{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T22:22:55Z","timestamp":1786486975532,"version":"build-2736575974"},"reference-count":42,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T00:00:00Z","timestamp":1745971200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0To meet the goals of primary palliative care for patients with advanced disease and to provide holistic patient-centred compassionate care that respects the experience of patients, dignity in its entirety needs to be understood from the patients\u2019 perspective. There are no studies to understand the predominant factors that impact the dignity experience of South African patients with advanced disease.\n\nMethods:\u00a0This was a descriptive qualitative study where a semi-structured interview guide was used to understand the dignity experience of adult patients with advanced disease (Stage IV cancer, AIDS, people living with human immunodeficiency virus [HIV]), receiving home care from two hospices in the North of Durban, KwaZulu-Natal. Purposive sampling was used to identify 14 patients from culturally, linguistically and socioeconomically diverse populations representative of South Africa. In-depth interviews allowed for an exploration of participants\u2019 lived experiences. Interviews were audiotaped and transcribed verbatim. Data were analysed using thematic analysis.\n\nResults:\u00a0Four major themes and numerous sub-themes defined the total dignity experience. The themes were: (1) Physical Concerns; (2) Psychological Concerns and coping mechanisms; (3) Social Concerns; and (4) Spiritual Concerns and coping mechanisms. Sub-themes are described in the main article.\n\nConclusion:\u00a0With awareness of the factors that affect the total dignity experience, healthcare providers can be considerate of and offer optimal dignity-conserving compassionate care to respect and improve the quality of life of South African patients living with advanced disease.\n\nContribution:\u00a0This study extensively explored new knowledge on the total dignity experience of South African patients with advanced disease.<\/jats:p>","DOI":"10.4102\/safp.v67i1.6047","type":"journal-article","created":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T09:33:03Z","timestamp":1745659983000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Understanding the dignity experience of South African patients in primary palliative care"],"prefix":"10.4102","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0433-9093","authenticated-orcid":false,"given":"Raksha","family":"Balbadhur","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7602-6168","authenticated-orcid":false,"given":"Elizabeth","family":"Gwyther","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2025,4,30]]},"reference":[{"key":"ref0","unstructured":"Balbadhur R. Understanding the dignity experience and exploring the impact of dignity therapy and guided imagery on patients with advanced disease - a South African perspective [Master\u2019s Thesis]. University of Cape Town, Faculty of Health Sciences, Department of Public Health and Family Medicine; 2017 [cited 2024 Jun 17]. Available from: http:\/\/hdl.handle.net\/11427\/24874"},{"key":"ref1","unstructured":"Dignity [homepage on the Internet]. http:\/\/Merriam-Webster.com Dictionary, Merriam-Webster. [cited 2024 Dec 19]. Available from: https:\/\/www.merriam-webster.com\/dictionary\/dignity"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Brennan F. Dignity: A unifying concept for palliative care and human rights. Prog Palliat Care. 2014;22(2):88\u201396. https:\/\/doi.org\/10.1179\/1743291X13Y.0000000064","DOI":"10.1179\/1743291X13Y.0000000064"},{"key":"ref3","unstructured":"Abiven M. Dying with dignity. World Health Forum. 1991;12(4):375\u2013381; discussion 382\u2013398."},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Madan TN. Dying with dignity. Soc Sci Med. 1992;35(4):425\u2013432. https:\/\/doi.org\/10.1016\/0277-9536(92)90335-N","DOI":"10.1016\/0277-9536(92)90335-N"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Chochinov HM, Hack T, McClement S, Kristjanson L, Harlos M. Dignity in the terminally ill: A developing empirical model. Soc Sci Med. 2002;54(3):433\u2013443. https:\/\/doi.org\/10.1016\/S0277-9536(01)00084-3","DOI":"10.1016\/S0277-9536(01)00084-3"},{"key":"ref6","unstructured":"Pokorny ME. The effect of nursing care on human dignity in the critically ill adult. University of Virginia; 1989."