Understanding of the efficacy of recording a diary of things for which one is grateful in the reduction of suffering in terminally-ill patients.

80 adult palliative care patients aged 18 and above will be recruited through random sampling in University Malaya, Malaysia. Patients who are not interested to enroll or confused (according to confusion assessment method) will be excluded from the study. Informed consent will be obtained from all participants. Demographic data of the patients will be collected. All participants will be interview face-to-face by me using Hospital Anxiety and Depression Scale (HADS), GQ-6 form, and the Suffering Pictogram. HADS comprises 14 items, seven of which relate to anxiety symptoms and seven to depressive symptoms. Each item is coded from 0 to 3. The scores for anxiety and depression can therefore vary from 0 to 21, depending on the presence and severity of the symptoms. Baseline score of the scale will be collected. After that, patients will then be randomized and divided into 2 groups – the control group and the intervention group. The control group (normal journaling) will receive standard care, which means they will need to chart the suffering score on Day 1 and Day 7 on the suffering score chart. The suffering score ranges from 0-10 (0 = no suffering, 10 = worst possible suffering). The suffering score will be plotted at the suffering chart. Additionally patients will be required to write down the things that happen around them on a daily basis 3 times a day for 7 days in a diary (provided by me). It can be as simple as news headlines, or a joke you heard from the nurse. The intervention group will receive standard care too, which means they will need to chart the suffering score on Day 1 and Day 7 on the suffering score chart as well. After that, the intervention group will be instructed to keep a diary that record 3 things that they are grateful for on a daily basis for seven days (Gratitude journaling). Participants will be given the following instructions: “For these seven days you are required to write down and record 3 things for which you are grateful on a daily basis. Think back over your day and include anything, no matter small or great, which was a source of gratitude that day. Make the list personal, and try to think of different things each day.” There will not be any specific requirements for the length of the text (how many words or lines written), time spent journaling (minutes per day), or set a daily schedule (e.g., having entries occur in morning or evening). To monitor the adherence, the researcher will pay daily visit to the participant to remind on the diary charting.