Thinking clearly about dignity: relationships between cognitive processes underlying perceived dignity as determinants of psychological adjustment

BACKGROUND Public and professional views strongly equate dignity among the dying with their abilities to make decisions about medical and personal treatment and care. To make these decisions requires cognitive processes that inform our understanding of circumstances by integrating thoughts, experiences, and perceptions with prior knowledge. But patients with terminal illnesses, especially cancer, often experience problems stemming from cognitive changes and the cognitive state of uncertainty that can interfere with knowing what options for care are essential to targeting their sense of dignity. This paper aims to propose and test a model that defines targets for dignity-conserving care from underlying cognitive changes as antecedents to uncertainty that impact psychological adjustment of patients with advanced cancer. PARTICIPANTS AND PROCEDURE This is a cross-sectional observational study using participant data from 257 patients with advanced cancer. The Patient Dignity Inventory and the Hospital Anxiety and Depression Scale were administered to patients and analyzed according to model hypotheses. RESULTS Analyses used structural equational modeling to confirm model pathways. In the context of perceived dignity in advanced cancer, there was a direct pathway from patient reported problems with cognitive changes to uncertainty, that in turn had both direct and indirect effects on depression. CONCLUSIONS The results suggest that cognitive changes challenge perceptions of dignity and can independently be targeted as modifiable processes to provide dignity-conserving care.