Loss of Dignity in Severe Chronic Obstructive Pulmonary Disease

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• 作者：Brahm K. Solomon ; BA (Hons)^a ; ^{brahm.solomon@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Keith G. Wilson ; PhD^c ; Peter R. Henderson ; PhD^c ; Patricia A. Poulin ; PhD^d ; John Kowal ; PhD^c ; Douglas A. McKim ; MD^b
• 关键词：Loss of dignity ; chronic obstructive pulmonary disease ; rehabilitation ; depression ; anxiety
• 刊名：Journal of Pain and Symptom Management
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：51
• 期：3
• 页码：529-537
• 全文大小：177 K

文摘

The maintenance of dignity is an important concept in palliative care, and the loss of dignity is a significant concern among patients with advanced cancer.

Objectives

The goals of this study were to examine whether loss of dignity is also a concern for patients receiving interdisciplinary rehabilitation for Stage III or IV chronic obstructive pulmonary disease. We examined the prevalence and correlates of loss of dignity and determined whether it improves with treatment.

Methods

Inpatients underwent a structured interview inquiry around their sense of dignity and completed measures of pulmonary, physical, and psychological function at admission (n = 195) and discharge (n = 162).

Results

Loss of dignity was identified as a prominent ongoing concern for 13% of patients. It was correlated with measures of depression and anxiety sensitivity, but not with pulmonary capacity or functional performance. A robust improvement in loss of dignity was demonstrated, with 88% of those who reported a significant problem at admission no longer reporting one at discharge.

Conclusion

The prevalence of a problematic loss of dignity among patients with severe chronic obstructive pulmonary disease is at least as high as among those receiving palliative cancer care. Loss of dignity may represent a concern among people with medical illnesses more broadly, and not just in the context of “death with dignity” at the end of life. Furthermore, interdisciplinary care may help to restore a sense of dignity to those individuals who are able to participate in rehabilitation.