Gratitude at the End of Life: A Promising Lead for Palliative Care

Background: Numerous studies, conducted largely with non-clinical populations, have shown a significant link between gratitude and psychological dimensions relevant for palliative care (e.g., psychological distress). However, the relevance of gratitude in the context of palliative care needs to be confirmed. Objectives: We strived to evaluate the association between gratitude and quality of life (QoL), psychological distress, post-traumatic growth, and health status in palliative patients, and to develop an explanatory model for QoL. An ancillary purpose was to identify which life domains patients considered sources of gratitude. Design: We performed an exploratory and cross-sectional study with palliative patients of the Lausanne University Hospital. Measurements: We used the Gratitude Questionnaire, the McGill Quality of Life questionnaire revised, the Hospital Anxiety and Depression Scale, the Post-traumatic Growth Inventory, and the health status items of the Eastern Cooperative Oncology Group. Spearman correlations and multivariate analyses were performed. Results: Sixty-four patients participated (34 women, mean age=67). The results showed significant positive correlations between gratitude and QoL (r=0.376), and the appreciation of life dimension of the post-traumatic growth (r=0.426). Significant negative correlations were found between gratitude and psychological distress (r=-0.324), and health status (r=-0.266). The best model for QoL explained 47.6% of the variance (F=26.906) and included psychological distress and gratitude. The relational dimension was the most frequently cited source of gratitude (61%). Conclusion: Gratitude may act positively on QoL and may protect against psychological distress in the palliative situation. The next step will be the adaptation and implementation of a gratitude-based intervention.