In using the dignity model of palliative care, Singapore Cancer Society enables patients to have closure.
Preserving one’s dignity in satisfying a person’s end-of-life care needs is often associated with describing a ‘good death’. Dignity care at Singapore Cancer Society (SCS) focuses on maintaining one’s dignity in three broad domains relating to illness-related concerns, psycho-spiritual wellbeing, and social needs. This approach is also known as the dignity model of palliative care (Chochinov, 2002). Addressing this spectrum of needs enables patients to make more informed choices, have better symptom management and offer opportunities for working on personal dignity-preserving matters for a good closure.
SCS adopts the dignity model approach in helping terminally ill patients to receive care beyond symptom control. These are stories of how SCS supports their patients and families to maintain their sense of dignity in a variety of ways.
Seventy-year-old Mr Zainal was diagnosed with terminal cancer a month before his 90-year-old mother was diagnosed with cancer. They were both referred to SCS Hospice Care Services. Mr Zainal’s mother had a wish to maintain her sense of autonomy and preferred to pass away at home with her son and grandchildren by her side. Mr Zainal wanted to continue his role as a son to his dying mother and requested for symptom control. Mr Zainal also wished to pass on at home.
SCS Hospice Care Services provided three months of intensive care and support for both patients and their family to achieve two ‘good goodbyes’ for the family. Mr Zainal’s daughter, Haslina, was awarded the Singapore Health Inspirational Caregiver Award 2021 for her courage and resilient spirit in working with SCS to look after her father and grandmother concurrently at home, and for demonstrating filial piety in honouring their wishes and dignity till the end. In her letter of appreciation to SCS, she wrote: “Looking back, I’ve never realised that I had fulfilled the wishes of my dear ones… I could have never completed it alone… It’s the beautiful kind souls that speak and these souls are within the SCS team. My family and I could never thank these God-sent angels enough. They journeyed with us till the end”.
For some, leaving a legacy for the living is important in preserving personal dignity. This may come in the form of a family photo album, video, personal memoir, letter, or journal. For Mr T, connecting to his daughter was very important. However, Mr T’s daughter was not emotionally ready to talk about his disease and hear his final words to her. As Mr T had wished to have closure with his daughter before his demise, a SCS social worker facilitated a letter-writing activity with the patient to share his thoughts, hopes and concerns for his daughter. Through this, the patient was able to have the opportunity to pass his words and legacy down to his daughter with hopes that she will one day be able to find the closure she needs.
In this pandemic situation, being separated from their loved ones overseas can exacerbate the sense of grief and loss for patients. The SCS team recognises the patients’ longing to be reunited with loved ones and leveraged on technology to enable them to connect with their loved ones. Saying their final goodbyes is essential for both patients and their family to achieve a good closure.
To enhance the patient’s sense of dignity, SCS also checks for any final wishes the team can help to fulfil. SCS Living Well Fund supports end-of-life patients who have financial challenges. SCS also partners with Ambulance Wish Singapore, an independent charity organisation that helps to actualise final requests from terminally ill patients. More than 20 patient wishes were fulfilled in the last 12 months. Patients and their families have given feedback that the act of wish-granting provided a positive end-of-life experience. Our patients have also expressed a sense of contentment and closure.
In conclusion, the dignity model is how we can make our end-of-life patients feel valued, thereby bolstering patients’ dignity in dying to bid their loved ones a good goodbye.