Choo, Ping Ying, Tan-Ho, Geraldine, Dutta, Oindrila ORCID: https://orcid.org/0000-0002-2925-2477, Patinadan, Paul Victor and Ho, Andy Hau Yan (2019) Reciprocal dynamics of dignity in end-of-life care: a multiperspective systematic review of qualitative and mixed methods research. American Journal of Hospice and Palliative Medicine (AJHPM), 37 (5). ISSN 1049-9091 (Print), 1938-2715 (Online) (doi:10.1177/1049909119878860)

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Abstract

Background: Preserving terminally ill patients’ dignity and well-being through dignified and holistic care has become the overarching goal in palliative care services. However, dignity is a multifaceted concept with a wide range of interpretations under different cultural contexts.
Aim: The aim of this review is to understand the variations in subjective interpretations and constitutions of dignity in palliative or end-of-life care via an integrative worldview.
Design: This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and used SPIDER tool to screen for appropriate and relevant articles for analysis.
Data Sources: Four major databases were searched including CINAHL, ERIC, Medline, and PsycARTICLES between 2009 and 2018. Forty-eight qualitative studies that examined dignity from the perspectives of patients, family caregivers, and health-care professionals were selected for full text data analysis using thematic synthesis.
Results:Analysis of the various concepts of dignity revealed 18 themes that were further categorized into 7 conceptual categories: (1) self-determination, (2) existential liberty, (3) relational connectedness, (4) caregiving revitalization, (5) mindful humanity, (6) patient–family care, and (7) sustainable culture. These 7 categories span across individual, familial, and institutional dimensions, forming a new Dynamic Reciprocity of Dignity model.
Conclusions: The Dynamic Reciprocity of Dignity model highlights the importance of adopting a systemic lens to address dignity-related needs and concerns at the end of life, while providing insights on how compassionate care and self-compassion can serve as the foundation of dignified care, which in turn serve as a buffer against patients’ existential suffering as well as caregivers’ burnout and fatigue. Recommendations for clinical practice and future research directions are discussed.

Item Type:	Article
Uncontrolled Keywords:	dignity, end-of-life, palliative care, self-compassion, compassionate care, dynamic reciprocity of dignity
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > R Medicine (General) R Medicine > RT Nursing
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Vulnerable Children and Families Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	04 Nov 2025 16:00
URI:	https://gala.gre.ac.uk/id/eprint/41732

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