Table 3 Summary table of inclusion and exclusion criteria

Setting

A middle Eastern context

The setting is that of palliative care inclusive of hospital, hospice, home-based, or community.

The countries of Algeria, The Comoros Islands, Djibouti, Mauritania, Morocco, Somalia, Sudan, Libya, Pakistan and Tunisia, though considered to be part of the eastern Mediterranean region, are excluded from the search.

They are geographically distant from the Middle- Eastern or Mediterranean area.

Perspective/ participants

Studies from the perspective of:

a) Adult patients with life-threatening or advanced chronic illnesses such as cancer, or any organ failure (heart, kidney, liver pulmonary), and neurological disorders, who need palliative care attention.

b) Health care providers like physicians, nurses, social workers, pharmacists, psychologists, dietitians, and chaplains

c) Caregiver- or ‘carer’ described as an adult, aged 18 or over, who provides or intends to provide care for another adult needing care. It could be a family member, relative or other. This excludes people providing paid care or people providing care as voluntary work [25].

Studies limited to adult population – age > 18 years

Older adults or frailty or patients with dementia.

Patients with mental health disorders.

Paediatric population

Dignity in dementia or frailty entails addressing unique care needs especially in the advanced stages [26].

Many mental health patients suffer from marginalization and injustice implying a broader action on dignity than that of palliative patients [27].

Children within palliative care have unique dignity needs that differ from adults [28].

Intervention/ phenomenon of Interest

Studies that focus on dignity, the meaning or perceptions of dignity, dignity experiences, dignity related distress, loss of dignity, and dignified care.

Studies related to barriers or enhancers of patient dignity will be included.

Only empirical studies from peer-reviewed journals that follow quantitative, qualitative, or mixed-method design are included.

Only English language papers were included.

Dignity discussed in relation to euthanasia, assisted suicide, assisted dying, right to die, death with dignity, or legislative aspects.

Review articles, reports, editorials, commentaries, letters to the editor, books, dissertations, and papers that discuss dignity from legal or policy perspectives are excluded

Dignity is the key focus of the review

Palliative care is understood as an approach that affirms life and does not hasten or postpone death. Its role is not only during the last days of life but from the time of diagnosis of an incurable disease. The goal is to improve the quality of life of those facing terminal illnesses as well as their family caregivers. For this reason, papers that tackle assisted suicide or euthanasia are outside the scope of the review and will be excluded [29].

Empirical studies are deemed appropriate to provide evidence on perceptions, influencing factors, or outcomes of dignity.

Due to restricted resources, papers are limited to English language.

Evaluation/ Outcomes

The outcome of enhanced or impaired dignity as well as perceived benefits or threats will be examined.

Studies that have dignity as a secondary outcome will also be included.

Outcomes other than dignity