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C
URRENT
O
PINION
Evolving definitions of hope in oncology
Ian N. Olver
Purpose of review
This review updates the literature on hope and oncology following a prior review of studies up until 2009.
It particularly focusses on the evolution of the definition of hope in the light of the clinical experience of
patients with cancer, their carers and health professionals.
Recent findings
Hope creates meaning for patients and is an important coping mechanism. Clinicians are wary of
communicating bad news because it may deprive patients of hope, but work with decision aids suggests
that this communication can be managed successfully. Hope and optimism negatively correlate with anxiety
and depression. Maintaining hope may result in patients with incurable cancer accepting treatments or
trials with little chance of benefit. Hope also needs to be maintained by palliative care nurses who
harmonize their hopes with the different degrees and constructs of hope around them. Hope interventions
can be successful in increasing hope and decreasing psychological distress.
Summary
More research is required into how to communicate about active anticancer treatment withdrawal and
prognosis without depriving patients with cancer of hope, given how important hope is in alleviating
psychological distress. The optimal intervention to increase levels of hope needs further investigation.
Keywords
cancer, communication, hope, psychological distress
INTRODUCTION
The definition of hope can be as concise as that in
the Oxford English dictionary, a feeling of expec-
tation and desire for a particular thing to happen or
more complex such as that of Duault and Martoc-
chio, a multidimensional dynamic life force charac-
terized by a confident yet uncertain expectation of
achieving a good future which, to the hoping
person, is realistically possible and personally signi-
ficant (http://oxforddictionaries.com/words/the-
oxford-english-dictionary, accessed 2 January
2012) [1]. In the medical context, all definitions
encompass the concept of a desirable future event,
which when articulated in the present can have a
positive influence on wellbeing or at least reflect a
positive state.
One simple manifestation of the complex
nature of hope is the difference when used as a verb
or a noun [2]. Discourse analysis of the speech of
patients who were dying of cancer revealed that
when they used it as a noun, it was a more concrete
entity that could be given or taken by the medical
team, either by the information that they gave or
the way they communicated it, and this determined
the patients choices. It was often expressed as no
hope. Occasionally, this could be more positive
because of a more subjective interpretation by a
patient of what the doctor said or including non-
medical sources of hope, rather than hope being
based purely on the medical facts. The interpret-
ation could alter according to the mood of the
patient. However, there were other sources of hope,
than medical prognosis, and when used as a verb,
hope was personalized to a positive future outcome,
of relevance to a patient such as achieving comfort
or reaching a milestone event. As the definition
suggests, hope is a dynamic process and can be used
by the same patient in both ways, which is one
demonstration of its multidimensionality and
makes it difficult to extinguish, but could also lead
to miscommunication. This situation shows that
clinicians may expect a level of hope based on
prognosis, but this may only apply to one expression
of hope and may therefore be an inaccurate measure
Cancer Council Australia, Sydney, New South Wales, Australia
Correspondence to Ian N. Olver, AM, MD, PhD, Clinical Professor
University of Sydney, CEO, Cancer Council Australia, GPO Box
4708, Sydney, NSW 2001, Australia. Tel: +61 280634111; mobile:
61 409220026; e-mail: ian.olver@cancer.org.au
Curr Opin Support Palliat Care 2012, 6:236241
DOI:10.1097/SPC.0b013e3283528d0c
www.supportiveandpalliativecare.com Volume 6 Number 2 June 2012
REVI EW
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of a patients hope where the patient is using a more
personalized sense of hope.
If sustaining hope is a virtue in medical care, and
if it can impact on wellbeing, communicating bad
news or a bad prognosis could be problematic in
contributing to a poorer outcome [3]. The issue
of false hope may seem counter to individual
autonomy, but may depend on what sense of hope
is being addressed. It is also relevant to a definition
of hope that an appropriate level of hope, or
whether hope was false, can only be determined
in retrospect.
A recent review of research in hope and cancer
was published after a comprehensive literature
review covering studies from 2005 to 2009 [4
&&
].
The years were chosen because a previous compre-
hensive review had covered the literature up until
2005 [5]. They both identified themes within the
literature. The assessment of hope was important.
Bothreviewers recognized the impact of hope onthe
way patients with cancer coped with both physical
symptoms and psychosocial and spiritual issues that
arose because of their cancers. They were keen to
explore interventions which may raise the level of
hope. Communication with patients and carers was
also a key theme. The more recent literature further
develops these themes.
