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Dignity in the Pediatric Population: A Systematic Review
Allison Silverstein1, Veronica Easton2, Cory Barrows3
1Department of Pediatrics (A.S.), Section of Palliative Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
Insights
Dignity in pediatric care is underexplored, with few studies defining or measuring it. Future research should focus on patient-centered dignity across all stages of illness.
Area of Science:
- Pediatric Healthcare Research
- Bioethics
- Patient-Centered Care
Background:
- Children possess limited self-advocacy, increasing vulnerability to dignity infringements.
- The concept of dignity in pediatrics is significantly under-researched compared to adult populations.
- Existing research often focuses on dignity in end-of-life care.
Purpose of the Study:
- To systematically review and characterize the definition, evaluation, and measurement of dignity in pediatric research.
- To identify key themes and gaps in the current understanding of pediatric dignity.
Main Methods:
- A systematic review adhering to PRISMA guidelines was conducted.
- Searched multiple databases (MEDLINE, Embase, PsycINFO, etc.) from inception to April 2023.
- Included English-language publications on children (0-18 years) focusing on dignity.
Main Results:
- Forty-four articles met inclusion criteria; 45% were original research.
- Key themes in dignity definitions included respect, communication, autonomy, and privacy.
- Only 43% of studies measured or evaluated dignity; 34% discussed dignity therapy.
Conclusions:
- There is a limited body of published research on dignity in pediatrics.
- Opportunities exist to expand scholarship on pediatric dignity through collaboration.
- The goal is to enhance dignity-centered care throughout a child's illness and end-of-life journey.
Context:
Children are a uniquely vulnerable patient population with restricted abilities for self-advocacy and autonomy, risking infringement upon their dignity. Yet the concept of dignity in pediatrics remains underexplored relative to the adult literature and other outcome measures.
Objectives:
To characterize how dignity is defined, evaluated, and/or measured in pediatrics.
Methods:
We conducted a systematic review following PRISMA guidelines across the following databases: MEDLINE, Embase, Cumulative Index of Nursing and Allied Health, PsycINFO, Global Health, Social Science Premium Collection, and Dissertation and Theses. We included publications from database inception through April 2023, in English, involving children aged 0-18 years, and prioritizing dignity as a central theme with a focus on defining, evaluating, or measuring dignity. Study descriptions and pertinent characteristics were extracted and synthesized using a predefined form.
Results:
Forty-four articles met inclusion criteria; fewer than half comprised original research (20/44, 45%). Most studies (38/44, 86%) included description of the meaning of dignity, with emergence of salient themes around respect, communication, agency/autonomy, and privacy. Less than half (19/44, 43%) included a measurement or evaluation of dignity; approximately one-third described dignity therapy. More than one-third of publications focused on dignity at end of life (17/44, 39%) and included discussions of palliative medicine and hospice (15/44, 34%).
Conclusion:
Relatively few published studies describe dignity in pediatrics. Opportunities exist to broaden scholarship on this topic in partnership with patients, families, and clinicians, with the goal of assessing and strengthening dignity-centered care across the illness course and at the end of life.
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