• Andy Hau Yan Ho, Cecilia Lai Wan Chan, Pamela Pui Yu Leung, Harvey Max Chochinov, Robert A Neimeyer, Samantha Mei Che Pang, and Doris Man Wah Tse.
• Centre on Behavioral Health, Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong. andyho@hku.hk
• Age Ageing. 2013 Jul 1;42(4):455-61.

Backgroundthe empirical Dignity Model has profoundly influenced the provision of palliative care for older terminally ill patients in the West, as it provides practical guidance and intervention strategies for promoting dignity and reducing distress at the end-of-life.Objectiveto examine the concept of 'living and dying with dignity' in the Chinese context, and explore the generalisability of the Dignity Model to older terminal patients in Hong Kong.Methodsusing qualitative interviews, the concept of dignity was explored among 16 older Chinese palliative care patients with terminal cancer. Framework analysis with both deductive and inductive methods was employed.Resultsthe three major categories of themes of the Dignity Model were broadly supported. However, the subtheme of death anxiety was not supported, while two subthemes of generativity/legacy and resilience/fighting spirit manifested differently in the Chinese context. Furthermore, four new emergent themes have been identified. They include enduring pain, moral transcendence, spiritual surrender and transgenerational unity.Conclusionthese findings highlight both a cultural and a familial dimension in the construct of dignity, underline the paramount importance of cultural awareness and competence for working with ethnically diverse groups, and call for a culturally sensitive and family oriented approach to palliative care interventions with older Chinese terminal patients.

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