The Patient Dignity Question
The PDQ is a simple, open-ended question: “What do I need to know about you as a person to give you the best care possible?”
The concept of dignity conserving care originally emerged within the field of palliative care. As part of a program of dignity focused research, Dr. Chochinov developed and tested a novel intervention coined the Patient Dignity Question (PDQ).
The PDQ consists of a brief (approximately ten-minute) conversation, framed by the question, what do we need to know about you as a person to take the best care of you possible. Using the PDQ, patients are encouraged to provide reflections on personhood and how they would like to be known or seen by their healthcare providers. PDQ responses often include reflections pertaining to:
Values & beliefs
Worries & concerns
Roles & responsibilities
History & stories
Research has shown that this single question can identify issues and stressors that may be important to consider when planning and delivering someone’s care and treatment. The intent is to reveal the “invisible” factors that might not otherwise come to light – and to identify these concerns early in the process.
For example, consider these scenarios:
A man arrives at the ER following a car accident. The impact of the airbag has broken some of his fingers and perhaps damaged some nerves. It’s amazing that the man escaped the crash without more serious injuries, and he’s lucky that the injury was to his left hand because he is clearly right-handed. His pain has been addressed.Even so, his level of agitation is completely over the top. He’s carrying on as if his life is at risk.
An observer might assume the man is just hysterical and unbalanced…until someone asks the Patient Dignity Question. They learn that the man is a professional musician who has recently been asked to join one of the finest symphony orchestras in the world, the job he’s dreamed of for a decade.
Suddenly the hospital staff has the key piece of information they need to deal with the distraught man in a constructive and sensitive way. This information will be valuable to the health care team, and to everyone who comes in contact with the patient through the entire course of treatment.
A woman stumbles through the doors of an inner-city hospital in soiled, ragged clothing. Her speech is slurred and she can’t seem to keep her balance. She smells of beer and cigarettes.
It would be easy to assume the woman is merely drunk, but asking the Patient Dignity Question reveals that she is a diabetic who has lost her medication. Her blood sugar levels have reached dangerously high levels and she is at risk of falling into a coma.
When to ask the PDQ:
The Patient Dignity Question is useful during every stage of care and treatment, such as:
During routine physicals
Before providing personal care
When admitting patients
While carrying out diagnostic tests
When considering forms of treatment or therapy
While discussing home care or long-term care arrangements
Not everyone needs to ask the question aloud, but everyone working in health care can consider the question as they reflect on the best way to deal with individuals and their families.
The intent is to get everyone in the health care community thinking about patients as unique human beings, rather than focusing only a specific illness or collection of symptoms.
Below are some anecdotes of family members and patients who completed the PDQ with a member of our research team.
“This was such a heart-warming experience. D.M is a pretty shy guy, so I don’t think he would ever voluntarily share all he’s accomplished in his life on his own. His memory isn’t all that great now either, so he may not even remember all he’s done in his life, so I’m happy I got to honor him by doing this PDQ research study”
– L.M (wife of patient)
“My mother was a stay-at-home-mom who worked really hard to make a name for herself in the community – all while raising 3 children. So not being able to share her life’s accomplishments would be doing her injustice”
– M.C (daughter of patient)
Below are some patient PDQ anecdotes:
“I know my two sons have grown tired of me talking about my youthful days, so talking to you about what my life was like before I came to this depressing place was really uplifting, thank you for this opportunity”
B.R – Riverview
“I normally don’t like talking about the tough life I lived. I put on a brave face. But this experience was kinda nice. It was nice to walk down memory lane. Made me realize my life wasn’t actually all that bad”.
J.C – Grace Hospice
“This was such a delightful experience. I’m really happy I had the opportunity to do this, thank you. My husband never had a chance to do anything like this when he was ill, so this PDQ was on behalf of him as well”.
M.Z – Grace Hospice