Dignity Violations and Barriers to Dignity Assurance for Terminally Ill Patients at the End of Life: A Cross-Sectional Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Questionnaire Development
2.2. Respondent Profile
2.3. Data Analysis
3. Results
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Component | Indicators | IL * | Descriptive Statistics | ||
---|---|---|---|---|---|
Always/Frequently | Rarely | Never | |||
Dignity Violations | |||||
Dehumanization | CR * = 0.90; AVE * = 0.61; VIF * = 2.68 | ||||
The patient was treated as if he/she was worth nothing | 0.86 | 0.6% | 19.1% | 80.3% | |
The patient was not acknowledged, as if he/she did not exist | 0.84 | 1.3% | 22.2% | 76.6% | |
The patient was made to feel inferior | 0.81 | 2.5% | 27.2% | 70.3% | |
The patient’s privacy was violated | 0.69 | 12.0% | 35.4% | 52.5% | |
The patient was viewed as a part of a group (e.g., ward) and not as a person | 0.64 | 3.8% | 25.9% | 70.3% | |
Humiliation | CR = 0.88; AVE = 0.54; VIF = 2.97 | ||||
The patient was prevented from satisfying basic needs | 0.77 | 1.3% | 15.9% | 82.8% | |
The patient was forced to act against his/her inner beliefs (e.g., a vegetarian is forced to eat meat) | 0.72 | 1.3% | 15.9% | 87.3% | |
The patient was viewed as disgusting, like a person with Hansen’s disease | 0.77 | 1.3% | 16.7% | 82.1% | |
The patient was labeled with derogatory terms | 0.68 | 1.3% | 13.3% | 85.4% | |
The patient was mocked | 0.79 | 1.3% | 9.0% | 89.7% | |
The patient was forced to feel unwelcome (e.g., in a resting room or the presence of others) | 0.67 | 2.5% | 18.5% | 79.0% | |
Inattentiveness | CR = 0.86; AVE = 0.61; VIF = 1.83 | ||||
The patient was treated disrespectfully | 0.74 | 1.3% | 36.1% | 62.7% | |
Communication with the patient was degrading (e.g., the patient was treated like a child) | 0.84 | 8.9% | 48.1% | 43.0% | |
The patient was not provided with enough attention, diligence, and/or care | 0.78 | 7.0% | 57.6% | 35.4% | |
A patient’s opinion and feelings were ignored | 0.76 | 5.1% | 46.5% | 48.4% | |
Control | CR = 0.85; AVE = 0.74; VIF =1.91 | ||||
The patient was made to feel dependent on the grace of others | 0.86 | 6.3% | 38.0% | 55.7% | |
The patient was granted limited control of his/her own life | 0.86 | 8.9% | 46.5% | 44.6% | |
Demonization | CR = 0.87; AVE = 0.70; VIF = 2.12 | ||||
The patient was viewed suspiciously as having bad intentions | 0.80 | 0.6% | 20.3% | 79.1% | |
The patient was demonized, depicted as a threat | 0.87 | 1.9% | 15.3% | 82.8% | |
Physical force or psychological pressure was used against the patient | 0.84 | 1.3% | 15.9% | 82.8% | |
Manipulation | CR = 0.86; AVE = 0.67; VIF = 1.92 | ||||
The patient was seen as a means to obtain a benefit (e.g., something of value) | 0.90 | 1.3% | 14.1% | 84.6% | |
The patients were treated differently according to their social status | 0.78 | 9.6% | 27.4% | 63.1% | |
The patient was lied to or manipulated for the benefit of others | 0.77 | 1.3% | 17.6% | 81.0% | |
Barriers to Dignity Assurance | |||||