DEFINITION AND ASSESSMENT OF HOPE
Further light on the nature of hope was reported in a
study from Sweden, where palliative care nurses
were interviewed in focus groups to ascertain the
existential issues they observed in their patients [6
&
].
One of the four categories that they identified was
meaning, and a part of that was hope. Patients knew
they were dying, but expressed hope for the future
and made plans accordingly. This was interpreted by
the staff as anescape fromthe reality of their disease,
which allowed for hope, even of a last minute
reprieve. Hope was recognized as important for
creating meaning.
Assessing hope in the experimental setting, Butt
found in her review that the questionnaire most
used was the Herth Hope Index (HHI), a 12-item
Likert scale with documented reliability and validity
[4
&&
,7]. This had also been commonly used in the
studies in the prior review [5].
COMMUNICATION AND HOPE
There are some new insights into communication
and hope in the most current literature. A survey of
620 oncologists fromJapanwitha 67%response rate
showed that communicating the decision to discon-
tinue anticancer treatment was rated as a high bur-
den by 47%[8
&
]. One of the key reasons was that the
discussion would deprive patients of hope. Whereas
there may be specific cultural issues influencing this
result, the underlying concern is likely to be univer-
sal and has previously been reported in the USA
[9
&&
].
Smith et al. [9
&&
] created a decision aid for
patients with incurable metastatic cancer (because
there had not been one used). They then tested it on
27 patients. The primary endpoint was the number
who opted for full disclosure once they viewed the
decision aid. They measured the impact of this
truthful information on hope, using the HHI. In a
pretest, all patients stated that they wanted full
disclosure of the information about their cancer
treatment and its likely outcome. All but one com-
pleted the decision aid. Prior to using the decision
aid, patients were overoptimistic about their chan-
ces of cure. Despite all patients being selected
because they had incurable metastatic cancer,
52% thought that a patient with their type of meta-
static cancer was curable. This fell to 32% after the
decision aid. The important outcome in the context
of this reviewwas that no patient, including the one
who did not complete the decision review, showed
any change in their HHI. This information may be
helpful in addressing the issue that in the USA, only
37% of terminally ill patients receive survival esti-
mates, even if they request them. A meta-analysis
has shown that prognosis is overestimated by 30%
[10]. I am not surprised at this. Referring back to our
work with patients who were dying, the prognostic
information would be the hope as a noun, whereas
the patients were sustained by more personal hopes
expressed as verbs where they were the subject doing
the hoping [2].
Other more recent insights inthe hope literature
refer to the communication between doctors and
KEY POINTS
One dimension of hope is the present expectation of a
good future.
Hope is an important coping mechanism for patients
with cancer and adds meaning to their lives.
Hope and optimism negatively correlate with
depression and anxiety.
Communication about the end of active anticancer
treatment or a poor prognosis need not deprive patients
of hope.
Interventions have been shown to increase hope and
decrease psychological distress, and therefore require
further research.
Evolving definitions of hope in oncology Olver
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carers. Olson [11
&
] undertook semistructured inter-
views of 32 carers whose spouses had a variety of
cancers. They found that carers use many more
coping strategies than just denial, most commonly
distraction. They shape their emotions to deal with
the diagnosis, and because of the uncertainty about
the prognosis, and an inability to plan as they would
once have done, they enter a period where time
seems suspended. This, the authors have designated
as temporal anomie. Many carers responded to this
by readjusting their temporal response and orien-
tation to the present. Some maintained a future
orientation by reinterpreting how they perceived
the diagnosis of cancer to be able to maintain a
future-oriented perspective. This readjustment is
prompted by how the cancer diagnosis is commu-
nicated. Often the communication strategy is
directed to maintaining hope. However, there are
so many ways that hope can be defined, including
linking it to goals, spiritual beliefs, inner resources
or refocusing time. In analysing this study, the
authors want to replace addressing hope with the
concept of addressing this temporal anomie of both
patients and carers, to encourage assuming specific
temporal orientations. That is they focus on day-to-
day issues in the present as a way of coping with
their illness, rather than on hope for future out-
comes. This effectively provides another challenge
for the broader definition of what the term hope
encompasses.
