• John M Galfin, Edward R Watkins, and Tim Harlow.
• School of Psychology, Washington Singer Laboratories, University of Exeter, Exeter, UK. jmg211@exeter.ac.uk
• J Palliat Med. 2010 Nov 1;13(11):1345-8.

BackgroundThis study is the first to explore how rumination or recurrent dwelling may contribute to psychological distress in palliative care. We hypothesised that rumination is important in palliative care because: (1) rumination is triggered by significant life events; (2) the diagnosis of a life-limiting illness means the reevaluation of a number of personal goals, which may become unattainable, and, thereby, lead to rumination; (3) palliative care patients and caregivers report a number of existential concerns, which in their style and content are characteristic of rumination.MethodsThis study adopted a cross-sectional design, comparing samples of palliative care patients (n = 36), their caregivers (n = 29), and an age-matched control group (n = 30). Participants completed a combination of standardized questionnaires to assess their levels of anxiety, depression, and rumination, and open-ended interviews to identify the concerns they were ruminating on and their idiosyncratic experience of rumination.ResultsAs predicted, palliative care patients and their caregivers reported significantly more psychological distress than the control group. Palliative care patients and their caregivers also reported significantly more rumination on existential concerns (e.g., about the future) than the control group. The frequency of existential concerns and measures of rumination reported by participants positively correlated with increased psychological distress.ConclusionThe results support the importance of addressing rumination on existential concerns in palliative care because of its association with psychological distress. Rumination was identified as a mechanism that may be important in addressing psychological distress in palliative care.

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