A Study Of Dignity Amidst Chinese Terminal Cancer Patients

Objective:1. To examine the concept of the dignity in Chinese context, in an effort to offer better dignity conserving care, and explore the generalisability of the Dignity Model to terminal cancer patients in WUHAN, China.2. To explore the issue of advanced cancer patients’ dignity from the perspective of medical staff, comparing similarities and differences of the understanding of dignity between medical staff and patients with terminal cancer, in order to provide better medical care services.3. According to the Dignity Model in Chinese context,try to revise the Patient Dignity Inventory(PDI). To investigate the dignity of hospitalized patients with terminal cancer in a tertiary hospital and its branch in WUHAN and test the reliability and validity of PDI.Methods:1. Qualitative Research: the semi-structured interviews were used to explore the concept of dignity among patients with terminal cancer and medical staff in the Oncology Department. The analysis was Giorgi method, and refined the themes.2. Expert Consultation Method: clinicians, nursing experts, psychologists, and etc were invited to evaluate the content validity of PDI.3. Questionnaire Survey Method: convenient sampling method was used and inpatients with terminal cancer were included. A questionnaire, including the31-item PDI, a Seven-point Sense of Dignity Item, and basic demographic information, was distributed to eligible participants.Results:1. Qualitative research among 21 terminal cancer patients: the three categories of Dignity Model were broadly supported. However, the sub-theme of cognitive acuity was not supported, while theme of privacy boundaries differently in Chinese context. Furthermore, new emergent themes include stigma, Q spirit,family support, medical support, financial support, and informed care decision.2. Qualitative research among 15 medical staff: patient dignity included three categories: individual factors, interpersonal factors and social factors, themes include level of independence, personal appearance, physical distress, anxiety,personal needs, hopefulness, resilience, care tenor, right to be informed, autonomy,privacy boundaries, knowledge and skills, medical environment, social support,family support, information support.3. The cross-sectional study: two hundred sixty-nine terminal cancer patients completed the study. Cronbach’s alpha coefficient for the 31-item PDI was 0.950. The split-half reliability was 0.872. The I-CVIs were from 0.78 to 1.00 and S-CVI/Ave was 0.965. The PDI significantly correlated with the Seven-point Sense of Dignity Item(r = 0.457; p < 0.001). Factor analysis showed five factors accounting for 65.507% of the variance. Factors were labeled development distress, spiritual distress, physical symptoms, social support, and emotional distress.4. The patient dignity: base on the analysis of the data, the mean of the PDI was53.91. The mean of the items were from 1.10 to 2.86. The patient dignity was different because of religion, the health state of caregiver and income, and the differences were statistically significant(p < 0.05).Conclusions:1. These findings add to our understanding of the concerns of Chinese terminal cancer patients on dignity and suggest that Dignity Model is also applicable to terminal cancer patients in Chinese context, while we should form a culturally sensitive dignity conserving care. The roles of families and social groups should be lit up. The attitude towards cancer disclosure should be changed from "respect the views of family members" to "respect the rights of patients".2. The medical staff should pay more attention to the patient dignity. The hospitals should not only increase the training of knowledge and skills but also increase the humanities training.3. The medical staff should be good at stimulating Dignity Conserving Repertoire:help patients learn to accept the way things are; instruct patients to maintain a sense of pride; encourage patients to review their life; help patients to maintain normal life and seek spiritual and mental comfort. Understanding each patient and provide personalized health care services.4. The revised 31-item PDI showed adequate psychometric properties when tested with terminal cancer patients in WUHAN, China. While investigations of wide samples and areas need to be further studied.