Perspectives of Healthcare Professionals Regarding Dignity and End-of-Life Care for the Elderly: A Systematic Literature Review

Ho Yeow Hung; Azlinda Binti  Azman; Paramjit Jamir  Singh

doi:10.25159/2520-5293/12875

Authors

Ho Yeow Hung Universiti Sains Malaysia https://orcid.org/0009-0004-2040-5571
Azlinda Binti Azman Universiti Sains Malaysia
Paramjit Jamir Singh Universiti Sains Malaysia

DOI:

https://doi.org/10.25159/2520-5293/12875

Keywords:

perspectives, views, elderly, dignity, care, healthcare professionals, nurses, doctors

Abstract

Dignity is key in the management of older patients as they approach the terminal phase of their lives. Thus, an in-depth investigation of healthcare professionals’ (HCPs) viewpoints on this subject is pertinent. This study aims to systematically review the perspectives of HCPs regarding dignity and end-of-life care for elderly patients. Utilising the PRISMA guideline, 23 articles were included in the systematic literature review following a comprehensive literature search of three electronic databases: MEDLINE, PubMed, and ScienceDirect. Five broad themes emerged from the analysed articles and were summarised as the main findings: HCPs’ understanding of dignity and patient needs, holistic patient‐centred care, family support, coordination of healthcare systems, and uncertainty at the end of life and factors affecting advanced care planning. Overall, HCPs agree on various critical aspects of treatment in end-of-life care for older patients, especially relating to respect for patient autonomy, holistic and patient-centred care, and the family’s role. Accumulated evidence suggests substantial progress in providing patient-centred care and recognising the family’s role in dignified care for older patients. Nevertheless, more improvement is needed in the area of coordinating healthcare systems, uncertainty about disease prognosis, advanced care planning, and communicating effectively regarding the goals of care and limitations of treatment options.

Metrics

Metrics Loading ...

Author Biographies

Azlinda Binti Azman, Universiti Sains Malaysia

School of Social Sciences, Professor

Paramjit Jamir Singh, Universiti Sains Malaysia

School of Social Sciences, Universiti Sains Malaysia

References

Akin Korhan, E., Ç. Üstün, and D. Uzelli Yilmaz. 2018. “Practices in Human Dignity in Palliative Care: A Qualitative Study.” Holistic Nursing Practice 32 (2): 71–80. https://doi.org/10.1097/HNP.0000000000000252.

Asmaningrum, N., and Y.-F. Tsai. 2018. “Nurse Perspectives of Maintaining Patient Dignity in Indonesian Clinical Care Settings: A Multicenter Qualitative Study.” Journal of Nursing Scholarship 50 (5): 482–91. https://doi.org/10.1111/jnu.12410.

Aydın Er, R., A. İncedere, and S. Öztürk. 2018. “Respectful Care of Human Dignity: How Is It Perceived by Patients and Nurses?” Journal of Medical Ethics 44 (10): 675–80. https://doi.org/10.1136/medethics-2017-104666.

Bidabadi, F. S., A. Yazdannik, and A. Zargham-Boroujeni. 2019. “Patient’s Dignity in Intensive Care Unit: A Critical Ethnography.” Nurse Ethics 26 (3): 738–52. https://doi.org/10.1177/0969733017720826.

Bovero, A., C. Tosi, R. Botto, A. Cito, V. Malerba, V. Molfetta, V. Ieraci, and R. Torta. 2020. “The Health Care Providers’ Perspectives on End-of-Life Patients’ Sense of Dignity. A Comparison among Four Different Professionals’ Categories.” Journal of Cancer Education 35: 1184–192. https://doi.org/10.1007/s13187-019-01577-4.

Bovero, A., C. Tosi, R. Botto, A. Pidinchedda, F. Gottardo, G. Asta, and R. Torta. 2022. “A Qualitative Study to Explore Healthcare Providers’ Perspectives on End-of-Life Patients’ Dignity. How Can Dignity be Defined, and Which Strategies Exist to Maintain Dignity?” Journal of Cancer Education 37 (2): 280–87. https://doi.org/10.1007/s13187-020-01808-z.

Brennan, F. 2017. “‘To Die with Dignity’: An Update on Palliative Care.” Internal Medicine Journal 47 (8): 865–71. https://doi.org/10.1111/imj.13520.

Cardona-Morrell, M., J. C. H. Kim, R. M. Turner, M. Anstey, I. A. Mitchell, and K. Hillman. 2016. “Non-Beneficial Treatments in Hospital at the End of Life: A Systematic Review on Extent of the Problem.” International Journal for Quality in Health Care 28 (4): 456–69. https://doi.org/10.1093/intqhc/mzw060.

