Conceptualizations of dignity at the end of life: exploring theoretical and cultural congruence with dignity therapy

Aim. To explore the conceptualization of patients' dignity in the context of end-of-life care in Taiwan. Background. Dignity therapy a novel nurse-delivered psychotherapeutic intervention has been demonstrated to have potential to alleviate terminal patients' psycho-existential distress in western countries. In Taiwan, over half of end-of-life patients experience psychological-spiritual suffering and dignity therapy might be helpful in improving this situation. Hence, a preliminary study to clarify Taiwanese conceptualizations of 'dignity' was conducted prior to planning a feasibility study to gauge the potential cultural fit of an intervention of this type. Design. Qualitative exploration. Methods. Nine people with terminal cancer and ten health professionals were recruited from palliative care services in 2008. In-depth interviews were audiotaped and transcribed verbatim. A hermeneutic approach was employed to analyse and interpret data. Findings. Being a valuable person is the core meaning of patients' dignity and this comprised intrinsic characteristics and extrinsic factors. Intrinsic characteristics of dignity encompassed living a moral life, having peace of mind and a sense of existence involving the perception of resignation to God's will. Extrinsic factors that influenced patients' dignity included illness related distress, care delivery and the perception of being loved, A dynamic relationship between these elements determined the state of patients' dignity. Conclusion. The concept of dignity is culturally bound and understood differently in the Chinese and Western context; such differences should be considered when planning and delivering care, Modifications should be made to dignity therapy to ensure it is culturally congruent with Taiwanese patients' beliefs.