背景:儿童是一个独特的弱势患者群体,自我倡导和自主能力受到限制,冒着侵犯他们尊严的风险。然而,相对于成人文学和其他结果指标,儿科中的尊严概念仍未得到充分探索。
目的:为了描述尊严是如何定义的,评估,和/或在儿科测量。
方法:我们在以下数据库中遵循PRISMA指南进行了系统综述:MEDLINE,Embase,护理和相关健康的累积指数,PsycINFO,全球卫生,社会科学高级收藏,和论文和论文。我们包括从数据库开始到2023年4月的出版物,英文,涉及0-18岁的儿童,把尊严作为一个中心主题,重点是定义,评估,或衡量尊严。使用预定义的形式提取和合成研究描述和相关特征。
结果:44篇文章符合纳入标准;不到一半包含原始研究(20/44,45%)。大多数研究(38/44,86%)包括对尊严含义的描述,随着围绕尊重的突出主题的出现,通信,代理/自治,和隐私。不到一半(19/44,43%)包括尊严的测量或评估;大约三分之一描述了尊严疗法。超过三分之一的出版物侧重于生命终结时的尊严(17/44,39%),并包括姑息治疗和临终关怀的讨论(15/44,34%)。
结论:关于儿科尊严的研究相对较少。与患者合作,有机会扩大有关该主题的奖学金,家庭,和临床医生,目的是评估和加强整个疾病过程和生命终点以尊严为中心的护理。
BACKGROUND: 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.
OBJECTIVE: 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%).
CONCLUSIONS: 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.