Dr. Harvey Chochinov
June 23, 2014
WINNIPEG – Dying patients need to be asked what it feels like to be dying and how that experience can be made better, says a Winnipeg physician devoted to palliative care.
Dr. Harvey Chochinov says maintaining and enhancing the dignity of the person at the end of life is a key aspect of providing comprehensive, quality palliative care.
"We need details about our patients to help us remember them," Chochinov said.
For the elderly, the dying and their loved ones, the topic of dignity evokes a range of emotions and opinions, he told the recent Canadian Association for Spiritual Care National Conference.
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 the CMA can bestow.
The ABCDs of dignity conserving care are attitude, behaviour, compassion and dialogue, he said. Together they form one part of a Patient Dignity Inventory (PDI) 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.
"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.
The most-downloaded article from the Winnipeg-based Canadian Virtual Hospice website at www.virtualhospice.ca 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.
CARE PROVIDER'S ATTITUDE
Chochinov said a care provider's attitude has a profound effect on a patient's sense of dignity.
"If people feel care is forthcoming, they are much more likely to be forthcoming with what is going on," he said.
Health care workers will speak of "routine medical examinations. But when it is your body being examined there is nothing routine about it," he said. "We come into this work with good intentions and if we can keep that top of mind we'll do okay."
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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