative Care Outcome Scale (POS) was shown to be a suitable instrument to assess not only patients who are cognitively able to participate but also people with moderate or severe dementia. [8]
 

Quality Statement

Overall, the evidence (from guidelines, systematic reviews (SRs), integrative reviews and a narrative review) is of good to high quality.


Page updated 10 January 2018

  • References

  • About PubMed Search

  1. Rodriguez-Prat A, Monforte-Royo C, Porta-Sales J, Escribano X, Balaguer A. Patient Perspectives of Dignity, Autonomy and Control at the End of Life: Systematic Review and Meta-Ethnography. PLoS One. 2016 Mar 24;11(3):e0151435.
  2. van Groenestijn AC, Kruitwagen-van Reenen ET, Visser-Meily JM, van den Berg LH, Schroder CD. Associations between psychological factors and health-related quality of life and global quality of life in patients with ALS: a systematic review. Health Qual Life Outcomes. 2016 Jul 20;14(1):107.
  3. Sinclair S, Norris JM, McConnell SJ, Chochinov HM, Hack TF, Hagen NA, et al. Compassion: a scoping review of the healthcare literature. BMC Palliat Care. 2016;15:6.
  4. Guo Q, Jacelon CS. An integrative review of dignity in end-of-life care. Palliat Med. 2014 Jul;28(7):931-40.
  5. McDonald R, Chow E, Rowbottom L, Bedard G, Lam H, Wong E, et al. Quality of life after palliative radiotherapy in bone metastases: A literature review. J Bone Oncol. 2014 Nov 18;4(1):24-31 eCollection 2015 Mar.
  6. Kavalieratos D, Corbelli J, Zhang D, Dionne-Odom JN, Ernecoff NC, Hanmer J, et al. Association between palliative care and patient and caregiver outcomes: A systematic review and meta-analysis. JAMA. 2016 Nov 22;316(20):2104-14.
  7. McCusker M, Ceronsky L, Crone C, Epstein H, Greene B, Halvorson J, et al. Palliative care for adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Nov.
  8. Hermans K, De Almeida Mello J, Spruytte N, Cohen J, Van Audenhove C, Declercq A. A comparative analysis of comprehensive geriatric assessments for nursing home residents receiving palliative care: a systematic review. J Am Med Dir Assoc. 2014 Jul;15(7):467-76.
  9. Martínez M, Arantzamendi M, Belar A, Carrasco JM, Carvajal A, Rullán M, et al. ‘Dignity therapy’, a promising intervention in palliative care: A comprehensive systematic literature review. Palliat Med. 2017 Jun;31(6):492-509.
  10. MacDonald JM, Barrett D. Companion animals and well-being in palliative care nursing: a literature review. J Clin Nurs. 2016 Feb;25(3-4):300-10.
  11. World Health Organization (WHO). WHO Definition of Palliative Care. 2018 [cited 2018 Jan 09].
  12. Ostlund U, Brown H, Johnston B. Dignity conserving care at end-of-life: a narrative review. Eur J Oncol Nurs. 2012 Sep;16(4):353-67.
  13. Johnston B, Larkin P, Connolly M, Barry C, Narayanasamy M, Ostlund U, et al. Dignity-conserving care in palliative care settings: An integrative review. J Clin Nurs. 2015 Jul;24(13-14):1743-72.
  14. Bentley B, O'Connor M, Shaw J, Breen L. A Narrative Review of Dignity Therapy Research. Aust Psychol. 2017 Oct;52(5):354-62.
  15. Fitchett G, Emanuel L, Handzo G, Boyken L, Wilkie DJ. Care of the human spirit and the role of dignity therapy: a systematic review of dignity therapy research. BMC Palliat Care. 2015 Mar 21;14:8. doi: 10.1186/s12904-015-0007-1. eCollection 2015.

Dignity and quality of life

Definitions

Quality of life: Mesh 

A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral, social environment as well as health and disease.

Caresearch

The goal of palliative care is to provide comfort. It also helps to maintain the highest possible quality of life. The term ‘quality of life’ is used a lot. It will mean different things to different people.

Quality of life often includes:

  • being comfortable and pain free

  • being able to socialise or spend time with loved ones

  • having as much independence as possible

  • not feeling you are a burden

  • feeling emotionally well.

Search

(personhood[majr] OR humanism[majr] OR quality of life[majr] OR dignity[ti] OR quality of life[ti])