Many emotions are experienced by people at the end of their lives and by their relatives, yet gratitude could be an overlooked but very signifcant key emotion to consider. For January 2024 Palliative Medicine’s Editor’s Choice, Emmanuelle Poncin, Gian Domenico Borasio and Mathieu Bernard share the findings of their recent research which brings a new perspective to this sometimes undervalued emotion.
Have you ever come home after a long day to find that the table was set and the dinner done? Had the bus driver waited just for you before closing the door when you were running late? Situations like these typically elicit the feeling of gratitude. These feelings can sometimes be fleeting, and it’s likely that you haven’t taken the time to realise the scope of this emotion and all the benefits it can bring. Research in psychology has shown that gratitude helps people experience greater wellbeing and less psychological distress, and that it can be fostered through interventions, from journaling and letter-writing to mindfulness techniques.
Inspired by the results of an initial study on the relevance of gratitude for people receiving palliative care, we hypothesized that gratitude interventions might be beneficial. We designed and piloted a gratitude intervention for palliative patients and a carer of their choice, asking them to write and share a letter of gratitude with each other. We found that the intervention helped most participants experience personal growth and emotional wellbeing, although some also experienced anxiety and sadness.
While these quantitative findings were generally encouraging, important questions remained: what did gratitude mean to our participants, and how did receiving the letters expressing gratitude affect them? We analysed our interview transcripts and gratitude letters, and the answers to these questions can be found in our recent article published in Palliative Medicine. For many people receiving palliative care and their relatives, gratitude represented ‘an extraordinary feeling. Very close to love’. As a relative wrote to her husband, ‘The illness has befallen you, us, without any warning, turning everything upside down, rendering everything futile, superfluous, without any interest, everything but one essential thing: Love’. Gratitude was also framed as appreciating loved ones, who are ‘the ray of sun in the darkness of the illness’.
Gratitude was defined as ‘a sort of grace’: ‘Thank you for sharing in the everyday difficulties that the illness is imposing on you, sweet moments of tenderness and love, pretty smiles and bursts of laughter, a craziness that belongs to us alone.’ A participant highlighted that appreciating the little things in life is the essence of gratitude: ‘To be grateful also helps cheer you up and I think that if we all made a little more effort to think about it, well maybe we would manage to improve our quality of life.’ However, some participants understood gratitude as a need to reciprocate, which may reaffirm the self-perception of being a powerless patient, pointing to the more ambivalent side of gratitude.
Whilst the perceptions and experiences of gratitude are likely to be shaped by participants’ social determinants and identities, such as socio-economic background, gender and sexual identities, ethnicity, and (dis)abilities, these were outside the scope of our study, and could be explored in future research.
Overall, we found that gratitude can be key to a good (end of) life, a source of individual and interpersonal benefits, for example, positive emotions, wellbeing, hope, and valuing of close relationships. María Arantzamendi and colleagues have suggested that expression of gratitude can also be beneficial for all professionals working in palliative care!
READ THE FULL ARTICLE IN ‘PALLIATIVE MEDICINE’!
“Thank you for loving me”: A qualitative study on perceptions of gratitude and their effects in palliative care patients and relatives. Emmanuelle Poncin and colleagues, Palliative Medicine, Vol 38 Issue 1, 2024.
Links and resources
- Betty Althaus and colleagues, Gratitude at the End of Life: A Promising Lead for Palliative Care, Journal of Palliative Medicine.
- María Arantzamendi and colleagues, A reflection on the essence of gratitude in palliative care: healing in severe disease and professional affirmation through accompanying patients until the end, Palliative Care and Social Practice.
- Find out more about gratitude and other topicsby watchingResource-oriented palliative care: An interprofessional approach.
- Find out more about the non profit organisation Grateful Living here.
About the authors
Prof. Mathieu Bernard is Chair in Palliative Psychology at the Palliative and Supportive Care Service of the Lausanne University Hospital (CHUV). In line with the general concept of ‘resource-oriented palliative care’, his main research interest concerns the application of positive psychology to palliative psychosocial care. He has undertaken research projects on meaning in life, gratitude, post-traumatic growth, and altruism, and has published extensively on these subjects. ORCID ID: 0000-0003-2823-8806.
Dr Gian Domenico Borasio, MD, neurologist and palliative care physician, was professor and chair in Palliative Medicine at the Universities of Munich, Germany (2006-11) and Lausanne, Switzerland (2011-23) before retirement. During his career, he established seven endowed academic chairs and professorships covering all key professions in palliative care (pediatric, adult, and geriatric palliative medicine, nursing, social work, spiritual care, and psychology). Dr. Borasio has published over 400 scientific articles and eighteen books, including the bestseller About Dying. ORCID ID: 0000-0002-2737-3662.
Dr Emmanuelle Poncin trained as a political scientist at the London School of Economics and Political Science (PhD). She is a senior researcher and lecturer at La Source School of Nursing and the Lausanne University Hospital, University of Lausanne (Switzerland). Her research is pluridisciplinary. Her interests include palliative, spiritual, and long-term care, international development, social justice and qualitative research. ORCID ID: 0000-0003-1517-6909.
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