HOPE AS PART OF PSYCHOSOCIAL AND
SPIRITUAL SUPPORT
In examining the components of quality-of-life
assessments at the end of life, Grant and Sun con-
sider four domains; physical, psychological, social
and spiritual. The spiritual domain includes mean-
ing, religiosity and hope [12
&
]. However these
domains can be interrelated. In exploring the
relationship between psychosocial adjustment and
hopelessness in 90 women with breast cancer in
Turkey, it was determined that as the psychosocial
adjustment worsens, the level of hopelessness
increases [13
&
]. The authors concluded that attempts
to increase hope and increase psychosocial adjust-
ment should increase the patients quality of life.
In 301 women in Egypt, after mastectomy it was
recognized that social support can predict hope
[14
&
]. However, no specific differences were found
among sociodemographic variables such as age,
residence, marital status or educational level and
social support and hope.
Rustoen et al. [15
&
] evaluated the relationships
among demographic and clinical characteristics,
health status, psychological distress, life satisfaction
and hope (as measured by the HHI) in 194 predom-
inantly breast cancer patients from the community
who were participating in a hope intervention and
whose data were collected at baseline. Hope was
found to mediate the relationship between health
status and psychological distress, and partially
mediated the relationship between psychological
distress and life satisfaction. This situation demon-
strates the extent to which hope is an important
resource and mechanism for coping.
Rajandramet al. [16
&
] report the first study of the
impact of hope and optimism on anxiety and
depression. Their emphasis in defining hope was
on its two components of agency and pathways,
as defined by the Synder model [17]. The agency
component is the motivational component of hope,
whereas the pathway is the route to attain the goal.
Optimism, a stable tendency to believe that good
things will happen, focuses on the actions rather
than the motivations, which bring the positive
events. The study was a retrospective cross-sectional
study in 50 patients treated for oral cancer in Hong
Kong. Depression and anxiety were measured by the
hospital anxiety and depression scale, hope by the
Chinese version of the hope scale of Ho et al. [18]
and optimism using the life orientation scale-
revised. Hope and optimism together had an inde-
pendent effect on depression and an equal associ-
ation with depression. The authors attribute this to
the importance of positivity regarding ones own
action, that is, hope, and the positive expectation of
the external environment, that is, optimism. It was
the agency component of hope which predicted
depression. Both together were significant predic-
tors of anxiety, but not individually. As previously
discussed, hope can be enhanced through psycho-
social interventions. The authors conclude, there-
fore, that psychotherapy programmes for these
patients should be specifically focused on the moti-
vational component of hope.
HOPE AND CANCER MANAGEMENT
Several studies in the recent literature illustrate the
impact of hope on symptoms, treatment decisions,
palliative care and survivorship.
Fatigue
There is a relationship between hope and fatigue.
This was demonstrated in 160 Norwegian patients
with cancer and fatigue who had hope measured
using the HHI [19
&
]. Hope was negatively, weakly
correlated with total fatigue and mental fatigue, but
not physical fatigue. The only demographic charac-
teristic associated with hope was the improved score
Psychosocial care in patients with metastatic cancers
238 www.supportiveandpalliativecare.com Volume 6 Number 2 June 2012
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in patients married or living together. This may
indicate that hope is likely to be higher if someone
has a supportive environment which means that
hope depends on other than prognostic expec-
tation.
A similar association was demonstrated between
fatigue, particularly its intensity and how it inter-
fered with mood and relationships with others, and
hope in 182 newly diagnosed Taiwanese patients
with solid tumours receiving chemotherapy [20
&
].
Assessing fatigue and reducing its duration and
impact onmood and relationships may allowhigher
levels of hope in patients.
Treatment decisions
The degree of hope that patients have can influence
their treatment decisions. This is particularly appa-
rent when accepting noncurative chemotherapies.
Daneault et al. [21
&
], in defining hope, drew a dis-
tinction between particular hopes and generalized
hopes. Aparticular hope may be for a cure, whereas a
generalized hope is a trust in the future which can
continue to give life a meaning despite a terminal
illness. Hope is not fixed but evolves and can switch
between the two. The problemis that a specific hope
for a cure may lead to a decision to accept a treat-
ment which has little chance of a meaningful
benefit, which means that it was a false hope. The
problem for clinicians is that they really do not
know in a particular case whether helping a specific
patient abandon a specific hope for a cure will
alleviate or exacerbate the suffering in the terminal
phase of cancer. An example of the dilemma is
offering an early phase experimental drug which
has no guaranteed benefit in this setting instead
of offering symptom control only. This is often a
decision made by the patients with their doctors,
although there will be an impact on families, and it
may lead to adverse outcomes for the patient. The
problem is that some patients after a detailed dis-
cussion will accept the no active treatment option,
whereas others will remain greatly distressed. There
is no generic answer to this dilemma.
