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| Illness-related concern: | Physical distress |
| What it means: | Pain or discomfort caused by the illness |
| Questions to ask: | “How comfortable are you?” “Is there something we can do to make you more comfortable?” |
| Interventions: | Conduct baseline and frequent ongoing assessment of physical and psychological symptoms Manage symptoms vigilantly Use comfort care |
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| Illness-related concern: | Psychological distress |
| What it means: | Anxiety, fear, agitation |
| Questions to ask: | “How are you coping with what is happening to you?” “Is there anything further about your illness that you would like to know?” “Are you getting all the information you feel you need?” “Are there things about the later stages of you illness that you would like to discuss?” |
| Interventions: | Conduct baseline and frequent ongoing assessment of physical and psychological symptoms Show you are supportive Listen with empathy Refer to counselling Provide information about treatment options or the expected course of the illness Upon request, provide accurate, understandable information and strategies to deal with possible future crises |
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| Illness-related concern: | Cognitive acuity |
| What it means: | Ability to think clearly, reason, remember |
| Questions to ask: | “Are you having difficulty with your thinking?” |
| Interventions: | Conduct baseline and ongoing assessment of cognitive functioning Detect and treat delirium When possible, avoid sedating medication(s) |
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| Illness-related concern: | Functional capacity |
| What it means: | Ability to perform the tasks of daily living |
| Questions to ask: | “How much are you able to do for yourself?” |
| Interventions: | Conduct baseline and ongoing assessment of ability to carry out activities Refer to occupational and physiotherapy as appropriate Provide supports needed to maintain independence (such as walker, raised toilet seat) Involve patient in decision-making regarding plan of care, as desired by patient |
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| Dignity-conserving trait: | Continuity of self |
| What it means: | The person’s belief that the essence of who they are is still intact, despite the illness |
| Questions to ask: | “Are there things about you that this disease does not affect?” |
| Interventions: | Talk to the person about the facets of life not affected by the illness Learn about the person’s biography, attending to those aspects of life that he/she values most See and relate to the patient as someone worthy of honour, respect and esteem |
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| Dignity-conserving trait: | Role preservation |
| What it means: | Ability to engage in the person’s usual roles |
| Questions to ask: | “What things did you do before you were sick that were most important to you?” |
| Interventions: | Learn about the patient’s biography, and understand the roles that are most important to him or her Facilitate enactment of these roles within the limitations of the person’s illness See and relate to the person as someone worthy of honour, respect and esteem |
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| Dignity-conserving trait: | Maintenance of pride |
| What it means: | The person’s ability to maintain positive self-regard and self-respect in the face of diminishing independence |
| Questions to ask: | “What about yourself and your life are you most proud of?” |
| Interventions: | Talk to the person about the aspects of his/her life that instil pride See and relate to the person as someone worthy of honour, respect and esteem Maintain a professional demeanour when providing care |
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| Dignity-conserving trait: | Hopefulness |
| What it means: | The person’s belief that activities and events in life are still possible and meaningful, despite the current situation |
| Questions to ask: | “What is still possible?” |
| Interventions: | Talk to the person about what is still possible, despite illness limitations Encourage the person to redefine goals and expectations Encourage and enable the person to participate in activities he/she feels are meaningful and purposeful |
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| Dignity-conserving trait: | Autonomy/control |
| What it means: | The person’s perception that they have autonomy and control over life circumstances, regardless of functional limitations |
| Questions to ask: | “How in control do you feel?” |
| Interventions: | Assess the person’s perceived level of control Involve patients in care, treatment and planning decisions, as desired by patient Where possible, provide choices |
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| Dignity-conserving trait: | Generativity/legacy |
| What it means: | Taking comfort in feeling that something of value will be left behind that transcends death |
| Questions to ask: | “How do you feel your life has affected and benefited others?” |
| Interventions: | Facilitate life review or support the patient in other projects that foster the sharing of memories that are meaningful to the person (for example, making audio/video tapes, writing letters, journaling) Suggest Dignity Therapy |
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| Dignity-conserving trait: | Acceptance |
| What it means: | Accepting the unavoidable course of illness so energy can be focused on appropriate and meaningful activities |
