Living and dying with dignity in Chinese society: perspectives of older palliative care patients in Hong Kong

TLDR

The empirical Dignity Model has shaped Western palliative care for older terminal patients by offering practical strategies to promote dignity and reduce distress at the end of life. This study aimed to examine living and dying with dignity in the Chinese context and assess the generalizability of the Dignity Model to older terminal patients in Hong Kong. Qualitative interviews with 16 older Chinese palliative care patients were analyzed using a deductive‑inductive framework analysis to explore the construct of dignity. The framework analysis confirmed the three major Dignity Model categories but found that death anxiety was absent, generativity/legacy and resilience/fighting spirit appeared differently, and identified four new themes—enduring pain, moral transcendence, spiritual surrender, and transgenerational unity—underscoring the need for culturally sensitive, family‑oriented palliative care in Hong Kong.

Abstract

the empirical Dignity Model has profoundly influenced the provision of palliative care for older terminally ill patients in the West, as it provides practical guidance and intervention strategies for promoting dignity and reducing distress at the end-of-life.to examine the concept of 'living and dying with dignity' in the Chinese context, and explore the generalisability of the Dignity Model to older terminal patients in Hong Kong.using qualitative interviews, the concept of dignity was explored among 16 older Chinese palliative care patients with terminal cancer. Framework analysis with both deductive and inductive methods was employed.the three major categories of themes of the Dignity Model were broadly supported. However, the subtheme of death anxiety was not supported, while two subthemes of generativity/legacy and resilience/fighting spirit manifested differently in the Chinese context. Furthermore, four new emergent themes have been identified. They include enduring pain, moral transcendence, spiritual surrender and transgenerational unity.these findings highlight both a cultural and a familial dimension in the construct of dignity, underline the paramount importance of cultural awareness and competence for working with ethnically diverse groups, and call for a culturally sensitive and family oriented approach to palliative care interventions with older Chinese terminal patients.