Conceptualizations of dignity at the end of life: exploring theoretical and cultural congruence with dignity therapy
Article first published online: 27 MAY 2014
© 2014 John Wiley & Sons Ltd
Journal of Advanced Nursing
Volume 70, Issue 12, pages 2920–2931, December 2014
How to Cite
2014) Conceptualisations of dignity at the end-of-life: exploring theoretical and cultural congruence with dignity therapy. Journal of Advanced Nursing 70(12), 2920–2931. doi: 10.1111/jan.12455, , & (
- Issue published online: 6 NOV 2014
- Article first published online: 27 MAY 2014
- Manuscript Accepted: 3 MAY 2014
- Studying Abroad Scholarship from Ministry of Education
- dignity therapy;
- palliative care;
- qualitative research;
- terminal illness
To explore the conceptualization of patients' dignity in the context of end-of-life care in Taiwan.
Dignity therapy – a novel nurse-delivered psychotherapeutic intervention – has been demonstrated to have potential to alleviate terminal patients' psycho-existential distress in western countries. In Taiwan, over half of end-of-life patients experience psychological-spiritual suffering and dignity therapy might be helpful in improving this situation. Hence, a preliminary study to clarify Taiwanese conceptualizations of ‘dignity’ was conducted prior to planning a feasibility study to gauge the potential cultural fit of an intervention of this type.
Nine people with terminal cancer and ten health professionals were recruited from palliative care services in 2008. In-depth interviews were audiotaped and transcribed verbatim. A hermeneutic approach was employed to analyse and interpret data.
Being a valuable person is the core meaning of patients' dignity and this comprised intrinsic characteristics and extrinsic factors. Intrinsic characteristics of dignity encompassed living a moral life, having peace of mind and a sense of existence involving the perception of resignation to God's will. Extrinsic factors that influenced patients' dignity included illness-related distress, care delivery and the perception of being loved. A dynamic relationship between these elements determined the state of patients' dignity.
The concept of dignity is culturally bound and understood differently in the Chinese and Western context; such differences should be considered when planning and delivering care. Modifications should be made to dignity therapy to ensure it is culturally congruent with Taiwanese patients' beliefs.