Dignity and Distress towards the End of Life across Four Non-Cancer Populations.
Harvey Max Chochinov, Wendy Johnston, Susan E McClement, Thomas F Hack, Brenden Dufault, Murray Enns, Genevieve Thompson, Mike Harlos, Ronald W Damant, Clare D Ramsey, Sara Davison, James Zacharias, Doris Milke, David Strang, Heather J Campbell-Enns, Maia S Kredentser
Author Information
Harvey Max Chochinov: Department of Psychiatry, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Wendy Johnston: Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada.
Susan E McClement: Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada.
Thomas F Hack: College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Brenden Dufault: George and Fay Yee Center for Healthcare Innovation, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
Murray Enns: Department of Psychiatry, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Genevieve Thompson: Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada.
Mike Harlos: Winnipeg Regional Health Authority, Palliative Care Program, Winnipeg, Canada.
Ronald W Damant: Division of Pulmonary Medicine, University of Alberta, Edmonton, Canada.
Clare D Ramsey: Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Sara Davison: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
James Zacharias: Community Health Sciences, University of Manitoba, Winnipeg, Canada.
Doris Milke: CapitalCare, Edmonton, Canada.
David Strang: Geriatric Medicine, University of Manitoba, Winnipeg, Canada.
Heather J Campbell-Enns: Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada.
Maia S Kredentser: Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada.
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. DESIGN: A prospective, multi-site approach was used. SETTING: Outpatient clinics, inpatient facilities or personal care homes, located in Winnipeg, Manitoba and Edmonton, Alberta, Canada. PARTICIPANTS: Patients with advanced Amyotrophic Lateral Sclerosis (ALS), Chronic Obstructive Pulmonary Disease (COPD), End Stage Renal Disease (ESRD); and the institutionalized alert frail elderly. MAIN OUTCOME MEASURE: 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. CONCLUSION: 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.
