“A gift” and “deeply encapsulated” - The Human Dignity Model for Palliative Care: A qualitative study

Background: Human dignity is central to palliative care, yet its contested meaning and ethical tensions make it challenging to uphold in everyday clinical practice. The model of human dignity in nursing proposed by Franco et al. (HDM) describes antecedents, attributes, and consequences of dignity but has not yet been specifically examined in palliative care. We explored the HDM from Swiss healthcare professionals’ and bereaved relatives’ perspectives to develop a context-specific extension. Methods: This qualitative descriptive study used data triangulation in inpatient and outpatient palliative care settings in German-speaking Switzerland. Between November 2024 and January 2025, we interviewed four expert palliative care nurses, four expert palliative care physicians, and four bereaved relatives. Narrative, semi-structured interviews were analyzed deductively and inductively using structured qualitative content analysis informed by Kuckartz and Rädiker. Results: Participants understood dignity as a dynamic relational process with individual, dialogical, and spiritual dimensions. Dignity was not understood something newly created in Palliative Care. Rather, its importance is accentuated by limited life expectancy, existential concentration, potentially irreversible decisions, cumulative vulnerability affecting relatives as well, and structural tensions among stakeholder groups. For relatives, its significance extended beyond the patient’s death. The HDM was extended into the Transformed Human Dignity Model (THDM), comprising 50 active subcategories: 37 newly developed, six modified, three expanded, and four remained unchanged; one original subcategory was omitted. Vulnerability and the organizational environment could both, as antecedents, facilitate and threaten dignity. Relational spirituality, an attribute of the THDM, may make dignity perceptible through encounters in which others reflect a person’s worth back to them. The THDM distinguishes consequences of preserved and violated dignity. Its integrated harm model describes five potential impact dimensions of dignity violations: socio-emotional escalation, existential erosion, communicative dysfunction, somatic reactions, and burden on relatives. Conclusions: Dignity in palliative care is not an empty phrase but a relational process. The THDM integrates structural sensitivity with antecedents, attributes, and consequences of dignity, offering a preliminary framework for reflection. It may help interprofessional teams and relatives discuss complex decisions and identify situations in which dignity could be fostered or threatened. Research should refine and examine the model.