A Preliminary Model of Dignity Management in Hospice

This study aims to develop a preliminary model of dignity management (MDM) in hospice describing the social process used by the interdisciplinary team to support the dignity of the patient-family unit in hospice. A qualitative, grounded theory methodology was used to achieve this goal. Research samples, including dying patients, their families and hospice staff, were recruited from a residential hospice in North Amherst, Massachusetts. Data collection methods included interview, observation, and document review. Symbolic interactionism and pragmatism provided the philosophical basis for this study. Thematic analysis was used to explore the definitions of dignity; and grounded theory analytic techniques for theory discovery, including constant comparison, opening, axial and selective coding, process, and the conditional matrix, were used to produce theoretical models. Definitions of dignity for patients and families, which were synthesized based on data from patients, families, and staff in hospice, were presented. The model of dignity in hospice (MDH) was developed by referring to the conditional matrix to elaborate the phenomenon of dignity in hospice. In this model, dignity was placed in the context of hospice with an extension to the community that patients and families belonged to. Resources and social support from community are located in the community level; agency policies and missions, environment of the residential hospice, and services and resources from the residential hospice are agency-level factors to support dignity. The interdisciplinary team locates in the group individual level of the model. Incidents in the interactional level and the core actions refer to the process of dignity management. The preliminary model of dignity management (MDM) was proposed to describe the process the interdisciplinary team used to manage dignity in hospice. The four modules in the model refer to the steps to manage dignity in hospice, flowing from “acknowledge,” “define” to “prepare” and “manage” to formalize the process of dignity management in hospice. Themes and subthemes within each module indicated the ways to complete each step. Finally, two cases were used to describe and tentatively verify the preliminary model of dignity management in hospice