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Psychological processes of suffering of palliative care patients in Malaysia: a thematic analysis. Although suffering in palliative care has received increasing attention over the past decade, the psychological processes that underpin suffering remain relatively unexplored. OBJECTIVE: To understand the psychological processes involved in the experiencing of suffering at the end phase of life. METHODS: Semistructured interviews were conducted with 20 palliative care inpatients from an academic medical centre in Kuala Lumpur, Malaysia. The transcripts were thematically analysed with NVIVO9. RESULTS: 5 themes of psychological processes of suffering were generated: (1) perceptions, (2) cognitive appraisals, (3) hope and the struggles with acceptance, (4) emotions and (5) clinging. A model of suffering formation was constructed. CONCLUSION: The findings may inform the development of mechanism-based interventions in the palliation of suffering.