{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T03:21:03Z","timestamp":1794540063938,"version":"4.9.1"},"reference-count":60,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2026,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Familial caregivers (FCGs) play a critical role in health care by providing unpaid care to loved ones with serious illness. Although caregiving is often associated with emotional and physical burden, increasing attention has been directed toward potential sources of meaning and psychological growth, including gratitude.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To investigate the role of gratitude on the well-being of hospice and palliative care FCGs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Cross-sectional, quantitative survey study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings\/Subjects:<\/jats:title>\n                    <jats:p>FCGs were recruited from a single hospice and palliative care organization in New York State, United States. Participants completed in-person or online surveys at their residence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements:<\/jats:title>\n                    <jats:p>Measures included demographics, perceived sources of gratitude, the Gratitude Questionnaire-6 (GQ-6), Positive Aspects of Caregiving Scale, Caregiver Strain Index\u2013Expanded Positive Version, and Flourishing Scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 196 FCGs, participants reported relatively high levels of gratitude (GQ-6 mean = 36.30, SD = 5.43), with family, social relationships, and personal health identified as the most common sources of gratitude. Higher gratitude (GQ-6) was significantly associated with greater self-perceived flourishing (\n                      <jats:italic toggle=\"yes\">r =<\/jats:italic>\n                      0.426,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01), greater recognition of positive aspects of caregiving (\n                      <jats:italic toggle=\"yes\">r =<\/jats:italic>\n                      0.221\u20130.348,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01), and lower caregiver strain (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = \u22120.131,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05). In addition, caregiver strain was negatively associated with flourishing (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = \u22120.250,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01) and positive aspects of caregiving (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = \u22120.273,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Higher levels of gratitude were associated with greater flourishing and recognition of positive caregiving experiences and were inversely associated with caregiver strain among FCGs of hospice and palliative care patients. Future longitudinal and intervention-based research is needed to determine whether gratitude-focused approaches can improve resilience, psychological well-being, and relational connection in end-of-life caregiving.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10966218261472171","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T06:49:19Z","timestamp":1784789359000},"page":"1695-1703","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["An Exploration of Gratitude on Well-Being in Hospice and Palliative Care Familial Caregivers"],"prefix":"10.1177","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1088-4324","authenticated-orcid":false,"given":"Kathryn","family":"Levy","sequence":"first","affiliation":[{"name":"Research Department, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA."},{"name":"Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, the State University of New York, Buffalo, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei C.","family":"Grant","sequence":"additional","affiliation":[{"name":"Research Department, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA."},{"name":"Phronesis Consulting, LLC, Clarence, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Rachiele","sequence":"additional","affiliation":[{"name":"Research Department, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Schuster","sequence":"additional","affiliation":[{"name":"Research Department, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan L.","family":"Rossi","sequence":"additional","affiliation":[{"name":"Response Crisis Center, Stony Brook, New York, USA."},{"name":"Department of Psychology, Roberts Wesleyan University, Chili, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila","family":"Conboy","sequence":"additional","affiliation":[{"name":"Research Department, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Gasper","sequence":"additional","affiliation":[{"name":"Research Department, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA."},{"name":"Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, the State University of New York, Buffalo, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher W.","family":"Kerr","sequence":"additional","affiliation":[{"name":"Research Department, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"e_1_3_3_2_1","unstructured":"1.Kullgren J Solway E Roberts S et al. 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