1 This work was supported by the National Cancer Institute of Canada, the Canadian Cancer Society, and the Canadian Institutes for Health Research.
Article first published online: 24 FEB 2009
Copyright © 2006 American Cancer Society
CA: A Cancer Journal for Clinicians
Volume 56, Issue 2, pages 84–103, March/April 2006
How to Cite
Chochinov, H. M. (2006), Dying, Dignity, and New Horizons in Palliative End-of-Life Care. CA: A Cancer Journal for Clinicians, 56: 84–103. doi: 10.3322/canjclin.56.2.84
This article is available online at http://CAonline.AmCancerSoc.org
- Issue published online: 24 FEB 2009
- Article first published online: 24 FEB 2009
Palliative care practitioners are now better able than ever before to ameliorate end-of-life symptom distress. What remains less developed, however, is the knowledgebase and skill set necessary to recognize, assess, and compassionately address the psychosocial, existential, and spiritual aspects of the patient's dying experience. This review provides an overview of these areas, focusing primarily on empirical data that has examined these issues. A brief overview of psychiatric challenges in end-of-life care is complemented with a list of resources for readers wishing to explore this area more extensively. The experience of spiritual or existential suffering toward the end of life is explored, with an examination of the conceptual correlates of suffering. These correlates include: hopelessness, burden to others, loss of sense of dignity, and desire for death or loss of will to live. An empirically-derived model of dignity is described in some detail, with practical examples of diagnostic questions and therapeutic interventions to preserve dignity. Other interventions to reduce existential or spiritual suffering are described and evidence of their efficacy is presented. The author concludes that palliative care must continue to develop compassionate, individually tailored, and effective responses to the mounting vulnerability and increasingly difficult physical, psychosocial, and spiritual challenges facing persons nearing the end of life.