Carlini, J., D. Bahudin, Z. A. Michaleff, E. Plunkett, É. N. Shé, J. Clark, and M. Cardona. 2022. “Discordance and Concordance on the Perception of Quality Care at End of Life between Older Patients, Caregivers and Clinicians: A Scoping Review.” European Geriatric Medicine 13 (1): 87–99. https://doi.org/10.1007/s41999-021-00549-6.

Caswell, G., K. Pollock, R. Harwood, and D. Porock. 2015. “Communication between Family Carers and Health Professionals about End-of-Life Care for Older People in the Acute Hospital Setting: A Qualitative Study.” BMC Palliative Care 14 (1): 35. https://doi.org/10.1186/s12904-015-0032-0.

Chochinov, H. M. 2007. “Dignity and the Essence of Medicine: The A, B, C, and D of Dignity Conserving Care.” The BMJ 335 (7612): 184–87. https://doi.org/10.1136/bmj.39244.650926.47.

De Boer, M., S. Reimer-Kirkham, and R. Sawatzky. 2022. “How Nurses’ and Physicians’ Emotions, Psychosocial Factors, and Professional Roles Influence the End-of-Life Decision-Making Process: An Interpretive Description Study.” Intensive and Critical Care Nursing 71: 103249. https://doi.org/10.1016/j.iccn.2022.103249.

Díaz-Cortés, M. del Mar, J. Granero-Molina, J. M. Hernández-Padilla, R. Pérez Rodríguez, M. Correa Casado, and C. Fernández-Sola. 2018. “Promoting Dignified End-of-Life Care in the Emergency Department: A Qualitative Study.” International Emergency Nursing 37: 23–28. https://doi.org/10.1016/j.ienj.2017.05.004.

Fien, S., E. Plunkett, C. Fien, S. Greenaway, D. K. Heyland, J. Clark, and M. Cardona. 2021. “Challenges and Facilitators in Delivering Optimal Care at the End of Life for Older Patients: A Scoping Review on the Clinicians’ Perspective.” Aging Clinical and Experimental Research 33: 2643–656. https://doi.org/10.1007/s40520-021-01816-z.

Fleming, R., F. Kelly, and G. Stillfried. 2015. “‘I Want to Feel at Home’: Establishing What Aspects of Environmental Design Are Important to People with Dementia Nearing the End of Life.” BMC Palliative Care 14: 26. https://doi.org/10.1186/s12904-015-0026-y.

Galekop, M. M. J., H. M. van Dijk, J. van Exel, and J. M. Cramm. 2019. “Views of Professionals and Volunteers in Palliative Care on Patient-Centred Care: A Q-Methodology Study in the Netherlands.” BMC Palliative Care 18 (1): 97. https://doi.org/10.1186/s12904-019-0479-5.

Ho, A. H. Y., J. K. H. Luk, F. H. W. Chan, W. Chun, C. K. K. Kwok, J. H. L. Yuen, M. Y. J. Tam, W. W. S. Kan, and C. L. W. Chan. 2016. “Dignified Palliative Long-Term Care: An Interpretive Systemic Framework of End-of-Life Integrated Care Pathway for Terminally Ill Chinese Older Adults.” American Journal of Hospice and Palliative Medicine 33 (5): 439–47. https://doi.org/10.1177/1049909114565789.

Institute of Medicine (US) Committee on Quality of Health Care in America. 2001. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press. https://doi.org/10.17226/10027.

Kane, P. M., C. I. Ellis-Smith, B. A. Daveson, K. Ryan, N. G. Mahon, B. McAdam, R. McQuillan, C. Tracey, C. Howley, G. O’Gara, C. Raleigh, I. J. Higginson, F. E. M. Murtagh, and J. Koffman. 2018. “Understanding How a Palliative-Specific Patient-Reported Outcome Intervention Works to Facilitate Patient-Centred Care in Advanced Heart Failure: A Qualitative Study.” Palliative Medicine 32 (1): 143–55. https://doi.org/10.1177/0269216317738161.

Lamahewa, K., R. Mathew, S. Iliffe, J. Wilcock, J. Manthorpe, E. L. Sampson, and N. Davies. 2018. “A Qualitative Study Exploring the Difficulties Influencing Decision Making at the End of Life for People with Dementia.” Health Expectations 21 (1): 118–27. https://doi.org/10.1111/hex.12593.

Lindskog, M., B. Tavelin, and S. Lundström. 2015. “Old Age as a Risk Indicator for Poor End-of-Life Care Quality—A Population-Based Study of Cancer Deaths from the Swedish Register of Palliative Care.” European Journal of Cancer 51 (10): 1331–339. https://doi.org/10.1016/j.ejca.2015.04.001.

