Advertisement

Qualitative study on perceived dignity of cancer patients undergoing chemotherapy in China

  • Jinnan Xiao
  • Ka Ming Chow
  • Carmen WH ChanEmail author
  • Minjie Li
  • Ying Deng
Original Article

Abstract

Purpose

Safeguarding the perceived dignity of cancer patients has been recently attracting attention, but its development is constrained by the ambiguous construct of dignity. This study aims to describe the perceived dignity of cancer patients undergoing chemotherapy on the basis of the dignity model and to provide insights into the promotion of dignity-conserving care in China.

Methods

A qualitative descriptive design was conducted with face-to-face, semi-structured, and individual interviews. Consecutive sampling of cancer patients undergoing chemotherapy in a public hospital was conducted. Semi-structured interviews were performed by a registered nurse with experience in palliative care research. Data were analysed using the framework method with inductive and deductive approaches.

Results

Twenty patients aged 28–70 years old completed the interviews. Perceived dignity themes were classified into three categories, namely illness-related concerns, dignity-conserving repertoire, and social dignity inventory. In comparison with the dignity model, social dignity inventory had two added themes: communication openness and financial burden. These themes affect the perceived dignity of Chinese patients.

Conclusions

The perceived dignity of patients can be affected by various issues, including illness, personal attitudes and practices and social environments. Culture and economics considerably affect the construct of dignity among the Chinese population. Family-oriented approaches are recommended to create an environment where patients feel valued, respected and supported. This method will help cancer patients adapt to the changes brought on by their illness and maintain dignity.

Keywords

Cancer Chemotherapy Dignity Qualitative study Chinese 

Notes

Acknowledgements

We wish to acknowledge the patients who shared their experiences and stories, as well as the health care professionals who assisted with the selection of the participants.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (University Survey and Behavioural Research Ethics Committee: SBREC 105-18) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Disclaimer

The authors have full control of all primary data and agree to allow the journal to review the data if requested.

