RT Journal Article SR Electronic T1 Mindful gratitude journaling: psychological distress, quality of life and suffering in advanced cancer: a randomised controlled trial JF BMJ Supportive & Palliative Care JO BMJ Support Palliat Care FD British Medical Journal Publishing Group SP bmjspcare-2021-003068 DO 10.1136/bmjspcare-2021-003068 A1 Tan, Ting Ting A1 Tan, Maw Pin A1 Lam, Chee Loong A1 Loh, Ee Chin A1 Capelle, David Paul A1 Zainuddin, Sheriza Izwa A1 Ang, Bin Ting A1 Lim, Min Ai A1 Lai, Natalie Zi A1 Tung, Yu Zhen A1 Yee, Hway Ann A1 Ng, Chong Guan A1 Ho, Gwo Fuang A1 See, Mee Hoong A1 Teh, Mei Sze A1 Lai, Lee Lee A1 Pritam Singh, Ranjit Kaur A1 Chai, Chee Shee A1 Ng, Diana Leh Ching A1 Tan, Seng Beng YR 2021 UL http://spcare.bmj.com/content/early/2021/07/07/bmjspcare-2021-003068.abstract AB Context Numerous studies have shown that gratitude can reduce stress and improve quality of life.Objective Our study aimed to examine the effect of mindful gratitude journaling on suffering, psychological distress and quality of life of patients with advanced cancer.Methods We conducted a parallel-group, blinded, randomised controlled trial at the University of Malaya Medical Centre, Malaysia. Ninety-two adult patients with advanced cancer, and an overall suffering score ≥4/10 based on the Suffering Pictogram were recruited and randomly assigned to either a mindful gratitude journaling group (N=49) or a routine journaling group (N=43).Results After 1 week, there were significant reductions in the overall suffering score from the baseline in both the intervention group (mean difference in overall suffering score=−2.0, 95% CI=−2.7 to −1.4, t=−6.125, p=0.000) and the control group (mean difference in overall suffering score=−1.6, 95% CI=−2.3 to −0.8, t=−4.106, p=0.037). There were also significant improvements in the total Hospital Anxiety and Depression Scale score (mean difference=−3.4, 95% CI=−5.3 to −1.5, t=−3.525, p=0.000) and the total Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being score (mean difference=7.3, 95% CI=1.5 to 13.1, t=2.460, p=0.014) in the intervention group after 7 days, but not in the control group.Conclusion The results provide evidence that 7 days of mindful gratitude journaling could positively affect the state of suffering, psychological distress and quality of life of patients with advanced cancer.Trial registration number The trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN1261800172191) and conducted in accordance with the Declaration of Helsinki.Data are available on reasonable request. Data are kept as hardcopy and soft copy by the authors.