Conversations Regarding Personhood: Use of the Patient Dignity Question in an Outpatient Psycho-Oncology Clinic

Introduction

There is growing interest in providing effective patient-centered care in today's complex health care environment. ¹ Providing patient-centered care is a multifaceted process, often with the promotion of dignity and personhood at its core.^2,3 Understanding cancer patients as people, fostering a sense of dignity, and aiming to understand patients' psychological needs and sources of suffering are paramount, and may ultimately diminish the occurrence of inappropriate or unwarranted health care interventions. ⁴ Increasing a sense of dignity in health care can begin with improved communication, particularly by understanding the narratives of patients' unique illness-related concerns and social aspects.^4–7

One emerging tool for enhanced health care communication is the Patient Dignity Question (PDQ). ⁸ The PDQ is a single question that directly asks the patient, “What should I know about you as a person to help me take the best care of you that I can?” Each patient's response to the PDQ is written and summarized (typically in the form of one to three paragraphs). This summary is read back to the patient to ensure accuracy and, once approved, patients are asked whether they would like to have the written summary placed in their medical chart for other health care providers to review.

To date, the largest study conducted involving the PDQ included 66 hospitalized palliative care patients (87% diagnosed with cancer), 60 family members, and 137 associated health care providers. ⁸ Results showed that 93% of patients and families believed the information elicited from the PDQ was important for their health care providers to know, 97% desired for the information to be included in their medical chart, and 99% recommended the process for others. Among the health care providers, 90% reported learning something new from the patients' PDQ responses, and 44% stated it influenced subsequent care. As a result, the authors noted that the PDQ “offers a brief and effective way to help clinicians place personhood on their radar, thereby enhancing quality humane health care.” ⁸

Johnston et al. ⁹ similarly found hospitalized palliative care patients' perceptions of the overall climate of care to be more positive after being asked the PDQ, with 100% of patients requesting that the completed PDQ be placed in their medical chart and 93% recommending the PDQ for others. Although these findings are promising, further research is needed to broaden an understanding of how the PDQ may positively benefit other patient populations.^8,9 Specifically, how might the PDQ benefit outpatient populations? Could the PDQ offer insights regarding outpatients' needs, preferences, and goals of care? Finally, could the PDQ help inform the creation of personally tailored biopsychosocial and spiritual interventions? This study begins to address these questions by analyzing the PDQ responses from people with cancer receiving outpatient psychological services.

Methods

This study was completed at University of California, San Diego Moores Cancer Center within the Department of Patient & Family Support Services, which offers psychiatry and psychology services to patients affected by cancer. The study involved a retrospective medical record review of data regarding patient responses to the PDQ and received IRB approval from UC San Diego.

Results

Patient responses to the PDQ were found to include three overarching themes: who I am, what my cancer journey has been, and what I want to achieve.

Discussion

This is the first study to implement the PDQ in this type of outpatient psycho-oncology setting. The PDQ was originally intended as a prompt to elicit conversations about personhood to enhance communication between health care providers and patients. Our results show promise that this brief assessment tool can be easily incorporated into standard psychological consults in a conversational manner to enhance clinical care with a focus on personhood. Although we hope that we are regularly achieving this goal as psychologists and mental health clinicians, too often we fall prey to focusing exclusively on the psychiatric symptomology that brings these individuals to our offices rather than the person who also suffers from psychological distress.

In our retrospective study, we found that the PDQ elicited information related to personal characteristics and core values that are not often directly asked or elicited during the initial psychology consult. As a result we learned what was most important to our patients' sense of identity when providing clinical care, which allows for better management of the patient and patient-centered biopsychosocial and spiritual interventions.

Incorporating the PDQ into standard psychological care allows patients to be better “seen” and helps us acknowledge the person in the patient, not just the DSM-5 diagnostic criteria. It is imperative that we ask our patients who they are outside of their physical and/or mental illness or ailments, as each individual expresses unique values, desires, and needs throughout the cancer trajectory and in direct relation to their health care needs. Chochinov et al. ⁸ encourage providers to utilize the PDQ in addition to standard care to further guide conversations that aid in disclosing personal factors that may impact medical decision making, as well as place personhood on the “clinical radar” (p. 978) during any stage of care and treatment.

Future studies could investigate whether PDQ responses differ depending on the setting in which the PDQ is asked and by whom (oncologist, nurse, spiritual counselor, etc.). Individuals receiving psychotherapy services may be more inclined to discuss the impact of cancer on their sense of personhood given the nature of this clinical service.