A reflection on the essence of gratitude in palliative care: healing in severe disease and professional affirmation through accompanying patients until the end

Abstract

Background: Gratitude has sparked interest in the world of health. It is considered as a personality characteristic or as an emotion. However, little has been explored in the context of the interpersonal relationship of caring. An exploration in the context of end of life is ground-breaking. Objectives: This study analyses and reflects on the object of gratitude from the perspective of both the persons being cared for and the professionals providing health care. What are patients and their family members grateful for in palliative care? What is the reason for gratitude? What do these health professionals perceive when there is gratitude? These questions were answered considering the gratitude generated in health care encounters, not gratitude as personality trait. Methods: The phenomenological approach was used starting from lived clinical experiences. In the light of the dialogue between clinical experiences and philosophy, this study proposes an explanation of the ‘real’ or essential object of gratitude in palliative care. It was conducted within the context of palliative care. The study materials were manifestations of gratitude expressed or felt in clinical encounters and published in newspapers or shared in daily encounters. These were the basis for analysis and reflection and interdisciplinary dialogue. Findings: The analyses performed indicated healing or deep relief in serious diseases as objects of gratitude according to patients’ perspective, and professional self-affirmation until the end according to the professionals’ perspective. Conclusion: The two perspectives shared an important common fact, namely, the need to consider the persons in their entirety, and the importance of not losing sight of the value they have. This concept would characterize the nature of gratitude, its object being the ‘objective good’ for patients, family members, and palliative care professionals.

‘Thank you for loving me’: A qualitative study on perceptions of gratitude and their effects in palliative care patients and relatives

“…Expressions of gratitude from patients and families were shown to improve the mood of professionals, encourage them to go on, act as a source of support in difficult times and reaffirm the meaning of their work. 31–33 These studies did not uncover negative effects of gratitude as moral obligation. Such effects may be particularly salient in relations where the power balance tips towards the ‘benefactor’ or ‘carer’ – a point put forward in the literature on the ‘dark side’ of gratitude 34 and illustrated in a body of work on informal care relations and health interventions in developing countries.…”

The DAISY Award

“…As noted in this clinician's quote: "For me, the tokens of gratitude from a patient give meaning to my work". 17 The connection of receiving gratitude and reflecting on the meaningfulness of caring is a formidable one integrated into the DAISY process.…”

“…Just as clinicians experienced benefits from gratitude during end-of-life care, patients experienced "healing or deep relief" as components of gratitude. 17 A nurse-led patient-centered gratitude intervention was helpful and improved patients' hospital experience. 32 Gratitude has been used as a positive intervention in therapy for addiction disorders.…”

“…Moreover, expressing gratitude can help with the grieving process for families. Just as clinicians experienced benefits from gratitude during end-of-life care, patients experienced “healing or deep relief” as components of gratitude 17 . A nurse-led patient-centered gratitude intervention was helpful and improved patients' hospital experience 32 .…”