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Dignity-conserving care for persons with palliative care needs - identifying outcomes studied in research: An integrative review
Örebro University, School of Health Sciences.ORCID iD: 0000-0002-8661-004x
Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
Centre for Collaborative Palliative Care, Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
Örebro University, School of Health Sciences.ORCID iD: 0000-0002-9209-5179
2020 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 18, no 6, p. 722-740Article, review/survey (Refereed) Published
Abstract [en]

OBJECTIVES: With people living longer, palliative care may be required for lengthier periods of time. This puts demands on healthcare organizations to provide optimal palliative care. Maintaining dignity is central for any person's health and quality of life, but especially for a person with palliative care needs. Dignity-conserving care needs to be evaluated to increase knowledge about outcomes and how to assess these. The purpose of this integrative review was to identify outcomes studied within dignity-conserving care and how these have been operationalized.

METHODS: An integrative review was conducted in 26 quantitative or mixed-method studies and study protocols. Thematic synthesis with an abductive approach was used for analysis.

RESULTS: Seven themes of studied outcomes were identified, as well as four cluster themes: themes related to Illness-Related Concerns, themes related to the Dignity-Conserving Repertoire, themes related to the Social Dignity Inventory, and themes regarding Overarching Dignity Issues. Most outcomes studied dealt with Illness-Related Concerns within the themes of "Performance, symptoms and emotional concerns" and "End-of-life and existential aspects". Themes linked to the Social Dignity Inventory had the lowest number of outcomes studied. Outcomes regarding overarching dignity issues such as "Dignity-related distress" and "Quality of life" were common. However, the results lacked concrete communication outcomes.

SIGNIFICANCE OF RESULTS: The results will underpin future research in which dignity-conserving care is implemented and evaluated, and contribute to the provision of evidence-based palliative care. A greater focus on outcomes within cluster themes related to the Dignity-Conserving Repertoire and the Social Dignity Inventory is needed, as is more focus on communication outcomes.

Place, publisher, year, edition, pages
Cambridge University Press, 2020. Vol. 18, no 6, p. 722-740
Keywords [en]
Dignity-conserving care, Human dignity, Outcome assessment, Palliative care, Review
National Category
Nursing
Identifiers
URN: urn:nbn:se:oru:diva-80481DOI: 10.1017/S1478951520000139ISI: 000604909900014PubMedID: 32131926Scopus ID: 2-s2.0-85082091480OAI: oai:DiVA.org:oru-80481DiVA, id: diva2:1413162
Note

Funding Agency:

Research School of Successful Ageing at Örebro University, Örebro, Sweden 

Available from: 2020-03-09 Created: 2020-03-09 Last updated: 2021-09-01Bibliographically approved
In thesis
1. Evaluating the Swedish Dignity Care Intervention within municipality healthcare: for older persons with palliative care needs
Open this publication in new window or tab >>Evaluating the Swedish Dignity Care Intervention within municipality healthcare: for older persons with palliative care needs
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Palliative care in Sweden is not equal in terms of age, disease, and place of care. An essential value within palliative care is dignity, therefore healthcare emphasizing this value must be prioritized. However, older persons are concerned their dignity would not be considered and dignity interventions are rare. The overall aim of the thesis was to evaluate the Swedish Dignity Care Intervention (DCI-SWE) and its implementation within municipal palliative healthcare in order to conserve older persons’ dignity and quality of life. Methods: Qualitative and mixed methods were used. Data were collected with an integrative review (study I), focus group and individual interviews with community nurses (CNs) (studies II, IV), healthcare professionals and managers (study IV), individual interviews with older persons and relatives (study III), reflective diaries and field notes (studies II, IV), and questionnaires measuring older persons’ dignity-related distress and quality of life (study III). Data were analysed using thematic synthesis (study I), inductive content analysis(study II), inductive thematic analysis and comparative statistical analysis (study III), directed content analysis and descriptive statistical analysis (study IV). Results: Within dignity-conserving care, broad outcomes like dignity-related distress and quality of life have been used. However, communication outcomes should also be considered (study I). The DCISWE has clear benefits if it is used with background of who the older person is and with respect of personal needs (studies II - IV). The feasibility of the DCI-SWE depends on the healthcare organization’s engagement and capacity (studies II, IV). The DCI-SWE can support CNs in communicating with older persons (studies II, IV). However, more communication training is needed, and managers leadership is an important component (studies II, IV). The implementation intervention needs further development, and the use of a behavior change model may be beneficial. 

Place, publisher, year, edition, pages
Örebro: Örebro University, 2021. p. 137
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 242
Keywords
Community-based healthcare, Dignity, Evaluation, Implementation, Intervention, Older persons, Palliative care
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-92383 (URN)978-91-7529-380-6 (ISBN)
Public defence
2021-09-17, Örebro universitet, Forumhuset, Hörsal F, Fakultetsgatan 1, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2021-06-16 Created: 2021-06-16 Last updated: 2021-09-01Bibliographically approved

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Söderman, AnnikaBlomberg, Karin

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