},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Enes SP. An exploration of dignity in palliative care. Palliat Med. 2003;17(3): 263\u2013269. https:\/\/doi.org\/10.1191\/0269216303pm699oa","DOI":"10.1191\/0269216303pm699oa"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Hack TF, Chochinov HM, Hassard T, Kristjanson LJ, McClement S, Harlos M. Defining dignity in terminally ill cancer patients: A factor-analytic approach. Psycho Oncol 2004;13(10):700\u2013708. https:\/\/doi.org\/10.1002\/pon.786","DOI":"10.1002\/pon.786"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Chochinov HM. Dying, dignity, and new horizons in palliative end-of-life care. CA Cancer J Clin. 2006;56(2):84\u2013103. https:\/\/doi.org\/10.3322\/canjclin.56.2.84","DOI":"10.3322\/canjclin.56.2.84"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Chochinov HM. Dignity-conserving care \u2013 A new model for palliative care: Helping the patient feel valued. JAMA. 2002;287(17):2253\u20132260. https:\/\/doi.org\/10.1001\/jama.287.17.2253","DOI":"10.1001\/jama.287.17.2253"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M. Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol. 2005;23(24):5520\u20135525. https:\/\/doi.org\/10.1200\/JCO.2005.08.391","DOI":"10.1200\/JCO.2005.08.391"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Chochinov HM. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. Bmj. 2007 Jul 26;335(7612):184\u2013187.","DOI":"10.1136\/bmj.39244.650926.47"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Mnyandu N. Exploring the concept of Ubuntu in relation to dying with dignity in palliative and hospice care. Obiter. 2018;39(2):384\u2013398. https:\/\/doi.org\/10.17159\/obiter.v39i2.11356","DOI":"10.17159\/obiter.v39i2.11356"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Mokgoro JY. Ubuntu and the law in South Africa. Potchefstroom Elect Law J. 1998;1(1):2. https:\/\/doi.org\/10.4314\/pelj.v1i1.43567","DOI":"10.4314\/pelj.v1i1.43567"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Bennett TW. Ubuntu: An African equity. Potchefstroom Elect Law J. 2011;14(4): 30\u201361. https:\/\/doi.org\/10.4314\/pelj.v14i4.2","DOI":"10.4314\/pelj.v14i4.2"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Nicolaides A. Considering the philosophy of Ubuntu in South African healthcare ethical practices. J Med Lab Sci Technol S Afr. 2023;5(1):71\u201376. https:\/\/doi.org\/10.36303\/JMLSTSA.133","DOI":"10.36303\/JMLSTSA.133"},{"key":"ref17","unstructured":"Statistics South Africa. Census 2022 products [homepage on the Internet]. [cited 2023 Oct 10]. Available from: https:\/\/census.statssa.gov.za\/#\/"},{"key":"ref18","unstructured":"Mbele B, Makhaba L, Nzima D, et al. An experiential investigation into the phenomenon of respect in Zulu culture. Indilinga Afr J Indigen Knowl Syst. 2015;14(1):87\u2013102."},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Ramlall S, Chipps J, Bhigjee AI, Pillay BJ. Screening a heterogeneous elderly South African population for cognitive impairment: The utility and performance of the mini-mental state examination, six item screener, subjective memory rating scale and deterioration cognitive observee: Original. Afr J Psychiatry. 2013;16(6):445\u2013455. https:\/\/doi.org\/10.4314\/ajpsy.v16i6.57","DOI":"10.4314\/ajpsy.v16i6.57"},{"key":"ref20","unstructured":"Clarke V, Braun V, Hayfield N. Thematic analysis. In: Block L, Dickens K, editors. Qualitative psychology: A practical guide to research methods. London: SAGE, 2015; p. 222\u2013248."},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Chochinov HM, Kristjanson LJ, Hack TF, Hassard T, McClement S, Harlos M. Burden to others and the terminally ill. J Pain Symptom Manage. 2007;34(5):463\u2013471. https:\/\/doi.org\/10.1016\/j.jpainsymman.2006.12.012","DOI":"10.1016\/j.jpainsymman.2006.12.012"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Malakoane B, Heunis JC, Chikobvu P, Kigozi NG, Kruger WH. Public health system challenges in the Free State, South Africa: A situation appraisal to inform health system strengthening. BMC Health Serv Res. 2020;20:1\u20134. https:\/\/doi.org\/10.1186\/s12913-019-4862-y","DOI":"10.1186\/s12913-019-4862-y"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Aikman N. The crisis within the South African healthcare system: A multifactorial disorder. S Afr J Bioeth Law. 2019;12(2):52\u201356. https:\/\/doi.org\/10.7196\/SAJBL.2019.v12i2.694","DOI":"10.7196\/SAJBL.2019.v12i2.694"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Sulmasy DP. Death and human dignity. Linacre Q. 1994;61(4):7. https:\/\/doi.org\/10.1080\/20508549.1999.11878278","DOI":"10.1080\/20508549.1999.11878278"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Dijxhoorn AF, Brom L, Van der Linden YM, Leget C, Raijmakers NJ. Prevalence of burnout in healthcare professionals providing palliative care and the effect of interventions to reduce symptoms: A systematic literature review. Palliat Med. 2021;35(1):6\u201326. https:\/\/doi.org\/10.1177\/0269216320956825","DOI":"10.1177\/0269216320956825"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Horn DJ, Johnston CB. Burnout and self care for palliative care practitioners. Med Clin. 2020;104(3):561\u2013572. https:\/\/doi.org\/10.1016\/j.mcna.2019.12.007","DOI":"10.1016\/j.mcna.2019.12.007"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Wilson KG, Curran