Dignity through integrated symptom management: lessons from the Breathlessness Support Service

CONTEXT: Dignity is poorly conceptualized and little empirically explored in end of life care. A qualitative evaluation of a service offering integrated palliative and respiratory care for patients with advanced disease and refractory breathlessness uncovered an unexpected outcome, it enhanced patients' dignity.

OBJECTIVES: To analyse what constitutes dignity for people suffering from refractory breathlessness with advanced disease, and its implications for the concept of dignity.

METHODS: Qualitative study of cross-sectional interviews with 20 patients as part of a phase III evaluation of a randomized controlled fast-track trial. The interviews were transcribed verbatim, imported into NVivo, and analysed through constant comparison. The findings were compared with Chochinov et al.'s dignity model. The model was adapted with the themes and sub-themes specific to patients suffering from breathlessness.

RESULTS: The findings of this study underscore the applicability of the conceptual model of dignity for patients with breathlessness. There were many similarities in themes and sub-themes. Differences specifically relevant for patients suffering from severe breathlessness were: a. Physical distress and psychological mechanisms are interlinked with the disability and dependence breathlessness causes, in the illness-related concerns; b. Stigma is an important component of the social dignity inventory; c. Conditions and perspectives need to be present to practice self-care in the dignity conserving repertoire.

CONCLUSION: Dignity is an integrated concept and can be affected by influences from other areas such as illness-related concerns. The intervention shows that targeting the symptom holistically and equipping patients with the means for self-care, realized the outcome of dignity.