Forgiveness, gratitude, loneliness, spiritual well-being and quality of life in palliative care patients

Background The main goal of palliative care (PC) is to achieve the best possible quality of life for patients and families. Physical, emotional, social, and spiritual dimensions are intertwined and can contribute to the quality of life (QoL). The relief of physical symptoms, such as pain, with pharmacological approaches is very important. The non-pharmacological aspects are also essential, as part of the holistic care. We aimed to investigate the QoL, loneliness, forgiveness, gratitude and spiritual well-being in patients under PC, and to examine the correlation between QoL and these non-pharmacological aspects. Methods A cross-sectional study was conducted between April 2019 and May 2022 with a convenience sample of PC patients, hospitalized and outpatients in Porto, Portugal. Besides demographic and disease characteristics, the EORTC Quality of Life Questionnaire Core 15 for Palliative Care (QLQ-C15-PAL), Heartland Forgiveness Scale (HFS), Gratitude Questionnaire 6 (GQ-6), revised UCLA Loneliness Scale, and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp-12) were collected. The Spearman correlation coefficient assessed the correlation between quantitative variables. Univariate analysis and multiple regression analysis were performed. Results A total of 75 patients in PC, from 2 inpatient and 2 outpatient settings, were included. The median age was 73 years (range: 45–91 years); 57% were male; 58.7% were married, and 92% were Catholic. The majority (89%) had cancer. The multiple regression analysis revealed that regarding the prediction of overall QoL, meaning (p = 0.016), and emotional functioning (p = 0.001) were significant predictors of overall QoL. For the prediction of pain, peace (p = 0.013), fatigue (p = 0.023) and insomnia (p = 0.009) were predictors of pain. With regards to the prediction of emotional functioning, peace (p < 0.001), faith (p = 0.002), self-forgiveness (p = 0.029), forgiveness of situations (p = 0.032), and fatigue (p < 0.001) were significant predictors of emotional functioning. Conclusion PC patients may consider as relevant for QoL some factors that are not included in the majority of QoL questionnaires. The most commonly used QoL instruments do not include existential questions, but these factors may be important domains in QoL at end of life, particularly issues of meaning and peace.