Manitoba researcher wins prestigious award for work that made dignity the focus in palliative care

September 25, 2024 Canuck

The Current24:43Asking doctors to see the person behind the patient

WARNING: This story contains discussion of suicide.

Dr. Harvey Max Chochinov, a groundbreaking palliative care researcher from the University of Manitoba, has won a prestigious international award for pioneering “dignity therapy” and other patient-centred approaches to caring for the dying.

A leader in the field of palliative care and communication, Chochinov’s approach that focusses on patient dignity has been adopted around the world.

For more than 30 years, the distinguished professor of psychiatry at the University of Manitoba and senior scientist at the CancerCare Manitoba research institute studied how health-care workers can alleviate emotional and mental suffering for end-of-life patients in practical ways.

This month, he will receive the 2024 Arthur M. Sutherland Award and Memorial Lecture from the International Psycho-Oncology Society (IPOS) in Maastricht, The Netherlands.

The award is given to an internationally recognized individual who has contributed to the area of psychological and social care for cancer patients over their whole career.

“Before my health and creativity and energy deteriorates, I will … do what I can to spread the word as widely in order to raise the bar on person-centered care,” Chochinov, 66, told The Current’s host Matt Galloway.

The photo shows a woman holding onto the hand of someone who is lying in a hospital bed. — Chochinov developed an intervention called ‘dignity therapy,’ which involves patients answering open-ended questions to talk about their lives or what matters most to them. (Photographee.eu / Shutterstock)

Maintaining patient dignity in palliative care

After Chochinov finished medical school, a psychiatry residency and a fellowship at the Memorial Sloan Kettering Cancer Center in New York, he delved into researching how patients cope with life-threatening or life-limiting conditions.

“When people enter into health care … oftentimes the things that become paramount … even overshadowing everything, is being ill and being understood on the basis of their illness,” said Chochinov.

When patients are perceived only through that lens, it causes mental and emotional suffering, he says.

“Nobody likes to be seen as being defined by their illness … nobody likes to be treated just like a patient…. It’s not based on who you are as an individual.”

Dignity therapy

So Chochinov developed an intervention called “dignity therapy.”

In a 30- to 60- minute session, patients answer open-ended questions, getting a critical opportunity to talk about their lives or what matters most to them. The transcribed conversation is then given to their loved ones to keep.

Chochinov says that this practice and others that prioritize dignity are vital to improving the quality of life for terminally ill patients, and has a profound impact on a patient’s will to live, he says.

We decided that if dignity is worth dying for, then dignity is worth studying.– Dr. Harvey Max Chochinov

Citing a study done in Holland that looked at why patients chose to end their lives through euthanasia and assisted suicide, Chochinov said that “over and above anything else that these Dutch physicians reported was ‘lost sense of dignity.'”

“We decided that if dignity is worth dying for, then dignity is worth studying … we went into [our studies] with the idea that loss of dignity … [renders] a state where life becomes untenable, unsustainable.”

Asking the patient dignity question

Another method of care that emerged from his research is something he calls the “patient dignity question.”

This is when a healthcare worker asks their patient, “What do I need to know about you as a person to give you the best care possible?”

“What the data shows is … all patients, and to my knowledge without exception, say ‘this is information that needs to be placed on my clinical chart … this is how I want to be seen,'” said Chochinov, “[and] all of them say this is something that should be offered to patients or families.”

For example, when Chochinov asked that question of one patient in her mid-to-late 80s, he said she replied with, “Well, what you need to know is that my coming death is not really such a tragedy.

“I have lived a long and good life, but if you want to know what keeps me awake at night, it’s the fact that my young son in his mid-50s is dying in the hospital on the other side of the river, and what will happen to my daughter-in-law, and what will happen to our grandchildren?”

Chochinov says interactions like this one allow the the health-care provider to learn new information about their patient, increasing connectedness, empathy and respect. And it changes how they view their profession, too.

“If you are engaged with people in a way that is not simply technical and transactional, but also relational, that increases job satisfaction,” said Chochinov.

WATCH / Dr. Chochinov delivers University of Manitoba’s Medicine Inauguration Keynote Speech:

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Chochinov’s work has also received numerous other accolades. He was inducted into the Canadian Medical Hall of Fame in 2020, and received the FNG Starr Award — Canadian Medical Association’s highest recognition — in 2021.

Adding the Arthur M. Sutherland Award in 2024, Chochinov told CBC, “This award means recognition by one’s international peers. For me, it also suggests that the work I’ve done in palliative care, and raising the bar on person-centred care, has resonated cross-culturally and transcends geography.”

“I hope this will focus further attention on the importance of the human side of medicine.”

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