Can People Experience Positive Growth While Facing a Terminal Illness?

What you need to know

• Over half of palliative care patients in this study experienced moderate to very high levels of positive psychological growth as they faced terminal illness
• Patients experienced the most growth in appreciating life more and relating better to others
• Higher levels of growth were associated with lower levels of depression, but not with anxiety or quality of life
• Growth can coexist with distress, as patients may simultaneously experience positive changes and struggle with difficult emotions

Understanding posttraumatic growth in serious illness

When faced with a life-threatening illness, many people experience significant psychological distress. However, some individuals also report positive psychological changes as they struggle with their illness - a phenomenon known as posttraumatic growth.

Posttraumatic growth refers to positive psychological changes that can occur as people cope with highly challenging life circumstances. With serious illness, the trauma may come from the shock of diagnosis, painful treatments, debilitating symptoms, and the looming threat of death. As people grapple with these difficult experiences, they may find themselves changing in unexpected positive ways.

Common areas of growth include:

• Greater appreciation for life
• Improved relationships with others
• Increased sense of personal strength
• New possibilities or opportunities
• Spiritual development

While it may seem counterintuitive, research shows that growth and distress often coexist. People may simultaneously struggle with anxiety or depression while also experiencing positive changes in how they view themselves, others, and life.

Posttraumatic growth has been studied in cancer patients and other illness populations. However, little was known about whether palliative care patients - who are directly confronting mortality - experience this kind of growth. This study aimed to investigate posttraumatic growth in palliative care patients and how it relates to psychological distress and quality of life.

Assessing growth in palliative care patients

The researchers recruited 55 palliative care patients in Switzerland to participate in the study. Patients completed questionnaires measuring:

• Posttraumatic growth (using the Posttraumatic Growth Inventory)
• Psychological distress (anxiety and depression)
• Quality of life

The Posttraumatic Growth Inventory assesses positive changes in five areas:

1. Relating to others
2. New possibilities
3. Personal strength
4. Spiritual change
5. Appreciation of life

Patients rate how much they experienced each change on a scale from 0 (not at all) to 5 (very great degree). The scores are added up to give an overall growth score from 0-105.

Many palliative patients experience growth

The results showed that over half of the palliative care patients (56%) reported experiencing moderate to very high levels of posttraumatic growth:

• 44% experienced no growth or low growth
• 47% experienced moderate growth
• 9% experienced high or very high growth

This suggests that posttraumatic growth is indeed relevant for many patients nearing the end of life. The overall average growth score was 61.5 out of 105, which is similar to or higher than growth levels reported in other illness populations.

Areas of greatest positive change

Patients experienced the most growth in two areas:

1. Appreciation of life - For example, changing priorities about what is important in life or appreciating each day more.

2. Relating to others - Such as having more compassion for others or putting more effort into relationships.

These align with findings from other studies of seriously ill patients. Facing mortality often leads people to feel more grateful for life and value their relationships more deeply.

Growth is linked to lower depression

The researchers examined how posttraumatic growth related to psychological distress and quality of life. They found:

• Higher growth scores were associated with lower depression scores
• There was no significant relationship between growth and anxiety
• There was no significant relationship between growth and quality of life

The link between growth and lower depression suggests that those experiencing more positive changes may be better able to process their struggles and maintain a more optimistic outlook. However, the lack of association with anxiety indicates that growth and distress can coexist - patients may still worry about the future even as they experience positive changes.

The finding that growth was not related to quality of life highlights that posttraumatic growth captures a unique aspect of patients’ experiences. It reflects how people find deeper meaning and appreciation through adversity, which is distinct from rating one’s current life satisfaction.

Growth and distress can coexist

An important insight from this study is that positive growth and negative emotions often occur simultaneously as patients cope with terminal illness. The researchers found no significant correlation between patients’ ratings of positive and negative changes in their lives due to illness.

This aligns with posttraumatic growth theory, which proposes that growth emerges through the struggle with adversity. Growth does not simply replace distress, but can occur alongside it. Patients may experience both deep appreciation for life and strong anxiety about the future. They may feel more connected to loved ones while also battling depression.

Understanding this complex interplay of positive and negative experiences is crucial for supporting patients’ psychological well-being. Clinicians should be aware that patients reporting positive changes are not necessarily free from distress. Likewise, patients struggling with difficult emotions may still be experiencing meaningful growth.

Conclusions

• Over half of palliative care patients in this study experienced moderate to high levels of posttraumatic growth, suggesting it is a relevant concept for those nearing end of life
• Patients experienced the most positive changes in appreciating life more and relating better to others
• Higher growth was associated with lower depression, but was unrelated to anxiety or quality of life
• Growth and distress can coexist - patients may simultaneously experience positive changes and difficult emotions as they cope with terminal illness

This study highlights the capacity for positive psychological change even in the face of terminal illness. While patients undoubtedly struggle with distress, many also experience meaningful growth as they grapple with mortality. Understanding and fostering this growth may be an important aspect of psychological care for palliative patients. Further research is needed to explore how to best support patients in accessing growth while also managing distress at the end of life.