Dignity-driven decision making: a compelling strategy for improving care for people with advanced illness.

Overview

The concept of dignity-driven decision making builds on previous efforts to define and develop patient- and family-centered care for people with advanced illness. More a framework than a rigid structure, the dignity-driven decision making model emphasizes the centrality of a collaborative process in which patients, most of whom are elderly; their families; and clinicians work together continuously to define the goals of care and how best to implement them. The early experiences of some organizations already practicing dignity-driven decision making in their care suggest that the model can improve patient care. Whether the system of care can produce enough savings to pay for its increased costs in the form of additional clinicians and managers is not yet known. Policy-driven actions, such as payment reform and closer alignment of quality incentives with the model's objectives, will be integral to further development and dissemination of the model.