A core concept in caring patients with advanced cancer is to treat them and preserve dignity independently the service of care. This cross-sectional study’s purpose was to explore the dignity of patients with advanced cancer.
A convenience sample of 99 (response rate 85%) patients with advanced cancer was recruited between April to December 2017 by a palliative care unit (PCU) (day (PDC) and home care (PHC)) and oncology units (chemotherapy outpatient (OU) and inpatient (IU)) of Athens. Patients with advanced cancer (stage III or IV) who consented, completed the Patient Dignity Inventory (PDI), a 25 items scale, 5 point Likert scale (1 (no problem) -5 (overwhelming problem) divided into: Symptom (SD) and Existential distress (ED), Peace of Mind (PM), Dependency (D), and Social Support (SS). Also Hospital Anxiety and Depression Scale (HADS), Edmonton Symptom Assessment Scale - short version and a demographic/ clinical form were collected.
Most patients were female (54.5%), the mean age was 64.9 years. Breast (22.2%), colorectal (16.2%) and lung cancer (15.2%) were the most frequent diagnoses. Almost half patients (56.6%) were hospitalized (36.4% OU, 20.2% IU) and the others were cared for at the PCU (28.2% PHC, 15.2% PDC). The PDI mean scores were: Total Dignity (TD) 50.2 (25-125), SD 15.3 (6-30), ED 12.7 (6-30), PM 4.7 (3-15), D 5.8 (3-15), SS 4.5 (3-15). Most of the demographic and clinical characteristics were not associated with total or subscales scores of PDI. On the other hand, women (p=.035) and breast cancer patients reported less SS (p=.022). The OU patients reported better TD (p=.029), SD (p=.001), ED (p=.002) and D (p=.003) than OU and PHC but not PDC. Higher scores of TD were significantly correlated with experience of pain, tiredness, lack of appetite, shorten of breath, anxiety and depression (p<.006). Reports of anxiety and depression measured by HADS were correlated with higher total and subscales dignity scores (.001 < p < .006).
The findings of this study support a quite good level of perceived dignity in Greek patients with advanced cancer. More research is needed to clarify the differences of dignity among various care settings. We thank Special Account for Research Grants and National and Kapodistrian University of Athens.
Clinical trial identification
Legal entity responsible for the study
Nursing Department, National and Kapodistrian University of Athens.
Special Account for Research Grants, National and Kapodistrian University of Athens.
All authors have declared no conflicts of interest.