ABCDs of 'dignity-conserving care'

June 4, 2014

Dr. Harvey Chochinov

By James Buchok

For the elderly, the dying and their loved ones, the topic of dignity eventually enters the room and evokes a range of emotions and opinions, but a Winnipeg-based physician devoted to palliative care believes hard data about dignity leads to better decisions and better care. Dr. Harvey Chochinov says patients should be asked, “what is it like to be dying and how can we make it better?”
Chochinov was a speaker at the Canadian Association for Spiritual Care National Conference in Winnipeg April 9-12. The theme of the gathering was Dignity at the Centre. He spoke of how maintaining and enhancing the dignity of the person at the end of life is a key aspect of providing comprehensive, quality palliative care.
Chochinov is a professor of psychiatry at the University of Manitoba and Director of the Manitoba Palliative Care Research Unit at Cancer Care Manitoba. He holds the only Canada Research Chair in Palliative Care and in 2012 he received the Canadian Medical Association’s Frederic Newton Gisborne Starr Award, the highest award that the CMA can bestow.
Chochinov spoke of “dignity conserving care” and said such an approach should “become part of the parlance of medicine.”
He said the ABCDs of dignity conserving care are attitude, behaviour, compassion and dialogue, and together they form one part of a Patient Dignity Inventory developed by his research unit. The PDI is designed to measure various sources of dignity-related distress among patients nearing the end of life. It asks 25 questions about a patient’s problems ranging from difficulty with bathing, to loss of individuality and feeling like a burden. Patients are asked to rate each stress factor from one to five. “We need details about our patients to help us remember them,” Chochinov said.
“Dignity is in the eye of the beholder,” he said. “When patients are looking in our eyes they are looking for a reflection that will affirm their personhood. If we are seen as our ailment we become the embodiment of that ailment. If you are seen in totality it leads to dignity.”
Chochinov said death anxiety; “not being able to picture what death will look like,” is a leading stressor for palliative patients and their families. He said the most-downloaded article from the Winnipeg-based Canadian Virtual Hospice website at is entitled When Death is Near. It touches on the dying person’s decreasing energy, difficulty taking food and medications and the role of a loved one at a bedside. The website offers extensive information and support on palliative and end-of-life care, loss and grief for patients and loved ones.
Chochinov said a care provider’s attitude has a profound effect on a patient’s sense of dignity. “If people feel caring is forthcoming they are much more likely to be forthcoming with what is going on,” he said. Healthcare workers will speak of “routine medical examinations. But when it is your body being examined there is nothing routine about it. We come into this work with good intentions and if we can keep that top of mind we’ll do okay,” Chochinov said.
Chochinov shared a story of how he had his own attitude checked when he referred to a friend who is an advocate for the disabled as being wheelchair bound. “He said, ‘I’m not wheelchair bound, I am wheelchair liberated. With this chair I can go wherever I need to go.’”
“It’s impossible to feel compassion without feeling your own vulnerability,” Chochinov said. “We have to realize there is very little difference between us and our patients besides luck and time.”

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