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Table 6 Features of the included studies

From: Dignity of patients with palliative needs in the Middle East: an integrative review

Author, Date & Country of Publication

Purpose

Research Design

Participants/ Context

Themes/ Findings

Studies from the patients’ perspective

 Bagherian et al., 2019 [35]

Iran

To evaluate the concept of dignity from the perspective of Iranian cancer patients.

Semi-structured interviews using Qualitative Content Analysis.

Sixteen Hospitalized cancer patients > 18 years, (5 men & 11 women)

• The key elements of dignified care were the preservation of personal space and privacy, respect for values, and the provision of adequate moral support to patients.

 Bagheri et al., 2018a,b [38, 39]

Iran

To determine the relationship between illness-related worries and social dignity of patients with heart failure.

Descriptive- analytic. Two questionnaires used: illness-related Worries Questionnaire (IRWQ) and Social Dignity Questionnaire (SDQ)

Total of 130 heart failure inpatients from cardiac hospital wards.

• A significant correlation was observed between illness-related worries and social dignity. So that, decrease in physical, mental, cognitive worries and worry about future of disease improves communication and decreases the sense of burden to other and vice versa

 Bagheri et al., 2012 [45]

Iran

To investigate perceptions of patient dignity and related factors in patients with heart failure.

Qualitative semi-structured interviews using qualitative content analysis method described by Hsieh and Shannon.

Twenty-two heart failure inpatients in cardiac hospital wards

Dignity means:

• being considered as a unique human being, being treated with respect, and having forgiveness.

• Factors enhancing or threatening patient dignity were classified into two main categories: ‘patient/care index’ and ‘resources’.

• Intrapersonal features (and interpersonal interactions) were classified as components of the patient/care index category. Human resources were classified as components of the resource’s category

 Bagheri et al. 2018a,b [38, 39]

Iran

To investigate factors related to dignity in patients with heart failure and to test the validity of the Dignity Model.

The study had a descriptive-correlational design. Using four questionnaires.

Hundred and thirty hospitalized heart failure patients.

• The research model is fit in patients with heart failure, and dignity related factors are in correlation with each other.

• Social dignity is the biggest factor in the dignity of patients with heart failure. ‘Dignity conserving repertoire’ and ‘Illness related worries’ (affected by the frequency of hospitalization and age) also affect dignity.

 Mehdipour-Rabori et al., 2015 [40]

Iran

To investigate the status of human dignity in patients with cardiovascular disease (CVD)

Cross-sectional descriptive design.

Two questionnaires used to collect data: A demographic questionnaire, and the Patient Dignity Inventory (PDI).

Two hundred cardiac patients hospitalized in Coronary Intensive care units

• Significant relationship between gender and emotional problems related to human dignity; women feel more problems associated with human dignity than men.

• Significant relationship between the number of hospitalizations and problems related to patient dignity.

• Significant correlation between living alone and problems associated with human dignity

 Amininasab et al., 2017 [49]

Iran

To determine the relationship between human dignity and medication adherence in patients with heart failure.

Cross-sectional descriptive design.

Data were collected using demographic and clinical questionnaires, PDI, and the Morisky Medication Adherence Scale (MMAS-8).

Three hundred hospitalized patients with heart failure.

• A negative relationship exists between medication adherence and a threat to human dignity (correlation coefficient r = − 0.6, significance level P < 0.001). The higher the score of threat to dignity, the lower the medication adherence.

 Shahhoseini et al. 2017 [48]

Iran

To determine the sources of dignity-related distress from the perspective of women with breast cancer undergoing chemotherapy.

Cross-sectional study design. Data collected using demographics and the PDI.

Two hundred seven patients with breast cancer undergoing chemotherapy.

• Patients mostly concerned about the distress caused by disease symptoms, existential distress, peace of mind, dependency, and social support.

• The patients undergoing mastectomy expressed higher level of social support and dependency distress than patients not undergoing the surgery.

• Income satisfaction had a significant relationship with Existential Distress and Symptom Distress.

 Borhani et al. 2016 [41]

Iran

To investigate facilitators and the factors threatening the dignity of the patients with heart disease.

Qualitative semi-structured interview. Content analysis constant comparative method with inductive approach used for analysis.

Twenty hospitalized cardiac patients from the cardiac intensive care units and 5 personnel.

• Care context is important for patients’ dignity and includes human and physical environments; also,

• Safe holistic care (Meeting the needs of patients in the hospital and after discharge; Creating a sense of security) are important aspects affecting the dignity of patients.

• Dignity is impaired when the staff do not perform effective communication like Respectful Relationship, and Involvement of the Family in the Health Team.

 Sharifi et al. 2016 [42]

Iran

The study aimed to investigate factors affecting dignity of patients with MS in the society.

