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Acknowledging accomplishments of terminal patients helps them retain dignity says Winnipeg researcher

"I was in the room of a dying patient who happened to be a professional musician," recalls Dr. Harvey Max Chochinov, Professor, Department of Psychiatry, University of Manitoba and head of the Department of Psychosocial Oncology, Cancer Care Manitoba. "I turned to his nurse, and said: 'did you know this person was a musician? He played with all the great symphonies of the world, and made music on every continent.'

"She looked at me as if to say, 'you're kidding!' At that point, my patient blushed and smiled with pride ¾ and I realized I had done something very important for him. I had acknowledged his sense of purpose and his achievements, and also altered the perception of his care giver. Hopefully, that bolstered his sense of dignity."

Dr. Chochinov paid his way through school by playing violin in a local Winnipeg band. As a musician himself, he realized how important it was for his patient's sense of dignity to see himself as an artist.

The search for ways to preserve the dignity of terminal patients has been one of the main focuses of Dr. Chochinov's work since he began researching psychiatric issues in end-of-life care a decade ago. He recently published a formal model to assist health professionals deliver "dignity conserving care" during the often undignified process of dying.

"Our research suggests that how health professionals perceive their patients is as important in terms of their dignity as what they actually do for them. Part of the way to conserve the dignity of dying patients is to perceive them as being worthy of esteem ¾ and be sure they realize it."

Using the dignity conserving care model may prompt innovative end-of-life interventions, as health professionals begin to go beyond treating physical symptoms only.

"For example, for some patients, the thought that nothing of their essence will survive death is the ultimate affront to dignity," says Dr. Chochinov. "Dignity conserving interventions might therefore include things that will help these patients achieve a sense of transcendence, such as the writing of letters, or creation of a journal detailing their life's accomplishments.

"It's a challenging area of research," he admits. "For one thing, patients' clinical status is always changing, and their energy and time is limited. Also, the research itself has to be conducted with dignity and sensitivity , because the personal well being of patients remains paramount."