Level and Direction of Hope in cancer patients: an exploratory longitudinal study
Hope is an important factor to consider when caring for cancer patients as a key component of coping with adversity. The aim of our study was to address the following questions: Is there a difference in level of hope between those patients being curatively and those palliatively treated, and how does this change over time? What are patients’ most important hopes? Better understanding of patients’ hopes may promote more effective patient-centered care.
Materials and methods
Outpatients referred to medical oncology or pain and symptom clinics at the London Regional Cancer Program were surveyed before consultation. The Herth Hope Index (HHI) questionnaire was administered to assess level of hope, and the patients were asked to indicate their highest priority hopes. Qualitative thematic analysis was performed on the responses, and comparison was made between patients treated with curative vs those treated with palliative intent. This survey was repeated 4 months after initial assessment.
Fifty patients were surveyed (29 curative-intent; 21 palliative). Highest priority initial hopes were categorized as follows: cure, other positive health outcomes, emotional well-being, life achievements/return to normalcy, interpersonal goals, other. There was no association noted between treatment intent and choice of highest-priority hope. Follow-up assessments after 4 months revealed no significant differences in the distribution pattern of hopes. There was a statistically significant increase in the HHI over time in curatively treated patients, but none in the combined analysis.
Discussion and conclusion
Our study indicates that patients receiving palliative therapy have a HHI score not significantly different from patients being treated for cure. The hope deemed most important is also similar between groups. Over time, overall hope was maintained or increased even in the presence of a trend towards fewer patients hoping for a cure. These results remind oncologists to explore the experience of hope with all patients to ensure that the subjective needs and goals of the patients are met by the proposed therapies.
- 1.Ballard A, Green T, McCaa A, Logsdon MC (1997) A comparison of the level of hope in patients with newly diagnosed and recurrent cancer. Oncol Nurs Forum 24:899–903PubMedGoogle Scholar
- 2.Benzein EG, Berg AC (2005) The level of and relation between hope, hopelessness and fatigue in patients and family members in palliative care. Palliat Med 19:234–240PubMedCrossRefGoogle Scholar
- 3.Breitbart W, Heller KS (2003) Reframing hope: Meaning-centered care for patients near the end of life. J Palliat Med 6:979–988PubMedCrossRefGoogle Scholar
- 4.Buckley J, Herth K (2004) Fostering hope in terminally ill patients. Nurs Standard 19(10):33–41Google Scholar
- 5.Calman KC (1984) Quality of life in cancer patients—a hypothesis. J Med Ethics 10:124–127PubMedCrossRefGoogle Scholar
- 6.Cassel EJ (1991) The nature of suffering and the goals of medicine. Oxford University Press, New YorkGoogle Scholar
- 7.Chochinov HM (2003) Thinking outside the box: depression, hope and meaning at the end of life. J Palliat Med 6:973–977PubMedCrossRefGoogle Scholar
- 8.Clayton JM, Butow PN, Arnold RM, Tattersall MHN (2005) Fostering coping and nurturing hope when discussing the future with terminally ill cancer patients and their caregivers. Cancer 103:1965–1975PubMedCrossRefGoogle Scholar
- 9.Dufault K, Martocchio BC (1985) Hope: its spheres and dimensions. Nurs Clin North Am 20(2):379–391PubMedGoogle Scholar
- 10.Eliott J, Olver I (2002) The discursive properties of “hope”: a qualitative analysis of cancer patients’ speech. Qual Health Res 12:173–193PubMedGoogle Scholar
- 11.Gil S, Gilbar O (2001) Hopelessness among cancer patients. J Psychosoc Oncol 19:21–33CrossRefGoogle Scholar
- 12.Greene S, O’Mahoney P, Rungasamy P (1982) Levels of measured hopelessness in physically-ill patients. J Psychosom Res 26(6):591–593PubMedCrossRefGoogle Scholar
- 13.Herth KA (1989) The relationship between level of hope and level of coping response and other variables in patients with cancer. Oncol Nurs Forum 16:67–72PubMedGoogle Scholar
- 14.Herth K (1992) An abbreviated instrument to measure hope: development and psychometric evaluation. J Adv Nurs 17:1251–1259PubMedCrossRefGoogle Scholar
- 15.Hinton J (1975) The influence of previous personality on reactions to having terminal cancer. Omega 6(2):95–111Google Scholar
- 16.Howat A, Veitch C, Cairns W (2006) A descriptive study comparing health attitudes of urban and rural oncology patients. Rural and Remote Health 6:563–571PubMedGoogle Scholar
- 17.Nekolaichuk CL, Bruera E (1998) On the nature of hope in palliative care. J Palliat Care 14:36–42PubMedGoogle Scholar
- 18.Nekolaichuk CL, Bruera E (2004) Assessing hope at the end of life: validation of an experience of hope scale in advanced cancer patients. Palliative Supportive Care 2:243–253PubMedCrossRefGoogle Scholar
- 19.Nowotny ML (1989) Assessment of hope in patients with cancer: Development of an instrument. Oncol Nurs Forum 16:57–61PubMedGoogle Scholar
- 20.O’Connor AP, Wicker CA, Germino BB (1990) Understanding the cancer patient’s search for meaning. Cancer Nurs 13:167–175PubMedCrossRefGoogle Scholar
- 21.Raleigh E (1980) An investigation of hope as manifested in the physically ill adult. Dissertation Abstracts International 42:44204-1313B. (University Microfilms No. 80-22, 786)Google Scholar
- 22.Rustøen T, Wiklund I (2000) Hope in newly diagnosed patients with cancer. Cancer Nurs 23(3):214–219PubMedCrossRefGoogle Scholar
- 23.Stoner M, Keampfer S (1985) Recalled life expectancy information, phase of illness and hope in cancer patients. Res Nurs Health 8(8):269–274PubMedGoogle Scholar
- 24.Sze J, Marisette S, Williams D et al (2006) Decision making in palliative radiation therapy: reframing hope in caregivers and patients with brain metastases. Support Care Cancer 14(10):1055–1063 (2006 Oct)PubMedCrossRefGoogle Scholar
- 25.Von Roenn JH, von Gunten CF (2003) Setting goals to maintain hope. J Clin Oncol 21:570–574CrossRefGoogle Scholar
- 26.Wahl A, Rustøen T, Lerdal A et al (2004) The Norwegian version of Herth Hope Index (HHI-N): a psychometric study. Palliative