| Questions to ask: | “How at peace are you with what is happening to you?” |
| Interventions: | Explore the impact of the illness for the patient Appreciate the dynamism of the process of responding to a life-threatening illness Support the person in his/her outlook Encourage doing things that enhance his/her sense of well-being (such as meditation, light exercise, listening to music, prayer) |
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| Dignity-conserving trait: | Resilience/fighting spirit |
| What it means: | The person’s ability to rally against his/her illness-related concerns |
| Questions to ask: | “What part of you is strongest right now?” |
| Interventions: | Support the person in his/her outlook Encourage doing things that are meaningful and enhance his/her sense of well-being (such as meditation, light exercise, listening to music, prayer) |
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| Dignity-conserving trait: | Living in the moment |
| What it means: | Focusing on the here and now, rather than worrying about the future |
| Questions to ask: | “Are there things that take your mind away from illness, and offer you comfort?” |
| Interventions: | Support the patient’s efforts to participate in normal routines, or to take comfort in momentary distractions (such as daily outings, light exercise, listening to music) Make appropriate use of humour, and discuss issues that are non-illness related |
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| Dignity-conserving trait: | Maintaining normalcy |
| What it means: | Maintaining some sense of normality while coping with the challenges of illness |
| Questions to ask: | “Are there things you still enjoy doing on a regular basis?” |
| Interventions: | Support the person’s efforts to participate in normal routines, or to take comfort in momentary distractions (such as daily outings, light exercise, listening to music) Support and enhance independence using appropriate resources, assistive devices and personnel |
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| Dignity-conserving trait: | Finding spiritual comfort |
| What it means: | Finding solace within a spiritual belief system, which may include rituals and practice of organized religion, being in touch with nature and/or connecting with a uniquely defined creative life force |
| Questions to ask: | “Is there a religious or spiritual community that you are, or would like to be, connected with?” |
| Interventions: | Sensitively assess the ways in which the person best expresses his/her sense of spirituality Respect individual belief systems Enable the person to participate in particular spiritual and/or culturally based practices Enlist support of spiritual care leaders identified as being important to the person |
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| Dignity-conserving trait: | Privacy boundaries |
| What it means: | Encroachment on someone’s personal space in the course of receiving care |
| Questions to ask: | “What about your privacy is important to you?” “How can we improve upon your sense of privacy?” |
| Interventions: | Be sensitive to the need for secure personal space Ask for the person’s permission to do an examination Practice proper draping to safeguard and respect privacy Knock on the patient’s door when entering |
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| Dignity-conserving trait: | Social support |
| What it means: | Availability of networks of support |
| Questions to ask: | “Who are the people that are most important to you? “Who is your closest confidante?” |
| Interventions: | Determine the individuals perceived by the patient to provide meaningful emotional support and practical assistance Encourage the involvement of a wide support network Allow liberal visitation policies and rooming in |
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| Dignity-conserving trait: | Care tenor |
| What it means: | Attitudes and behaviours of those interacting with the patient |
| Questions to ask: | “Is there anything in the way you are treated that is undermining your sense of dignity?” |
| Interventions: | Treat the person as someone worthy of honour, esteem and respect Respect the person’s individuality Explore with the patient any facets of care that are perceived as eroding dignity Be mindful of reactions toward the person, particularly with regard to changing physical appearance Learn and practice the ABCDs of Dignity in Care |
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| Dignity-conserving trait: | Burden to others |
| What it means: | The person’s concern that his/her care is burdensome to others, or may become so in future |
| Questions to ask: | “Do you worry about being a burden to others? If so, to whom and in what ways?” |
| Interventions: | Anticipate and explore this potential area of concern, with both patients and care providers Encourage explicit discussion of these concerns with those they fear they are burdening |
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| Dignity-conserving trait: | Aftermath concerns |
| What it means: | A person’s worries about the difficulties loved ones will face once death finally occurs (such as funeral planning, legal and financial concerns, care of minor children) |
| Questions to ask: | “What are your biggest concerns for the people you will leave behind?” |
| Interventions: | Encourage patients to reflect on these worries Help the person prepare a plan of action to address the most pressing issues (such as settling affairs, preparing an advanced directive, making a will and funeral planning) |