Table 2 Coding tree of superordinate and subordinate themes

Protective relationship

Providing unconditional positive attachments

‘She is very affectionate, and she is always showing it … She seems to sense if you’re not feeling well and she seems to stick by you. So she is just like a wee comfort kind of thing’. (Participant Claire & CA Daisy)

Claire explains that Daisy provides unconditional positive regard and displays emotional congruence towards her. These behaviours foster a human-like attachment that provides a sense of comfort for Claire and increases her overall sense of wellbeing

Promoting post-traumatic growth

‘I have a wee bit more time … I can appreciate then the benefits of being out with her. So rather than it being uh an extra job to do, it is maybe a more pleasurable part of my day to be taking her out for a walk’. (Participant Claire & CA Daisy)

Claire reflects on how Daisy has allowed her to gain a greater appreciation for life. There is a recognition of how Daisy facilitates a greater appreciation of everyday things and encourages Claire to focus on the present moment

Expressing the emotional effects of illness

‘I don’t have a deep conversation like when I was with the psychologist or neurologist … it is just how you feel or how I am feeling. … if I am feeling very low or down, I like the dog beside me. I will say come over here Buster and give us a hug’. (Participant Mac & CA Buster)

Buster offers an outlet for Mac to communicate his feelings while living with advanced cancer. Although Mac highlights that this support is unique to the human-animal bond, he explains that it provides an important support to him that helps him manage his advanced cancer diagnosis

Positive behavioural change

Promoting behavioural activation

‘Once he gets that walk, oh my mind is content… He helps me in that way because I walk up and down the garden with him’. (Participant Agnes & CA Precious)

Precious increases Agnes behavioural activation, which improves her wellbeing by meeting Precious’s needs, while also providing Agnes with the benefits of physical activity

Generating routine and structure

‘The main thing is something else to look after and to get out and walk. And you can’t just sit on the sofa and do nothing, because she is needing, she is needing things done and that helps me mentally’. (Participant Claire & CA Daisy)

Daisy provides Claire with a novel structure and routine. This increased purpose improves her wellbeing and reduces the negative psychological consequences of living with advanced cancer

Facilitating meaningful social connections

Access to practical support

Additional social support

‘The fact that I have dog walkers coming to have a wee talk to. The fact that you yourself are here, you know it breaks up my day for me. … It is nice to get company and company is coming from having him’. (Participant Neil & CA Teddy)

Teddy generates a variety of connections to others, which Neil explains improves his wellbeing by reducing his feelings of loneliness and isolation by providing outlets that mitigate the negative consequences of the illness

Loss-orientated cognitions

Increased reflection on separation anxiety

‘So I am glad he is here rather than not being here, but I just worry in case, what happens to him if I go first?’. (Participant Neil & CA Teddy)

Neil’s reflection on the potential future of their CA, projects his worries about losing Teddy, while also highlighting his own death anxiety

Focussing on novel limitations

‘If I seen him not getting walked, I would have a go at myself. I would rather (walk him) than see him closed in all the time, I would go out and it is a wee bit dangerous for me because I stagger’. (Participant Agnes & CA Precious)

Agnes worries about not being able to meet Precious’s needs. This worry seems interrelated with her attachment to Precious and leads her to engage in increased risk behaviours, driven by a desire to meet the Precious’s needs