References

  1. 1.
    Chochinov HM (2004) Dignity and the eye of the beholder. J Clin Oncol 22:1336–1340PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Chochinov HM (2002) Dignity-conserving care--a new model for palliative care: helping the patient feel valued. JAMA 287:2253–2260PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Hosseini A, Rezaei M, Bahrami M et al (2017) The relationship between dignity status and quality of life in Iranian terminally ill patients with cancer. Iran J Nurs Midwifery Res 22:178–183PubMedPubMedCentralGoogle Scholar
  4. 4.
    Ferlay J, Soerjomataram I, Dikshit R et al (2014) Cancer incidence and mortality worldwide : sources , methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Burdett S, Pignon J, Tierney J et al (2006) Adjuvant chemotherapy for resected non-small cell lung cancer. Oncology 1:180–187Google Scholar
  6. 6.
    Li HC, Richardson A, Speck P, Armes J (2014) Conceptualizations of dignity at the end of life: exploring theoretical and cultural congruence with dignity therapy. J Adv Nurs 70:2920–2931PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Chochinov HM, Hack T, Hassard T et al (2005) Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol 23:5520–5525PubMedCrossRefGoogle Scholar
  8. 8.
    Branigan M (2015) Desire for hastened death: exploring the emotions and the ethics. Curr Opin Support Palliat Care 9:64–71PubMedCrossRefGoogle Scholar
  9. 9.
    Ganzini L, Nelson HD, Schmidt TA et al (2000) Physicians’ experiences with the Oregon Death with Dignity Act. N Engl J Med 342:557–563PubMedCrossRefGoogle Scholar
  10. 10.
    Georges J, Onwuteaka-philipsen BD, van der Wai G, van der Maas PJ (2006) Requests to forgo potentially life-prolonging treatment and to hasten death in terminally ill cancer patients : a prospective study. J Pain Symptom Manage 31:100–110PubMedCrossRefGoogle Scholar
  11. 11.
    Nissim R, Gagliese L, Rodin G (2009) The desire for hastened death in individuals with advanced cancer : a longitudinal qualitative study. Soc Sci Med 69:165–171PubMedCrossRefGoogle Scholar
  12. 12.
    Anderberg P, Lepp M, Berglund AL, Segesten K (2007) Preserving dignity in caring for older adults: a concept analysis. J Adv Nurs 59:635–643PubMedCrossRefGoogle Scholar
  13. 13.
    Monforte-Royo C, Villavicencio-Chavez C, Tomas-Sabado J et al (2012) What lies behind the wish to hasten death ? A systematic review and meta-ethnography from the perspective of patients. PLoS One 7:e37117PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Sulmasy DP (2013) The varieties of human dignity: a logical and conceptual analysis. Med Heal Care Philos 16:937–944CrossRefGoogle Scholar
  15. 15.
    Pleschberger S (2007) Dignity and the challenge of dying in nursing homes: the residents’ view. Age Ageing 36:197–202PubMedCrossRefGoogle Scholar
  16. 16.
    Periyakoil VS, Noda AM, Chmura Kraemer H (2010) Assessment of factors influencing preservation of dignity at life’s end: creation and the cross-cultural validation of the preservation of dignity card-sort tool. J Palliat Med 13:495–500PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Chochinov HM, Hack T, Mc Clement S et al (2002) Dignity in the terminally ill: a developing empirical model. Soc Sci Med 54:433–443PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Chochinov HM, Krisjanson LJ, Hack TF et al (2006) Dignity in the terminally ill: revisited. J Palliat Med 9:666–672PubMedCrossRefGoogle Scholar
  19. 19.
    Chochinov HM, Hack T, Hassard T et al (2002) Dignity in the terminally ill: a cross-sectional, cohort study. Lancet (London, England) 360:2026–2030CrossRefGoogle Scholar
  20. 20.
    Xiao J, Chow KM, Liu Y, CWH C (2019) Effects of dignity therapy on dignity, psychological well-being and quality of life among palliative care cancer patients: a systematic review and meta-analysis. Psychooncology 28:1791–1802PubMedCrossRefGoogle Scholar
  21. 21.
    Chochinov HM, Kristjanson LJ, Breitbart W et al (2011) Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncol 12:753–762PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Sandelowski M (2000) Whatever happened to qualitative description ? Res Nurs Health 23:334–340PubMedCrossRefGoogle Scholar
  23. 23.
    Palinkas LA, Horwitz SM, Green CA et al (2015) Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Heal 42:533–544CrossRefGoogle Scholar
  24. 24.
    Srivastava A, Thomson SB (2009) Framework analysis : a qualitative methodology for applied policy research. J Adm Gov 4:72–79Google Scholar
  25. 25.
    Chon SY, RWC B, Geddes ER, Rashid RM (2012) Chemotherapy-induced alopecia. J Am Dermatology 67:e37–e47CrossRefGoogle Scholar
  26. 26.
    Chang O, Choi E, Kim I et al (2014) Association between socioeconomic status and altered appearance distress, body image, and quality of life among breast cancer patients. Asian Pacific J Cancer Prev 15:8607–8612CrossRefGoogle Scholar
  27. 27.
    Chan AK, Tan S (2004) Filial piety in Chinese thought and history. RoutledgeCurzon, LondonCrossRefGoogle Scholar
  28. 28.
    AHY H, CLW C, PPY L et al (2013) Living and dying with dignity in Chinese society : perspectives of older palliative care patients in Hong Kong. Age Ageing 42:455–461CrossRefGoogle Scholar
  29. 29.
    Talley A, Molix L, Schlegel RJ et al (2010) The influence of breast cancer survivors’ perceived partner social support and need satisfaction on depressive symptoms : a longitudinal analysis. Psychol Health 25:433–449PubMedCrossRefGoogle Scholar
  30. 30.
    Section G (2005) Mental health outcomes in older women with breast cancer: impact of perceived family support and adjustment. Pyschoonchology 14:535–545CrossRefGoogle Scholar
  31. 31.
    Muhamad M, Afshari M, Kazilan F (2011) Family support in cancer survivorship. Asian Nurs Res (Korean Soc Nurs Sci) 12:1389–1397Google Scholar
  32. 32.
    Sanderman R, Bolks HN, Tuinstra J, Coyne JC (2008) Distress in couples coping with cancer : a meta-analysis and critical review of role and gender effects. PLoS One 134:1–30Google Scholar
  33. 33.
    CWH C, Choi KC, Chien WT et al (2014) Health-related quality-of-life and psychological distress of young adult survivors of childhood cancer in Hong Kong, vol 236, pp 229–236Google Scholar
  34. 34.
    Surbone A (2006) Telling the truth to patients with cancer : what is the truth ? Lancet Oncol 7:944–950PubMedCrossRefGoogle Scholar
  35. 35.
    CWH C, Choi KC, HYL C et al (2019) Unfolding and displaying the influencing factors of advance directives from the stakeholder’s perspective : a concept mapping approach. J Adv Nurs 75:1549–1562CrossRefGoogle Scholar
  36. 36.
    Fan R, Li B (2004) Truth telling in medicine : the Confucian view. J Med Philos 29:179–193PubMedCrossRefGoogle Scholar
  37. 37.
    Jiang Y, Liu C, Li J et al (2007) Different attitudes of Chinese patients and their families toward truth telling of different stages of cancer. Psychooncology 16:928–936PubMedCrossRefGoogle Scholar
  38. 38.
    Martin D, Miller AP, Quesnel-vallée A et al (2018) Canada’s universal health-care system : achieving its potential. Canada’s Glob Leadersh Heal 391:1718–1735Google Scholar
  39. 39.
    Chen G, Liu GG, Xu F (2014) The impact of the urban resident basic medical insurance on health services utilisation in China. Pharm Econ 32:277–292CrossRefGoogle Scholar
  40. 40.
    BKM F, Evans SB, Mccorkle R et al (2019) Impact of financial burden of cancer on survivors’ quality of life. Jounal Oncol Pract 10:332–338Google Scholar
  41. 41.
    Manuscript A (2015) Dealing with the financial burden of cancer: perspectives of older breast cancer survivors. Support Care Cancer 22:3045–3052Google Scholar
  42. 42.
    Manookian A, Cheraghi MA, Nasrabadi AN (2014) Factors influencing patients’ dignity : a qualitative study. Nurs Ethics 21:323–334PubMedCrossRefGoogle Scholar
  43. 43.
    Östlund U, Blomberg K, Söderman A, Harstäde CW (2019) How to conserve dignity in palliative care : suggestions from older patients, significant others, and healthcare professionals in Swedish municipal care. BMC Palliat Care 18:10PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Farrell C, Heaven C (2018) Understanding the impact of chemotherapy on dignity for older people and their partners. Eur J Oncol Nurs 36:82–88PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The Nethersole School of NursingThe Chinese University of Hong KongHong KongChina
  2. 2.Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of MedicineCentral South UniversityChangshaChina

Personalised recommendations