title: Loss of Dignity in Severe Chronic Obstructive Pulmonary Disease.
abstract: BACKGROUND
  The maintenance of dignity is an important concept in palliative care, and the loss of dignity is a significant concern among patients with advanced cancer.
  
  
  OBJECTIVE
  The goals of this study were to examine whether loss of dignity is also a concern for patients receiving interdisciplinary rehabilitation for Stage III or IV chronic obstructive pulmonary disease. We examined the prevalence and correlates of loss of dignity and determined whether it improves with treatment.
  
  
  METHODS
  Inpatients underwent a structured interview inquiry around their sense of dignity and completed measures of pulmonary, physical, and psychological function at admission (n = 195) and discharge (n = 162).
  
  
  RESULTS
  Loss of dignity was identified as a prominent ongoing concern for 13% of patients. It was correlated with measures of depression and anxiety sensitivity, but not with pulmonary capacity or functional performance. A robust improvement in loss of dignity was demonstrated, with 88% of those who reported a significant problem at admission no longer reporting one at discharge.
  
  
  CONCLUSIONS
  The prevalence of a problematic loss of dignity among patients with severe chronic obstructive pulmonary disease is at least as high as among those receiving palliative cancer care. Loss of dignity may represent a concern among people with medical illnesses more broadly, and not just in the context of "death with dignity" at the end of life. Furthermore, interdisciplinary care may help to restore a sense of dignity to those individuals who are able to participate in rehabilitation.
authors.affiliation: School of Psychology, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: brahm.solomon@gmail.com.
authors.forename: Brahm K
authors.initials: BK
authors.lastname: Solomon
authors.affiliation: Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada.
authors.forename: Keith G
authors.initials: KG
authors.lastname: Wilson
authors.affiliation: Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Henderson
authors.affiliation: Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Poulin
authors.affiliation: Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Kowal
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: McKim
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005080:Exercise Test; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D028723:Personhood; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation; D057566:Self Report; D012720:Severity of Illness Index; D013147:Spirometry
keywords: Loss of dignity; anxiety; chronic obstructive pulmonary disease; depression; rehabilitation