Patients’ dignity in palliative care: An integrative review of lived experiences and family perspectives across cultures

BACKGROUND: Dignity is a cornerstone of palliative care and represents a complex, multidimensional concept that warrants further conceptual integration. AIM: To synthesise evidence regarding patients' experiences of dignity in palliative care, with a particular emphasis on cultural influenceVs. DESIGN: An integrative review was conducted following Whittemore and Knafl's framework. DATA SOURCES: Six databases (CINAHL, MEDLINE, ProQuest Sociological Abstracts, PsycINFO, Scopus, and Web of Science) were searched from inception to 28 February 2025. Targeted hand-searches of key journals were performed between March and June 2025. RESULTS: A total of 32 articles were included. Patients' understandings varied but dignity was commonly described as "being treated like a human being." Three themes were identified: (1) Inner experience, encompassing physical and psychological experiences, self-worth, resilience, and spirituality; (2) Relational and interactional dynamics, including personal autonomy and self-determination, and social relationships and support systems; and (3) Macro-structural determinants, comprising healthcare systems and delivery, as well as economic and socio-political circumstances. Cultural values shaped the perception and preservation of dignity. In collectivist societies, dignity was intricately linked to family, community, religion, and social harmony, whereas in individualist societies, dignity centred on autonomy and control over end-of-life decisions. Immigrants negotiated dignity through interactions between cultural values and healthcare expectations within host countries. CONCLUSIONS: This review provides an integrated understanding of the factors shaping patients' perceptions of dignity in palliative care across cultures. The findings could usefully inform patient-centred and culturally sensitive palliative care practices that uphold dignity and promote well-being at the end of life.