Winnipeg, Canada - May 7, 2002 - Findings from a Canadian study conducted at CancerCare Manitoba have resulted in a new model of care that preserves the dignity of patients with advanced terminal cancer. Study results are being published in the May 1, 2002 issue of the Journal of the American Medical Association (JAMA).

Dr. Harvey Max Chochinov, Head of Psychosocial Oncology at CancerCare Manitoba, and member of the Department of Psychiatry, University of Manitoba, drew from a study on dignity that involved 50 patients with advanced terminal cancer. The study highlighted a broad range of issues that can impact on a patient’s sense of personal dignity.

“Dignity-conserving care needs to be a standard of palliative care for all patients nearing death. Such care should encompass a broad range of interventions, based on an understanding of the many sources of distress that may affect a patient’s sense of dignity.” Chochinov said.

Dignity has a unique meaning for each patient and his or her family. Clinicians must identify the source of a patient’s sense of dignity in order to provide comprehensive, empathetic end-of-life care. The model of dignity offered in the study provides a framework by which clinicians can pursue this task, and expand therapeutic options to ensure that dying with dignity is an explicitly targeted outcome.

“The ‘death with dignity’ research by Dr. Chochinov and colleagues clarifies the individual-specific contributors to the dying person’s sense of well being, and suggests relevant types of support care. It should open the door for improved care and lessened suffering at the end of life,” remarked Canada’s pioneer and leading palliative care expert, Dr. Balfour Mount, Eric M. Flander’s Professor of Palliative Medicine at McGill University.

“Dignity-conserving care is comprised not only of what one does to patients, but how one sees patients. Finding ways to remind the dying of their continued value and worth is so much a part of what it means to comfort the dying,” Chochinov explained. When patients are seen, and know that those who care for them see them as being worthy of honor and esteem, dignity is more likely to be maintained.

Practical tools include dignity psychotherapy

The study provides model interventions to deal with end-of-life concerns most commonly experienced by dying patients. In addition to encouraging health care professionals to view their patients as individuals beyond their medical symptoms, practical tools for caregivers are provided. Some interventions include having patients participate in decision-making, encouraging the continuation of normal routines, and participating in “dignity psychotherapy”. One component of dignity psychotherapy helps dying patients create a record of their lives that can be left for family and friends.

This unique psychotherapy is presently being piloted in Perth, Australia and in Canada in Ottawa and Winnipeg, with initial promising results.

“Dignity psychotherapy is a very powerful experience. It gives dying patients the chance to participate in something that feels extremely meaningful, and to leave something important behind for those they love,” Dr. Chochinov explains.

“People facing a terminal prognosis deserve end-of-life care that honors their dignity. Research that offers a model to help palliative care workers offer this is a welcome move forward,” says Dr. Barb Whylie, Director, Cancer Control Programs, Canadian Cancer Society.

This study was supported by grants from the National Cancer Institute of Canada with funding from the Canadian Cancer Society, the American Foundation for Suicide Prevention, and the Open Society Institute, Project on Death in America.

CancerCare Manitoba, by an act of legislature, is responsible for cancer prevention, detection, care, research and education throughout Manitoba.

The mission of the Open Society Institute’s Project on Death in America is to understand and transform the culture and experience of dying and bereavement through funding initiatives in research and scholarship, and to foster innovations in the provision of care, public education, professional education, and public policy. The Open Society Institute, a private operating and grantmaking foundation, is part of the network of foundations, created and funded by George Soros, active in more than 50 countries around the world.