Understanding posttraumatic growth in palliative care: a qualitatively driven mixed-methods study using patients' life narratives.

BACKGROUND

Numerous studies have revealed that the shock engendered by a serious illness can lead to positive psychological changes known as posttraumatic growth (PTG). Most studies examined this phenomenon in early-stage cancer and with the Posttraumatic Growth Inventory (PTGI). Our current understanding of the psychological processes behind PTG remains limited. Through life narrative interviews, our study aims (i) to describe profiles of psychological changes of palliative care patients and to highlight characteristics of these changes, and (ii) to link these profiles with quality of life and PTGI.

METHODS

This study adopted a multi method design. Semi-structured interviews were conducted with patients based on the Biographic Narrative Interpretive Method (BNIM) in three centres in Switzerland. An ideal-type analysis was used to establish ideal-types of changes and a thematic analysis to highlight characteristics of these changes. In addition, posttraumatic growth and quality of life were assessed through the PTGI and the McGill Quality of Life-Revised questionnaire (MQOL-R).

RESULTS

In total, 23 patients participated (13 female, median age = 73). The ideal-type analysis identified four types of psychological changes: (i) "Overcoming adversity" (n = 6), (ii) "Resilience" (n = 7), (iii) "Resigned acceptance" (n = 3), (iv) "Psychological suffering" (n = 7). "Overcoming adversity" and "Resilience" showed higher PTGI scores than "Resigned acceptance" and "Psychological suffering". "Overcoming adversity", "Resilience" and "Resigned acceptance" showed higher MQOL-R scores than "Psychological suffering".

CONCLUSIONS

Regarding research, life stories offer an innovative way to understand and highlight patient's psychological profiles shaped by past experiences and surpassing the limits of questionnaires. In term of clinical perspective, narrative techniques, known to promote meaning-making, offer valuable opportunities to consider both past and present experiences of patients and thus understand and support their psychological adaptation to face serious illness at the end-of-life.