title: Does health status affect perceptions of factors influencing dignity at the end of life?
abstract: BACKGROUND
  More people are surviving into old age, and chronic diseases tend to become more common with age. Ill health and disability can lead to concerns about loss of personal dignity.
  
  
  OBJECTIVE
  To investigate whether health status affects the perceptions of factors influencing personal dignity at the end of life, and the relationship between those perceptions and sociodemographic characteristics.
  
  
  METHODS
  A subsample (n=2282) of a large advance directives cohort study was used. Three different health status groups (good, moderate, and poor) were defined based on the Euroqol-5D and a question on whether they had an illness. For each health status group, we calculated the percentage of respondents who indicated the extent to which the items of the Patient Dignity Inventory would influence their dignity as (very) large. Logistic regression analyses were used to investigate the associations between the perceptions of factors influencing personal dignity and sociodemographics.
  
  
  RESULTS
  The percentage of respondents who indicated the factors as having a (very) large influence on dignity at the end of life were not significantly different for the three health status groups, except for three physical items on symptoms, roles, and routines. Those items were significantly more influential on dignity for people with a poor health status. Gender, old age, having a partner, and having a belief or religion that is important to one's life were associated with an understanding of factors influential to dignity.
  
  
  CONCLUSIONS
  Health status seems only to affect the perceptions of physical factors maintaining dignity at the end of life. This might suggest that the understanding of dignity will not substantially change as health status changes and may support starting advance care planning early.
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. g.albers@vumc.nl
authors.forename: Gwenda
authors.initials: G
authors.lastname: Albers
authors.forename: H Roeline W
authors.initials: HR
authors.lastname: Pasman
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Henrica C W
authors.initials: HC
authors.lastname: de Vet
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D000293:Adolescent; D000328:Adult; D032722:Advance Care Planning / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001294:Attitude to Health; D002908:Chronic Disease / Q000401:mortality* / Q000523:psychology; D006233:Persons with Disabilities; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D029181:Spirituality; D013727:Terminal Care / Q000523:psychology / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000523:psychology; D055815:Young Adult