D, McPherson CJ. A burden to others: A common source of distress for the terminally ill. Cognit Behav Ther. 2005;34(2):115\u2013123. https:\/\/doi.org\/10.1080\/16506070510008461","DOI":"10.1080\/16506070510008461"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"McPherson CJ, Wilson KG, Murray MA. Feeling like a burden: Exploring the perspectives of patients at the end of life. Soc Sci Med. 2007;64(2):417\u2013427. https:\/\/doi.org\/10.1016\/j.socscimed.2006.09.013","DOI":"10.1016\/j.socscimed.2006.09.013"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Metz T. African conceptions of human dignity: Vitality and community as the ground of human rights. Hum Rights Rev. 2012;13(1):19\u201337. https:\/\/doi.org\/10.1007\/s12142-011-0200-4","DOI":"10.1007\/s12142-011-0200-4"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Street AF, Kissane DW. Constructions of dignity in end-of-life care. J Palliat Care. 2001;17(2):93. https:\/\/doi.org\/10.1177\/082585970101700205","DOI":"10.1177\/082585970101700205"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"De Lima L, Woodruff R, Pettus K, et al. International association for hospice and palliative care position statement: Euthanasia and physician-assisted suicide. J Palliat Med. 2017;20(1):8\u201314. https:\/\/doi.org\/10.1089\/jpm.2016.0290","DOI":"10.1089\/jpm.2016.0290"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Maslow AH. A theory of human motivation. Psychol Rev. 1943;50(4):370. https:\/\/doi.org\/10.1037\/h0054346","DOI":"10.1037\/h0054346"},{"key":"ref33","unstructured":"Neves D, Samson M, Van Niekerk I, Hlatshwayo S, Du Toit A. The use and effectiveness of social grants in South Africa. Finmark Trust. 2009 Sep 30;60."},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Abel J, Bowra J, Walter T, Howarth G. Compassionate community networks: Supporting home dying. BMJ Support Palliat Care. 2011;1(2):129\u2013133. https:\/\/doi.org\/10.1136\/bmjspcare-2011-000068","DOI":"10.1136\/bmjspcare-2011-000068"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Kellehear A. Compassionate communities: End-of-life care as everyone\u2019s responsibility. QJM. 2013;106(12):1071\u20131075. https:\/\/doi.org\/10.1093\/qjmed\/hct200","DOI":"10.1093\/qjmed\/hct200"},{"key":"ref36","unstructured":"Fraser G. I want to be a burden on my family as I die and for them to be a burden on me. The Guardian [serial online]. 2013 May 03 [cited 2013 May 03]. Available from: https:\/\/www.theguardian.com\/commentisfree\/belief\/2013\/may\/03\/burden-loved-ones-dying-euthanasia"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Proulx K, Jacelon C. Dying with dignity: The good patient versus the good death. Am J Hosp Palliat Care. 2004;21(2):116\u2013120. https:\/\/doi.org\/10.1177\/104990910402100209","DOI":"10.1177\/104990910402100209"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Gamlin R. Dignity and palliative care. Int J Palliat Nurs. 2002;8(1):49. https:\/\/doi.org\/10.12968\/ijpn.2002.8.1.12644","DOI":"10.12968\/ijpn.2002.8.1.12644"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"Cole B, Pargament K. Re-creating your life: A spiritual\/psychotherapeutic intervention for people diagnosed with cancer. Psycho Oncol. 1999;8(5):395\u2013407. https:\/\/doi.org\/10.1002\/(SICI)1099-1611(199909\/10)8:5%3C395::AID-PON408%3E3.0.CO;2-B","DOI":"10.1002\/(SICI)1099-1611(199909\/10)8:5<395::AID-PON408>3.3.CO;2-2"},{"key":"ref40","unstructured":"United Nations. General Assembly. Universal declaration of human rights. Department of State, United States of America; 1949."},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"Krakauer EL, Wenk R, Buitrago R, Jenkins P, Scholten W. Opioid inaccessibility and its human consequences: Reports from the field. J Pain Palliat Care Pharmacother. 2010;24(3):239\u2013243. https:\/\/doi.org\/10.3109\/15360288.2010.501852","DOI":"10.3109\/15360288.2010.501852"}],"container-title":["South African Family Practice"],"original-title":[],"link":[{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/viewFile\/6047\/9571","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/viewFile\/6047\/9572","content-type":"application\/epub+zip","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/viewFile\/6047\/9573","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/viewFile\/6047\/9574","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/view\/6047\/9574","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T10:23:07Z","timestamp":1763115787000},"score":1,"resource":{"primary":{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/view\/6047"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,30]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/safp.v67i1.6047","relation":{},"ISSN":["2078-6190","2078-6204"],"issn-type":[{"value":"2078-6190","type":"print"},{"value":"2078-6204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,30]]},"article-number":"a6047"}}