One question may help provide dignity at the end of life: study
31 July 2013
In the last weeks and days of a patient’s life, palliative care teams manage pain and other physical symptoms with the best medicine available. But when it comes to patients’ emotional and psychological states, a new study shows that patients who are asked one simple question may receive more empathy from their caregivers, helping patients to spend the last days of life with dignity.
The question is known as the Patient Dignity Question (PDQ): “What do I need to know about you as a person to give you the best care possible?” Funded by the Canadian Cancer Society, the study was led by Dr Harvey Max Chochinov. Dr Chochinov – a world-renowned expert in palliative care – is the director of the Manitoba Palliative Care Research Unit, CancerCare Manitoba and a Canada Research chair in palliative care.
According to Dr Chochinov, there is little research that defines practical ways for healthcare providers to offer more empathic care to their terminally ill cancer patients. The goal of his study was to see if the Patient Dignity Question helps healthcare providers feel and act with more empathy toward their patients. “Preliminary results show that on the basis of a very brief, cost-effective intervention, we are able to increase empathy in the majority of healthcare providers,” said Dr Chochinov.
Over the last 2 years, Dr Chochinov and his team collected patients’ responses to the Patient Dignity Question and, if the patients wished, included the information in their medical charts. Almost all of the patients felt this was important information for their healthcare providers to know and that this could affect their care. Every single patient said they would recommend it to others.
The responses gathered through the PDQ ranged from the practical to the spiritual. While one patient revealed that she was afraid of dying alone and hoped that one of the staff would be with her at the time of her death, another said she had difficulty trusting doctors and felt they might assume she was unable to make her own decisions. One patient asked to be served food on the right side of the tray because of a visual field defect. One family member, answering the question for a relative, told how the patient drew a lot of pride from acting as a support for his community and lamented the fact that he couldn’t give that support anymore.
With large workloads, doctors often rush to get to the next patient and may not dedicate enough time to learn anything personal about each patient. However, after reading patients’ responses, the vast majority of healthcare providers said they were emotionally affected by the experience and that it influenced their sense of empathy. “This simple intervention provides a deeper knowledge of the person we are caring for and helps us understand what matters most at what is likely a very difficult time. The PDQ has become a routine part of my practice as it yields valuable information that improves patient care, while enriching my own experience of the practice of medicine,” says Dr Robin McClure, an attending physician for the Palliative Care Program of Winnipeg Regional Health Authority where the study took place.
Dr Chochinov’s team has already begun piloting the PDQ with cancer patients at various stages of the disease. PDQ resources for healthcare professionals are available at the Dignity in Care website.
“The Canadian Cancer Society is very proud to support this important work,” says Dr Siân Bevan, Director of Research, Canadian Cancer Society. “Dr Chochinov and his team have achieved tremendous results in end-of-life care research that have the potential to change the way people with cancer are supported during a very sensitive time.”
The Canadian Cancer Society has been funding Dr Chochinov’s important, practice-changing work since 1999, thanks to the generous donations of Canadians. Over the last 15 years, Dr Chochinov and his team have studied a variety of topics, including how to help patients die with dignity. Their research led to the development of the Dignity Model for the terminally ill, the ABCDs of Dignity Conserving Care and the development of Dignity Therapy – a brief individualized therapy for terminally ill patients that is used in many palliative care programs around the world.
Dr Chochinov is just one of the high-impact researchers supported by the Society. For other research success stories, visit cancer.ca/75years.
About the Canadian Cancer Society
For 75 years the Canadian Cancer Society has been with Canadians in the fight for life. We have been relentless in our commitment to prevent cancer, fund research and support Canadians touched by cancer. From this foundation, we will work with Canadians to change cancer forever so fewer Canadians are diagnosed with the disease and more survive. To learn more, visit cancer.ca or call us at 1-888-939-3333 (TTY 1-866-786-3934).