Patients' experiences and perceptions of dignity in end-of-life care in emergency departments: A qualitative study.
Celia Martí-García, Alba Fernández-Férez, Cayetano Fernández-Sola and 4 others
PMID 36062865WHAT IT FOUND
Patients with advanced illness viewed dignity as personal autonomy and emotional control, not just respectful treatment.
They resisted life-prolonging interventions that threatened their cognitive capacity, prioritizing the freedom to decide the timing and mode of their death over medical protocols.
Key findings
01Participants defined dignity primarily as an inherent personal attribute involving autonomy and the freedom to decide when and how to die, often rejecting palliative sedation to maintain cognitive capacity.
02Patients used behavioral strategies such as maintaining daily routines, reminiscing, and humor to preserve their sense of self and dignity during emergency department visits.
03Therapeutic obstinacy and ED protocols focused on saving lives were perceived by patients as impediments to dignity, causing suffering by forcing them to deteriorate against their wishes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was small (16 participants) and heavily skewed towards patients with cancer (93.75%) and retirees (81.25%), limiting generalizability to other illnesses or working-age populations. Interviews were conducted after ED discharge, sometimes in the patients' homes, which may have affected the immediacy and intensity of recollections compared to interviewing in the ED itself. The researchers were nurses who had previously cared for some participants, which may have influenced the dynamics of the interviews, although they did not provide care in the ED.
Declared interests
The study was funded by the Spanish Government and the European Union. No conflicts of interest were declared by the authors.
The easy way to misread this
Do not interpret the patients' resistance to sedation and life-prolonging care as a universal preference or a direct result of the ED environment alone. These findings reflect the subjective experiences of 16 specific patients, mostly with cancer, and do not constitute evidence that standard ED protocols are ineffective or harmful for all patients with advanced illness.