Posttraumatic growth in palliative care patients and its associations with psychological distress and quality of life

Abstract

Objectives Posttraumatic growth (PTG) refers to positive psychological changes resulting from individuals’ inner struggles with traumatic events such as life-threatening illness. Although palliative care patients are confronted with their own mortality, little is known about their PTG experience. This study investigates whether PTG is an empirically relevant concept for palliative patients by assessing the prevalence and areas of growth, and examining associations with psychological distress and quality of life. Methods Participants were recruited in Switzerland. Using validated questionnaires, we assessed PTG (Posttraumatic Growth Inventory, PTGI), psychological distress (Hospital Anxiety and Depression Scale), and quality of life (McGill-Quality of Life Questionnaire – Revised). We performed descriptive analyses, Spearman correlations, and linear regressions. Results Fifty-five patients completed the PTGI, 44% of whom experienced no/low growth, 47% moderate growth, and 9% high/very high growth. Participants experienced the greatest positive changes in terms of appreciating life and relating to others. We found significant negative bivariate correlations between PTG and psychological distress (r = −0.33) and between PTG and depression (r = −0.47). Linear regressions showed that PTG is associated with depression (β = −0.468; p = 0.000), but not with anxiety or quality of life (adjusted R2 = 0.219). Significance of results Over half of our patients experienced moderate to very high growth, indicating that PTG is an empirically relevant psychological process in palliative care. PTG is associated with lower levels of depression, possibly as those experiencing growth are more able to process past traumas and build a more positive outlook on one's life and self. By contrast, the relative independence of anxiety and PTG points to the likely coexistence of positive and negative psychological responses to trauma. The lack of association between PTG and quality of life points to the uniqueness of the PTG concept in capturing how people access deeper meaning and greater appreciation of life along the path toward posttraumatic self-reconstruction.

Psychological health in COVID-19 patients after discharge from an intensive care unit

“…Others have reported high rates of PTG, especially in "appreciation of life" and "relating to others, " in a sample of parents in Portugal during the pandemic (78). An assessment of PTG in hospitalized patients undergoing bone marrow and/or stem cell transplantation and palliative care (79,80), found, as did our study, that "appreciation of life" was among the areas of most significant growth; the assessment also found no change in "personal strength." Finally, a study conducted by Holtmaat et al (81) on cancer patients that the most impacted domain was "relating to others.…”

Posttraumatic growth in palliative care settings: A scoping review of prevalence, characteristics and interventions

“…57 Thirteen studies only included people with terminal cancer diagnoses 31,32,46–52,54,55,58,59 while four studies also included people with chronic heart failure, chronic obstructive airways disease and amyotrophic lateral sclerosis. 31,32,44–52,54–59 All quantitative studies used the Posttraumatic Growth Inventory (PTGI) to assess posttraumatic growth, while Mosher et al 55 and Wright et al 56 used a semi-structured questionnaire to gain qualitative data. A summary of included studies is found in Table 2.…”

“…[44][45][46]48,51,52,58 Higherlevelsofposttraumaticgrowthwerereportedbyyoungerpatients 45,59 and women. 45,47,57,59 Two studies found higher PTGI scores withparticipantsreportinggreatertimesincediagnosis/ timesincerecognitionofterminalillnessstatus, 31,59 while tworeportednodifference. 46,48 TwostudiesfromTangetal.…”

Giving and receiving thanks: a mixed methods pilot study of a gratitude intervention for palliative patients and their carers

“…of physical functions, independence, sense of identity, and future, and to reflect on their own mortality [ 25 ]. These considerations prompted us to investigate gratitude in palliative care patients in an exploratory study, which found that gratitude was correlated with better quality of life, greater posttraumatic growth, and less psychological distress [ 26 , 27 ].…”