Department of Anesthesiology, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA.
Emory Critical Care Center, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA.
J Palliat Med. 2024 Apr;27(4):537-544. doi: 10.1089/jpm.2023.0544. Epub 2023 Oct 13.
The acknowledgment and promotion of dignity is commonly viewed as the cornerstone of person-centered care. Although the preservation of dignity is often highlighted as a key tenet of palliative care provision, the concept of dignity and its implications for practice remain nebulous to many clinicians. Dignity in care encompasses a series of theories describing different forms of dignity, the factors that impact them, and strategies to encourage dignity-conserving care. Different modalities and validated instruments of dignity in care have been shown to lessen existential distress at the end of life and promote patient-clinician understanding. It is essential that palliative care clinicians be aware of the impacts of dignity-related distress, how it manifests, and common solutions that can easily be adapted, applied, and integrated into practice settings. Dignity-based constructs can be learned as a component of postgraduate or continuing education. Implemented as a routine component of palliative care, they can provide a means of enhancing patient-clinician relationships, reducing bias, and reinforcing patient agency across the span of serious illness. Palliative care clinicians-often engaging patients, families, and communities in times of serious illness and end of life-wield significant influence on whether dignity is intentionally integrated into the experience of health care delivery. Thus, dignity can be a tangible, actionable, and measurable palliative care goal and outcome. This article, written by a team of palliative care specialists and dignity researchers, offers 10 tips to facilitate the implementation of dignity-centered care in serious illness.
承认和促进尊严通常被视为以患者为中心的护理的基石。尽管保留尊严通常被强调为提供姑息治疗的关键原则，但尊严的概念及其对实践的影响对许多临床医生来说仍然模糊不清。关怀中的尊严包括一系列描述不同形式的尊严、影响它们的因素以及鼓励保持尊严的关怀的策略的理论。已经证明，不同的关怀尊严模式和经过验证的工具可以减轻生命末期的存在性痛苦，并促进患者与临床医生的理解。姑息治疗临床医生必须意识到与尊严相关的痛苦的影响、它的表现形式以及可以轻松适应、应用和整合到实践环境中的常见解决方案。尊严相关的构建可以作为研究生或继续教育的一部分来学习。作为姑息治疗的常规组成部分实施，它们可以提供一种增强医患关系、减少偏见和加强患者在严重疾病期间的自主权的手段。姑息治疗临床医生——在严重疾病和生命末期经常与患者、家庭和社区合作——对尊严是否被有意纳入医疗保健提供的体验中具有重大影响。因此，尊严可以成为一个切实可行、可衡量的姑息治疗目标和结果。本文由一组姑息治疗专家和尊严研究人员撰写，提供了 10 个提示，以促进在严重疾病中实施以尊严为中心的护理。
