• Emmanuelle Poncin, Emilie Bovet, Emmanuel Tamches, Boris Cantin, Josiane Pralong, Betty Althaus, Gian Domenico Borasio, and Mathieu Bernard.
• Palliative and Supportive Care Service, Lausanne University Hospital, University of Lausanne, Lausanne, Vaud, Switzerland.
• Palliat Med. 2024 Jan 1; 38 (1): 110120110-120.

BackgroundEmpirical studies suggest that gratitude positively influence the quality of life of palliative patients and relatives. However, the literature is marked by a lack of conceptual clarity about what gratitude is and whether it can bring about individual and social benefits.AimThis paper explores how palliative care patients and relatives understand gratitude, how discursive representations of gratitude may affect their positions, perceptions and relations, and how to conceptualise gratitude in the palliative context.DesignWe examine 33 gratitude letters written by patients and relatives and 25 semi-structured interviews conducted as part of a pilot gratitude intervention study. We use a qualitative approach, thematic analysis, within a conceptual framework of discourse analysis.Settings/ParticipantsData were collected from 23 patients and 13 relatives recruited through three hospital palliative care services in French-speaking Switzerland.ResultsParticipants articulate gratitude in five ways: (1) appreciating others; (2) love; (3) need to reciprocate; (4) appreciating the little things; (5) solace amid serious illness. While some of these representations are sources of positive emotions and outlook, wellbeing and hope, others may confirm self-perceptions of powerlessness and burden. These results support a tridimensional conceptualisation of gratitude in palliative care as source of individual benefits, valuing closest relationships and moral obligation.ConclusionOur study suggests that gratitude is a key to a good (end of) life, whilst highlighting potential negative effects. It could help healthcare professionals to better understand what gratitude means to patients and relatives, which may facilitate awareness and fostering of gratitude in palliative care.

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