Organizational barriers | CR = 0.87; AVE = 0.58; VIF = 1.50 | ||||
Lack of human resources | 0.76 | 51.9% | 35.4% | 12.7% | |
Lack of support from management | 0.73 | 28.0% | 40.8% | 31.2% | |
Lack of means for care | 0.75 | 23.4% | 45.6% | 31.0% | |
Lack of motivation system | 0.77 | 44.3% | 30.4% | 25.3% | |
Patient as obstacle | CR = 0.88; AVE = 0.72; VIF = 1.60 | ||||
Patients unwilling to cooperate | 0.83 | 21.2% | 70.5% | 8.3% | |
Unrealistic expectations from patients | 0.82 | 44.9% | 49.4% | 5.8% | |
Family unwilling to cooperate | 0.89 | 29.3% | 59.2% | 11.5% | |
Unrealistic expectations from patients | 0.82 | 44.9% | 49.4% | 5.8% | |
Family unwilling to cooperate | 0.89 | 29.3% | 59.2% | 11.5% |
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | |
---|---|---|---|---|---|---|---|---|
(1) Organizational barriers | 0.76 | 0.51 | 0.25 | 0.30 | 0.34 | 0.27 | 0.30 | 0.32 |
(2) Patient as obstacle | 0.63 | 0.85 | 0.32 | 0.43 | 0.32 | 0.32 | 0.26 | 0.33 |
(3) Dehumanization | 0.31 | 0.39 | 0.78 | 0.65 | 0.61 | 0.62 | 0.53 | 0.60 |
(4) Humiliation | 0.37 | 0.53 | 0.77 | 0.74 | 0.43 | 0.44 | 0.69 | 0.63 |
(5) Inattentiveness | 0.43 | 0.41 | 0.74 | 0.54 | 0.78 | 0.55 | 0.33 | 0.41 |
(6) Control | 0.37 | 0.45 | 0.83 | 0.60 | 0.77 | 0.86 | 0.46 | 0.46 |
(7) Demonization | 0.37 | 0.32 | 0.64 | 0.85 | 0.43 | 0.65 | 0.83 | 0.48 |
(8) Manipulation | 0.42 | 0.43 | 0.75 | 0.81 | 0.54 | 0.68 | 0.63 | 0.82 |
Indirect Effects | Total Effects | Type of Mediation | |
---|---|---|---|
Dehumanization | 0.19 (p < 0.001) f2 = 0.08 | 0.19 (p < 0.001) f2 = 0.05 | Full |
Humiliation | 0.28 (p < 0.001) f2 = 0.05 | 0.28 (p < 0.001) f2 = 0.08 | Full |
Inattentiveness | 0.11 (p < 0.01) f2 = 0.04 | 0.35 (p < 0.001) f2 = 0.12 | Partial |
Control | 0.18 (p < 0.001) f2 = 0.05 | 0.18 (p < 0.001) f2 = 0.05 | Full |
Demonization | 0.22 (p < 0.01) f2 = 0.07 | 0.22 (p < 0.01) f2 = 0.07 | Full |
Manipulation | 0.12 (p < 0.05) f2 = 0.04 | 0.33 (p < 0.001) f2 = 0.11 | Partial |
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Peičius, E.; Urbonas, G.; Harrison, W.D.; Urbonienė, A.; Kuznecovienė, J.; Butkevičienė, R.; Astromskė, K.; Kalėdienė, R. Dignity Violations and Barriers to Dignity Assurance for Terminally Ill Patients at the End of Life: A Cross-Sectional Analysis. Medicina 2022, 58, 294. https://doi.org/10.3390/medicina58020294
Peičius E, Urbonas G, Harrison WD, Urbonienė A, Kuznecovienė J, Butkevičienė R, Astromskė K, Kalėdienė R. Dignity Violations and Barriers to Dignity Assurance for Terminally Ill Patients at the End of Life: A Cross-Sectional Analysis. Medicina. 2022; 58(2):294. https://doi.org/10.3390/medicina58020294
Chicago/Turabian StylePeičius, Eimantas, Gvidas Urbonas, W. David Harrison, Aušra Urbonienė, Jolanta Kuznecovienė, Rūta Butkevičienė, Kristina Astromskė, and Ramunė Kalėdienė. 2022. "Dignity Violations and Barriers to Dignity Assurance for Terminally Ill Patients at the End of Life: A Cross-Sectional Analysis" Medicina 58, no. 2: 294. https://doi.org/10.3390/medicina58020294