Motamedi, M., C. Brandenburg, M. Bakhit, Z. A. Michaleff, L. Albarqouni, J. Clark, M. Ooi, D. Bahudin, D. N. Chróinín, and M. Cardona. 2021. “Concerns and Potential Improvements in End-of-Life Care from the Perspectives of Older Patients and Informal Caregivers: A Scoping Review.” BMC Geriatrics 21 (1): 729. https://doi.org/10.1186/s12877-021-02680-2.

Östlund, U., K. Blomberg, A. Söderman, and C. Werkander Harstäde. 2019. “How to Conserve Dignity in Palliative Care: Suggestions from Older Patients, Significant Others, and Healthcare Professionals in Swedish Municipal Care.” BMC Palliative Care 18 (1): 10. https://doi.org/10.1186/s12904-019-0393-x.

Page, M. J., J. E. McKenzie, P. M. Bossuyt, I. Boutron, T. C. Hoffmann, C. D. Mulrow, L. Shamseer, J. M. Tetzlaff, E. A. Akl, S. E. Brennan, R. Chou, J. Glanville, J. M. Grimshaw, A. Hróbjartsson, M. M. Lalu, T. Li, E. W. Loder, E. Mayo-Wilson, S. McDonald, L. A. McGuinness, L. A. Stewart, J. Thomas, A. C. Tricco, V. A. Welch, P. Whiting, and D. Moher. 2021. “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews.” BMJ 372: 71. https://doi.org/10.1136/bmj.n71.

Peicius, E., A. Blazeviciene, and R. Kaminskas. 2017. “Are Advance Directives Helpful for Good End of Life Decision Making: A Cross-Sectional Survey of Health Professionals.” BMC Med Ethics 18 (1): 40. https://doi.org/10.1186/s12910-017-0197-6.

Rawlings, D., K. Devery, and N. Poole. 2019. “Improving Quality in Hospital End-of-Life Care: Honest Communication, Compassion and Empathy.” BMJ Open Quality 8 (2): e000669-e. https://doi.org/10.1136/bmjoq-2019-000669.

Söderman, A., C. Werkander Harstäde, U. Östlund, and K. Blomberg. 2021. “Community Nurses’ Experiences of the Swedish Dignity Care Intervention for Older Persons with Palliative Care Needs—A Qualitative Feasibility Study in Municipal Home Health Care.” International Journal of Older People Nursing 16 (4): e12372. https://doi.org/10.1111/opn.12372.

Tauber-Gilmore, M., G. Addis, Z. Zahran, S. Black, L. Baillie, S. Procter, and C. Norton. 2018. “The Views of Older People and Health Professionals about Dignity in Acute Hospital Care.” Journal of Clinical Nursing 27 (1–2): 223–34. https://doi.org/10.1111/jocn.13877.

Tehranineshat, B., M. Rakhshan, C. Torabizadeh, and M. Fararouei. 2020. “Patient Dignity in Iranian Clinical Care Settings as Perceived by Physicians, Caregivers, and Patients.” Journal of Multidisciplinary Healthcare 13: 923–33. https://doi.org/10.2147/JMDH.S258962.

Van de Pol, M. H., C. R. M. G. Fluit, J. Lagro, D. Niessen, M. G. M. O. Rikkert, and A. L. M. Lagro-Janssen. 2015. “Quality Care Provision for Older People: An Interview Study with Patients and Primary Healthcare Professionals.” British Journal of General Practice 65 (637): e500–e507. https://doi.org/10.3399/bjgp15X686065.

WHO (World Health Organization). 2022. “Ageing and Health.” WHO, October 1, 2022. Accessed March 24, 2023. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health.

Williams, V., D. Kinnear, and C. Victor. 2016. “‘It’s the Little Things That Count’: Healthcare Professionals’ Views on Delivering Dignified Care: A Qualitative Study.” Journal of Advanced Nursing 72 (4): 782–90. https://doi.org/10.1111/jan.12878.

Wong, E. L.-Y., N. Kiang, R. Y.-N. Chung, J. Lau, P. Y.-K. Chau, S. Y.-S. Wong, J. Woo, E. Y.-Y. Chan, and E.-K. Yeoh. 2020. “Quality of Palliative and End-of-Life Care in Hong Kong: Perspectives of Healthcare Providers.” IJERPH: International Journal of Environmental Research and Public Health 17 (14): 5130. https://doi.org/10.3390/ijerph17145130.

Yu, J., R. Saltus, and P. Jarvis. 2020. “Perceived Inequalities in Care and Support for Older Women from Black and Minority Ethnic Backgrounds in Wales: Findings from a Survey Exploring Dignity from Service Providers’ Perspectives.” Ethnicity and Health 25 (2): 222–42. https://doi.org/10.1080/13557858.2017.1399200.