title: Dignity in the terminally ill: a cross-sectional, cohort study.
abstract: BACKGROUND
  Considerations of dignity are often raised in reference to the care of dying patients. However, little research that addresses this issue has been done. Our aim was to identify the extent to which dying patients perceive they are able to maintain a sense of dignity, and to ascertain how demographic and disease-specific variables relate to the issue of dignity in these individuals.
  
  
  METHODS
  We did a cross-sectional study of a cohort of terminally ill patients with cancer, who had a life expectancy of less than 6 months. We enrolled 213 patients from two palliative care units in Winnipeg, Canada, and asked them to rate their sense of dignity. Our main outcome measures included: a 7-point sense of dignity item; the symptom distress scale; the McGill pain questionnaire; the index of independence in activities of daily living (IADL); a quality of life scale; a brief battery of self-report measures, including screening for desire for death, anxiety, hopelessness, and will to live; burden to others; and requirement for social support.
  
  
  RESULTS
  16 of 213 patients (7.5%; 95% CI 4-11) indicated that loss of dignity was a great concern. These patients were far more than likely than the rest of the cohort to report psychological distress and symptom distress, heightened dependency needs, and loss of will to live.
  
  
  CONCLUSIONS
  Loss of dignity is closely associated with certain types of distress often seen among the terminally ill. Preservation of dignity should be an overall aim of treatment and care in patients who are nearing death.
authors.affiliation: Department of Psychiatry, University of Manitoba, Winnipeg, Canada. chochin@cc.UManitoba.CA
authors.forename: Harvey Max
authors.initials: HM
authors.lastname: Chochinov
authors.forename: Thomas
authors.initials: T
authors.lastname: Hack
authors.forename: Thomas
authors.initials: T
authors.lastname: Hassard
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Kristjanson
authors.forename: Susan
authors.initials: S
authors.lastname: McClement
authors.forename: Mike
authors.initials: M
authors.lastname: Harlos
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008350:Manitoba; D009369:Neoplasms; D010166:Palliative Care; D011788:Quality of Life; D012297:Right to Die; D011795:Surveys and Questionnaires