Qualitative semi-structured interviews; using conventional inductive content analysis.

Thirteen patients with multiple sclerosis.

Factors affecting patient’s dignity classified into personal and social factors.

• Personal factors include the four subcategories of patient’s communication with self, patients’ knowledge, patient’s values and beliefs, and patient’s resources.

• Social factors also include four subcategories of others’ communication with patients, social knowledge, social values and beliefs, and social resources.

 Borhani et al. 2015 [43]

Iran

To explore the meaning of patient dignity.

Qualitative- interviews using content analysis

Sixteen hospitalized heart patients admitted to the cardiac intensive care units.

Two main categories; Basic dignity and Transcendent dignity.

• Basic dignity is related to physical and psychological health. It included subthemes of human security, comprehensive care, education and awareness, respect, effective communication, and privacy.

• Transcendent dignity aims to create a full human with spiritual health. Subthemes such as trust, gratitude, appreciation, and spiritual growth were included in this category.

• Findings showed that some of the participants were not satisfied with the basic dignity alone, and they were seeking transcendent dignity.

 Avestan et al. 2015 [44]

Iran

To explore cancer patient perceptions of respecting their dignity and related variables.

Descriptive Correlational design. Data collected through demographics and then the Dignity Inventory (PDI).

Two hundred and fifty cancer patients.

• Perceived dignity violation in illness-related concerns.

• The sense of anxiety and depression, uncertainty regarding the disease and treatments, and worrying about the future were the main symptoms of lack of preserved dignity in this sub-scale.

 Hosseini et al. 2017 [47]

Iran

To assess the association between the status of patient dignity and quality of life (QOL) in terminally ill patients with cancer.

Descriptive correlational study. Data collected using the (PDI) and the Persian version of the (EORTC QLQ-C30)

Two hundred and ten end-stage cancer patients (102 men and 108 women).

• High dignity status in terminally ill patients associated with higher QOL in terms of functional intactness and lower symptom distress.

Studies from the health care providers’ perspective

 Bidabadi et al., 2019 [36].

Iran

To uncover the cultural factors of power that impeded maintaining patients’dignity in the cardiac surgery intensive care unit

Critical Ethnography- Observations; data analysed conducted hermeneutically and reconstructively.

Nurses, physicians, internal medicine specialists, cardiac surgeons, anaesthesiologists, auxiliary nurses from an adult cardiac surgery unit

• Factors that impeded maintaining patient dignity were Reductionism, Instrumental objectified attitudes.

• A value - Action gap existed in adhering to the human equality principle. This theme consisted of two subthemes: ‘authoritative behaviours’ and ‘Blaming the patients.

 Hamooleh et al., 2013 [46].

Iran

To explain nurses’ perception about ethics-based palliative care in cancer patients.

In-depth interviews using Qualitative Content analysis

Nurses taking care of cancer patients.

Ethical palliative care from the nurse’s perspective had three themes:

• ‘human dignity’, ‘professional truthfulness’ and ‘altruism’.

• Human dignity had 3 sub-categories consisting of ‘respecting patients’, ‘paying attention to patient values’ and ‘empathizing’.

 Korhan et al., 2018 [37]

Turkey

To determine the approach to human dignity that nurses and physicians have while providing palliative care

Phenomenology - Semi-structured interviews using a guide prepared by the investigators. Data analysis was guided by the Colaizzi method.

Physicians & Nurses in the Palliative Care

Department of Training & Research Hospital

Eight Themes and 43 subthemes:

Decision for patients to know their diagnosis; Ensuring the quality of end-of-life care; Care procedures carried out on patients; Adequate provision of medical care services; Prioritization in palliative care; Pointless treatment in palliative care; Views on the concept of respectful care; Views on palliative care. The results showed that there was a lack of awareness of ethical, medical, and social responsibilities that led to violation of human dignity.

Studies from patients’ and Caregivers’ Perspective

 de Voogd et al. 2020 [34].

Netherlands

1) To gain insight into what patients and their relatives with a Turkish, Moroccan, or Surinamese background, find important to preserve their dignity in their last phase of life and 2) how care professionals can preserve and strengthen sthe dignity of these patients.

Qualitative thematic analysis

Twenty-three patients with a Turkish, Moroccan or Surinamese background and 21 relatives.

• Dignity encompassed surrender to God’s will and meaningful relationships with others, rather than preserving autonomy.

• Surrender to God meant accepting the illness and performing religious practice.

• A meaningful relationship meant being assisted or cared for by family members and maintaining a social role.

• Professionals could preserve dignity by showing respect and attention; guaranteeing physical integrity, hygiene, and self-direction; and indirect communication about diagnoses and prognoses.