Thanksgiving on Hospice: Giving Thanks, Receiving Grace
A Guide to Meaning, Presence, and Steadying Serious Illness During the Holiday Season
Author: Brian H. Black, D.O.
Primary Module: 14B – Public Death Literacy & Family Meaning-Making
Secondary Modules: 13B – Leadership & Team Resilience • 3A – Communication & Emotional Preparedness
Opening Frame: Thanksgiving at the Bedside
Thanksgiving bring gratitude.
Hospice brings presence.
This day sets the table for both.
Thanksgiving’s roots in the US lie in centuries of harvest gatherings where people marked survival, community, and gratitude. Then, in 1863, Abraham Lincoln declared a national day of thanks to help a grieving nation at war with itself pause and gather. Lincoln asks Americans to gather in gratitude despite their grief. Hospice families do the same: they find meaning around a table that holds both loss and love.
Clinically, Thanksgiving lays bare appetite loss, fatigue, and emotion because the day revolves around food and cultural expectation. The shared meal often becomes quieter and more intimate.
At the end of life, body changes the rituals. Smells grow stronger than tastes and energy fades faster than plans. Thanksgiving becomes a moment where gratitude and grief share the same table.
A patient may say, “Leave the door open. I just want to hear everyone arrive while I rest.” Sometimes presence, not participation, is the point. The hum of voices in the hallway, the clatter of dishes, and the familiar footsteps can be enough.
Thanksgiving is Grounding
Gratitude is not a seasonal emotion. It steadies people throughout the year.
Gratitude practices reduce anxiety, lower cortisol, and support emotional regulation for caregivers and clinicians (Emmons & McCullough, 2003).
For hospice teams, simple habits steady the work:
• Close IDG with one moment of grace.
• Note one family strength during charting.
• Thank a colleague by name for a specific act of presence.
Gratitude does not remove suffering. It gives families and clinicians a place to stand inside it.
Appetite and Emotion
Thanksgiving is the holiday when a meal means so much. That makes appetite loss especially painful for families. When a patient takes only a taste or declines the meal, loved ones may misinterpret it as withdrawal or rejection.
Name the truth early: reduced appetite and anorexia near the end of life are physiologic and expected. The National Comprehensive Cancer Network notes that absence of hunger and thirst is normal in dying patients and that nutritional interventions rarely reverse weight loss or improve outcomes (National Comprehensive Cancer Network, 2025). The American Society of Clinical Oncology adds that appetite loss reflects disease processes, and that pushing food often increases distress and harms interactions (Roeland et al., 2020).
Eating-related distress is common on hospice. Families often experience guilt, conflict, or a sense of failure when intake declines, especially during holidays where shared meals carry cultural meaning (Amano et al., 2019; Raijmakers et al., 2013; Del Río et al., 2012).
Holidays intensify family patterns. Closeness deepens. Conflict sharpens. Guilt resurfaces. Someone may try to create a “perfect holiday” in ways the body can no longer support. Evidence shows clinicians should normalize mixed emotions and guide families from performance to presence (Wilson et al., 2021; Block, 2001; Rabow et al., 2004).
Clinicians can support that shift:
• Keep plans simple. A short visit can still be Thanksgiving.
• Prepare families for expected symptoms. Appetite loss, fatigue, and naps are normal, not emergencies.
• Normalize emotional complexity. Laughter and tears belong at the same table.
• Watch for dyspnea triggers. Warm kitchens and crowded rooms can increase shortness of breath; offer quieter spaces.
Sometimes patients do not want a plate. They want connection. Sensory comfort such as a familiar smell or a familiar voice often outlasts appetite (Otani et al., 2023; Brisbois et al., 2011).
Thanksgiving Guidance for Families
Adapt rituals to what matters now:
Keep traditions small and meaningful. A taste of a familiar dish or a family song can carry the whole day without overwhelming.
Name gratitude aloud. Invite short stories or one-sentence memories.
Honor absence. A candle or empty chair acknowledges grief without overtaking the table.
Use holiday forecasting. Prepare for naps, fatigue, and changes in energy.
Let presence-based planning allow meaning. If the patient sleeps through dinner, warm a plate later.
CNAs know that warm cloths and gentle mouth care before a holiday meal can make the moment. Sometimes tasting is enough. Small acts help patients engage without pressure.
Team Support: Presence Over Perfection
Hospice clinicians often step away from their own tables to sit at someone else’s. That sacrifice deserves recognition and support.
Team practices that steady the holiday:
• Gratitude rounds during huddles
• Micro-breaks before and after difficult visits
• Thank-you messages naming specific acts of care
• Clear boundaries around nonessential holiday charting
Volunteers and aides often carry much of the season’s emotional weight. Helping a patient to the table, refreshing warm or cool cloths, assisting with handwashing, or sitting quietly while the family talks can become quiet forms of ministry.
