{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T09:45:10Z","timestamp":1791798310073,"version":"4.3.4"},"reference-count":31,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"unspecified","delay-in-days":284,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1478951526104076_sec1a\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The DiRePal model understands dignity at the end of life as relational and temporal, shaped by recognition, narrative continuity, and prudent listening. This study explores how patients with advanced cancer, informal caregivers, and physicians understand and experience dignity, providing empirical foundations for the model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526104076_sec2b\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multicentre qualitative study comprised six semi-structured focus groups involving oncology patients (n = 10), informal caregivers (n = 14), and pulmonology\/oncology physicians (n = 15), conducted via a secure digital platform between April and November 2025 with IQVIA Portugal. Transcripts underwent reflexive thematic analysis, with independent initial coding, discussion-based consensus, and researcher reflexivity. Given participants\u2019 clinical fragility, member checking was not undertaken; credibility relied on triangulation, thick description, and an audit trail.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526104076_sec3c\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six themes emerged: personal understanding of dignity, narrative flexibility, negotiating technical rationality and relational care, temporal sensitivity, professional reciprocity, and digital\/structural integration. Dignity was inseparable from personal recognition, interpersonal gestures, and listening within time-constrained encounters. Physicians\u2019 emotional overload and insufficient institutional support compromised their dignity and, indirectly, patients\u2019; caregivers frequently rendered themselves invisible. Patients associated dignity with respect, autonomy, and relief of suffering, while depersonalised or fragmented care eroded it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526104076_sec4d\">\n                    <jats:title>Significance of results<\/jats:title>\n                    <jats:p>These findings ground a relational\u2013temporal account of dignity in reciprocal recognition between patients, caregivers, and clinicians across shared, unevenly experienced time. Listening, temporal prudence, and recognition of clinicians\u2019 vulnerability should be clinical priorities, alongside cautious, relationally framed integration of digital tools.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1478951526104076","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T08:51:25Z","timestamp":1791795085000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["From voices to dignity: Empirical foundations of the DiRePal model in persons with advanced cancer"],"prefix":"10.1017","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4115-5012","authenticated-orcid":false,"given":"Abel","family":"Garc\u00eda Abejas","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03nf36p02","id-type":"ROR","asserted-by":"publisher"}],"name":"Universidade da Beira Interior Faculdade de Ciencias da Saude"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Geraldes","family":"Santos","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03nf36p02","id-type":"ROR","asserted-by":"publisher"}],"name":"Universidade da Beira Interior Faculdade de Artes e Letras"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helder","family":"Mota-Filipe","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01c27hj86","id-type":"ROR","asserted-by":"publisher"}],"name":"Universidade de Lisboa Unidade de Farmacologia e Farmacotoxicologia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio Costa","family":"Leite","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03nf36p02","id-type":"ROR","asserted-by":"publisher"}],"name":"Universidade da Beira Interior"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida","family":"Cordero Botejara","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03nf36p02","id-type":"ROR","asserted-by":"publisher"}],"name":"Universidade da Beira Interior Faculdade de Ciencias da Saude"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"S1478951526104076_ref2","volume-title":"The Nicomachean Ethics","year":"2009"},{"key":"S1478951526104076_ref26","volume-title":"Oneself as Another","author":"Ricoeur","year":"1992"},{"key":"S1478951526104076_ref22","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511840715"},{"key":"S1478951526104076_ref10","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780199641321.001.0001"},{"key":"S1478951526104076_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sapharm.2020.02.005"},{"key":"S1478951526104076_ref15","unstructured":"Honneth, A (1996) The Struggle for Recognition: The Moral Grammar of Social Conflicts, Cambridge, MA: MIT Press."},{"key":"S1478951526104076_ref21","doi-asserted-by":"publisher","DOI":"10.1002\/ev.1427"},{"key":"S1478951526104076_ref16","unstructured":"IQVIA Portugal (2025a) Relat\u00f3rio qualitativo: Como \u00e9 entendida e experimentada a dignidade em fim de vida \u2013 Doentes e cuidadores. IQVIA Portugal."},{"key":"S1478951526104076_ref23","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afl152"},{"key":"S1478951526104076_ref29","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0B013E3181659096"},{"key":"S1478951526104076_ref18","doi-asserted-by":"publisher","DOI":"10.21037\/apm.2018.04.04"},{"key":"S1478951526104076_ref5","first-page":"84","article-title":"Dying, dignity, and new horizons in palliative end-of-life care","volume":"56","author":"Chochinov","year":"2006","journal-title":"CA: A Cancer Journal for Clinicians"},{"key":"S1478951526104076_ref30","doi-asserted-by":"publisher","DOI":"10.1080\/713685822"},{"key":"S1478951526104076_ref25","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2014.9427"},{"key":"S1478951526104076_ref4","volume-title":"Precarious Life: The Powers of Mourning and Violence","author":"Butler","year":"2004"},{"key":"S1478951526104076_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(11)70153-X"},{"key":"S1478951526104076_ref28","volume-title":"Moral Boundaries: A Political Argument for an Ethic of Care","author":"Tronto","year":"1993"},{"key":"S1478951526104076_ref24","first-page":"538","article-title":"Brief note on the origins, evolution, and meaning of the qualitative research concept \u201cThick description\u201d","volume":"11","author":"Ponterotto","year":"2006","journal-title":"Qualitative Reporter"},{"key":"S1478951526104076_ref11","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951526102648"},{"key":"S1478951526104076_ref9","unstructured":"Finlay, L and Gough, B (2008) Reflexivity: A practical guide for researchers in health and social sciences. Oxford: John Wiley & Sons.."},{"key":"S1478951526104076_ref31","doi-asserted-by":"publisher","DOI":"10.4135\/9781412984591"},{"key":"S1478951526104076_ref27","doi-asserted-by":"publisher","DOI":"10.1177\/0269216316663499"},{"key":"S1478951526104076_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2006.05.011"},{"key":"S1478951526104076_ref3","doi-asserted-by":"publisher","DOI":"10.1080\/2159676X.2019.1628806"},{"key":"S1478951526104076_ref14","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:osobl\/9780195111194.001.0001"},{"key":"S1478951526104076_ref19","doi-asserted-by":"publisher","DOI":"10.1007\/s11019-012-9427-3"},{"key":"S1478951526104076_ref13","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951525100990"},{"key":"S1478951526104076_ref20","volume-title":"Humanisme de L\u2019autre Homme","author":"L\u00e9vinas","year":"1972"},{"key":"S1478951526104076_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(01)00084-3"},{"key":"S1478951526104076_ref12","doi-asserted-by":"publisher","DOI":"10.2196\/73517"},{"key":"S1478951526104076_ref17","unstructured":"IQVIA Portugal (2025b) Relat\u00f3rio qualitativo: Como \u00e9 entendida e experimentada a dignidade em fim de vida \u2013 M\u00e9dicos. IQVIA Portugal."}],"container-title":["Palliative and Supportive Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1478951526104076","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T08:51:30Z","timestamp":1791795090000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1478951526104076\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":31,"alternative-id":["S1478951526104076"],"URL":"https:\/\/doi.org\/10.1017\/s1478951526104076","relation":{},"ISSN":["1478-9515","1478-9523"],"issn-type":[{"value":"1478-9515","type":"print"},{"value":"1478-9523","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e259"}}