Evaluating the Swedish Dignity Care Intervention within municipality healthcare : for older persons with palliative care needs

Background: Palliative care in Sweden is not equal in terms of age, disease, and place of care. An essential value within palliative care is dignity, therefore healthcare emphasizing this value must be prioritized. However, older persons are concerned their dignity would not be considered and dignity interventions are rare. The overall aim of the thesis was to evaluate the Swedish Dignity Care Intervention (DCI-SWE) and its implementation within municipal palliative healthcare in order to conserve older persons’ dignity and quality of life. Methods: Qualitative and mixed methods were used. Data were collected with an integrative review (study I), focus group and individual interviews with community nurses (CNs) (studies II, IV), healthcare professionals and managers (study IV), individual interviews with older persons and relatives (study III), reflective diaries and field notes (studies II, IV), and questionnaires measuring older persons’ dignity-related distress and quality of life (study III). Data were analysed using thematic synthesis (study I), inductive content analysis(study II), inductive thematic analysis and comparative statistical analysis (study III), directed content analysis and descriptive statistical analysis (study IV). Results: Within dignity-conserving care, broad outcomes like dignity-related distress and quality of life have been used. However, communication outcomes should also be considered (study I). The DCISWE has clear benefits if it is used with background of who the older person is and with respect of personal needs (studies II - IV). The feasibility of the DCI-SWE depends on the healthcare organization’s engagement and capacity (studies II, IV). The DCI-SWE can support CNs in communicating with older persons (studies II, IV). However, more communication training is needed, and managers leadership is an important component (studies II, IV). The implementation intervention needs further development, and the use of a behavior change model may be beneficial.