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Gratitude from patients and relatives in palliative care—characteristics and impact: a national survey
  1. Maria Aparicio1,2,
  2. Carlos Centeno1,3,
  3. Guillermo Juliá4 and
  4. Maria Arantzamendi1,3
  1. 1ICS, ATLANTES, Universidad de Navarra, Pamplona, Spain
  2. 2Community Team, St Christopher's Hospice, London, UK
  3. 3IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
  4. 4ICS, Statistics Unit, Universidad de Navarra - Campus Universitario, Pamplona, Spain
  1. Correspondence to Dr Maria Aparicio, ICS, ATLANTES, Universidad de Navarra, Pamplona 31009, Spain;{at}


Objectives To explore the expressions of gratitude (EoG) received from patients and relatives and their influence on palliative care professionals (PCPs).

Methods A national online survey was sent to a representative of PCPs of each service listed in the national directory of palliative care (PC) services (n=272) (ie, hospital PC support team, hospice, paediatrics, etc). The questionnaire was pilot tested with experts. It comprised three sections: the overall perspective of receiving gratitude in the service, the personal experience of its influence and sociodemographic questions. A mailing schedule was designed to enhance the response rate.

Results 186 representatives from all over Spain completed the questionnaire (68% response rate). 79% of service representatives reported that they almost always received EoG. These came mainly from families (93%). These EoG were very often put on display (84%) and shared with other health professionals (HPs) involved in care (45%). EoG evoked positive feelings in the team members. Based on their experience, respondents attributed different functions to these EoG: increased professional satisfaction (89%), a source of support in difficult times (89%), mood improvement, encouragement to continue and rewards for effort (88%). Services, where gratitude was more frequently received, were associated with PCPs who more frequently reported being proud of their work (p=0.039, Pearson’s correlation test).

Conclusions Gratitude from patients and relatives was frequent and significant to those who work in PC. HPs considered that EoG offer multiple beneficial effects and also a protective role in their practice against distress and an increase in resilience skills.

  • Gratitude
  • palliative care
  • relatives
  • satisfaction
  • resilience
  • health professionals

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  • Contributors All the authors meet the conditions of all of these points: All of them made a substantial contribution to the concept or design of the work; or acquisition, analysis or interpretation of data, All of them drafted the article or revised it critically for important intellectual content, All of them approved the version to be published, All of them have participated sufficiently in the work to take public responsibility for appropriate portions of the content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Committee on Research Ethics at the Universidad de Navarra approved this study (number 2016.071) on the 3rd of November of 2016.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.