title: Dignity and Distress towards the End of Life across Four Non-Cancer Populations.
abstract: OBJECTIVE
  The purpose of this study was to identify four non-cancer populations that might benefit from a palliative approach; and describe and compare the prevalence and patterns of dignity related distress across these diverse clinical populations.
  
  
  METHODS
  A prospective, multi-site approach was used.
  
  
  METHODS
  Outpatient clinics, inpatient facilities or personal care homes, located in Winnipeg, Manitoba and Edmonton, Alberta, Canada.
  
  
  METHODS
  Patients with advanced Amyotrophic Lateral Sclerosis (ALS), Chronic Obstructive Pulmonary Disease (COPD), End Stage Renal Disease (ESRD); and the institutionalized alert frail elderly.
  
  
  METHODS
  In addition to standardized measures of physical, psychological and spiritual aspects of patient experience, the Patient Dignity Inventory (PDI).
  
  
  RESULTS
  Between February 2009 and December 2012, 404 participants were recruited (ALS, 101; COPD, 100; ESRD, 101; and frail elderly, 102). Depending on group designation, 35% to 58% died within one year of taking part in the study. While moderate to severe loss of sense of dignity did not differ significantly across the four study populations (4-11%), the number of PDI items reported as problematic was significantly different i.e. ALS 6.2 (5.2), COPD 5.6 (5.9), frail elderly 3.0 (4.4) and ESRD 2.3 (3.9) [p < .0001]. Each of the study populations also revealed unique and distinct patterns of physical, psychological and existential distress.
  
  
  CONCLUSIONS
  People with ALS, COPD, ESRD and the frail elderly face unique challenges as they move towards the end of life. Knowing the intricacies of distress and how they differ across these groups broadens our understanding of end-of-life experience within non-cancer populations and how best to meet their palliative care needs.
authors.affiliation: Department of Psychiatry, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.|Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada.
authors.forename: Harvey Max
authors.initials: HM
authors.lastname: Chochinov
authors.affiliation: Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Wendy
authors.initials: W
authors.lastname: Johnston
authors.affiliation: Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada.|College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Susan E
authors.initials: SE
authors.lastname: McClement
authors.affiliation: College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Hack
authors.affiliation: George and Fay Yee Center for Healthcare Innovation, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Brenden
authors.initials: B
authors.lastname: Dufault
authors.affiliation: Department of Psychiatry, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Murray
authors.initials: M
authors.lastname: Enns
authors.affiliation: Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada.|College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Thompson
authors.affiliation: Winnipeg Regional Health Authority, Palliative Care Program, Winnipeg, Canada.
authors.forename: Mike
authors.initials: M
authors.lastname: Harlos
authors.affiliation: Division of Pulmonary Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Damant
authors.affiliation: Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.|Community Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Clare D
authors.initials: CD
authors.lastname: Ramsey
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sara
authors.initials: S
authors.lastname: Davison
authors.affiliation: Community Health Sciences, University of Manitoba, Winnipeg, Canada.|Section of Nephrology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Zacharias
authors.affiliation: CapitalCare, Edmonton, Canada.|Faculty of Nursing, University of Alberta, Edmonton, Canada.|Department of Psychology, University of Alberta, Edmonton, Canada.
authors.forename: Doris
authors.initials: D
authors.lastname: Milke
authors.affiliation: Geriatric Medicine, University of Manitoba, Winnipeg, Canada.|Geriatrics Program, Winnipeg Regional Health Authority, Winnipeg, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Strang
authors.affiliation: Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada.|Interdisciplinary Cancer Control, Faculty of Health Sciences, Faculty of Graduate Studies, University of Manitoba, Winnipeg, Canada.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Campbell-Enns
authors.affiliation: Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada.|Department of Psychology, University of Manitoba, Winnipeg, Canada.
authors.forename: Maia S
authors.initials: MS
authors.lastname: Kredentser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000523:psychology; D016330:Frail Elderly; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology; D010166:Palliative Care; D028723:Personhood; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology; D012944:Social Support; D013315:Stress, Psychological