Gratitude-based leadership reduces burnout and strengthens team resilience (Laschinger & Fida, 2019).
“Grace given inward sustains care given outward.” – Brian H. Black D.O.
Honoring Traditions
Thanksgiving is not universal, but gratitude is.
Families may mark the day with harvest traditions from Native, African, Caribbean, Latin, Asian, or Appalachian cultures. Others may not celebrate at all. Hospice should treat the holiday as a lens, not a script.
Ask:
• “What does this time of year mean for your family?”
• “Are there foods, prayers, or sounds that matter most?”
• “How can we support these safely at home?”
Be mindful that some cultural cooking practices can increase heat, smoke, or crowding in the home. Ask what feels safe for the patient.
Let families know it is acceptable to adapt traditions this year; honoring meaning can matter more than recreating historical ritual.
Such questions ground the visit in humility and respect.
Abundance and Awareness
Thanksgiving offers no gifts, but hospice gives many:
• Presence
• Clarity
• Connection
• Permission
• Peace
Sometimes the pie cools untouched. Sometimes the chair is empty. Sometimes the room fills with a quiet that does not ask to be interpreted.
Gratitude does not fix this. It steadies us inside it.
Hospice teaches what Thanksgiving tries to remind us:
Gratitude is not what is on the table. It is who is still gathered around it.
May this season bring what hospice brings every day:
Presence over pressure.
Story over silence.
Purpose over protocol.
3-2-1 Summary
3 Takeaways
Thanksgiving magnifies appetite loss and fatigue, so families need clear, holiday-specific guidance.
Gratitude practices steady caregivers, clinicians, and teams during emotionally charged seasons.
Thanksgiving becomes meaningful, not perfect, when the day follows the patient’s rhythm.
2 Quotes
• “Hospice teaches what Thanksgiving tries to remind us: gratitude is not what is on the table. It is who is still gathered around it.”
• “Grace given inward sustains care given outward.”
1 Question
What small act could make gratitude visible this season?
Glossary Additions
Holiday Forecasting
Preparing families for emotional and physical changes during holidays through anticipatory guidance, expectation alignment, and realistic planning based on the patient’s condition.
Gratitude Rounds
A brief team practice in which clinicians name one specific moment of appreciation to strengthen resilience, connection, and emotional grounding.
Presence-Based Planning
Adapting holiday or visit expectations to a patient’s energy, comfort, and rhythm rather than the calendar or tradition.
Bibliography:
Amano, K., Morita, T., Koshimoto, S., et al. (2019). Eating-related distress in advanced cancer patients with cachexia and family members. Supportive Care in Cancer, 27(8), 2869–2876. https://doi.org/10.1007/s00520-018-4590-6
Aparicio, M., Centeno, C., Robinson, C. A., & Arantzamendi, M. (2022). Palliative professionals’ experiences of receiving gratitude: A transformative and protective resource. Qualitative Health Research, 32(7), 1126–1138. https://doi.org/10.1177/10497323221097247
Del Río, M. I., Shand, B., Bonati, P., et al. (2012). Hydration and nutrition at the end of life: A systematic review of emotional impact, perceptions, and decision-making. Psycho‐Oncology, 21(9), 913–921. https://doi.org/10.1002/pon.2099
Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and well-being. Journal of Personality and Social Psychology, 84(2), 377–389. https://doi.org/10.1037/0022-3514.84.2.377
Fast Fact #190. (n.d.). Anorexia/cachexia in advanced illness. Palliative Care Network of Wisconsin. https://www.mypcnow.org/fast-fact/the-anorexia-cachexia-syndrome-pharmacologic-management/
Otani, H., Amano, K., Morita, T., et al. (2023). Impact of taste and smell disturbances on dietary intake and quality of life in advanced cancer. Supportive Care in Cancer, 31, 141. https://doi.org/10.1007/s00520-023-07598-6
Raijmakers, N. J. H., Clark, J. B., van Zuylen, L., Allan, S. G., & van der Heide, A. (2013). Bereaved relatives’ perspectives of the patient’s oral intake toward the end of life. Palliative Medicine, 27(7), 665–672. https://doi.org/10.1177/0269216313477178
Roeland, E. J., Bohlke, K., Baracos, V. E., et al. (2020). Management of cancer cachexia: ASCO guideline. Journal of Clinical Oncology, 38(21), 2438–2453. https://doi.org/10.1200/JCO.20.00611
Spence Laschinger, H. K., & Fida, R. (2019). New nurses’ experiences of empowerment and burnout: The role of workplace gratitude. Journal of Nursing Management, 27(6), 1125–1132. https://doi.org/10.1111/jonm.12782
Wilson, D. M., Anafi, F., Roh, S. J., & Errasti-Ibarrondo, B. (2021). End-of-life intra-family conflict: A scoping research literature review. Health Communication, 36(13), 1616–1622. https://doi.org/10.1080/10410236.2020.1775448