A similar issue was taken up by Sulmasy et al.
[22
&
], inwhichpatients were interviewed about their
decision to accept early phase clinical trials of anti-
cancer treatments, in which the actual chance of
benefit was low. There is a concern that the patients
are misinformed about the chances of benefit, and
this compromises their ability to give truly informed
consent. The 45 patients interviewed did have a
high expectation of therapeutic benefit from their
early phase trial. However, the reason for this was
that it was an expression of hope and optimism, not
an expression of their knowledge of the facts.
In a similar study, 40 patients completed ques-
tionnaires asking about their reason for participat-
ing in Phase I cancer trials. To maintain hope was
the response of 15% [23
&
]. Other responses included
expectation of benefit (21%), the trial being the
best option (21%) and to help with research
(13%). Only one patient responded that altruism
was their main motivation. Clearly, optimistic
expectation of personal benefit was the main driver
for accepting these early phase trials.
Palliative care
Hope in the palliative care setting raises similar
dilemmas. Toh [24
&
] believes that the medicaliza-
tion of dying is what may be leading to a false hope.
However, not all healthcare professionals take the
same view about treatments near the end of life.
Buiting et al. [25
&
] interviewed 14 physicians and 13
nurses from the Netherlands about providing che-
motherapy for end-stage cancer. Nurses were more
inclined to be against providing chemotherapy, so
that patients could make the best use of the time
available to them. Physicians often mutually
reinforced the patients not giving up attitude.
They factored the loss of hope engendered by stop-
ping treatment into assessment of the patients
quality of life. The ideal balance may be achieved
by seeking the spectrum of viewpoints from a multi-
disciplinary treatment team in end-of-life decision-
making.
If members of the healthcare professions have
diverging views on when to use chemotherapy or
focus on supportive care only, it is not surprising
that healthcare professionals and family carers take
different perspectives. In the paediatric palliative
care setting, parents and healthcare professionals
were asked to describe what factors influenced their
decision-making about treatment [26
&
]. For parents,
hope, increased survival and their childs quality of
life were the top three. These ranked higher than for
healthcare workers, who ranked financial burden on
parents higher than the parents. The healthcare
workers who had stronger ranking for parents
opinions had a stronger ranking for more aggressive
chemotherapy. Hope was fourth on the healthcare
professionals ranking.
Hope is required to sustain palliative care
workers as well. In a study of 14 community pallia-
tive care nurses, they defined hope as a positive
state of being involved in a perseverant and realistic
understanding of future possibilities [27
&
]. Their
hope was sustaining and motivating for their work.
The main newfinding from this study was howthey
dealt with the situation when their hopes differed
from those around them. They harmonized their
Evolving definitions of hope in oncology Olver
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hope. This meant allowing different perspectives to
co-exist rather than having to reach consensus.
Intervention
In 2011, a longitudinal study of the effects of a
hope interventiononthe levels of hope andpsycho-
logical distress was reported in community-based
oncology patients [28
&&
]. A previous randomized
trial had shown the efficacy of HOPE-IN, an 8-week
small group intervention programme consisting of
eight 2-h sessions [29]. The first and last sessions
were introductory and a summary session, whereas
the other six sessions focussed on belief in oneself
and ones own ability, emotional reactions,
relationships with others, active involvement,
spiritual beliefs and values and, finally, acknow-
ledgement that there is a future. In 195 patients,
the level of hope, as measured by the HHI, increased
significantly from baseline to 8 weeks, and then
decreased slightly by the 3-month and 12-month
measurements. Psychological distress, with its
components of intrusion and avoidance, was
measured by the Impact of Event Scale (IES).
Psychological distress decreased significantly
from baseline to 8 weeks and then continued to
decrease slightly at 3 months and by 12 months.
The effects on hope and psychological distress
were independent.
The findings indicated to the authors that the
trajectory of hope scores remained the same, con-
ditioned on intrusion and avoidance. More work
was needed to determine the most effective
approaches and the optimal duration of therapy
to increase hope and reduce psychological distress
in cancer.
CONCLUSION
The definition of hope is evolving as its clinical
utility in patients with cancer is explored. This
expectation of a good future provides patients with
meaning to their lives and impacts positively on
their psychological wellbeing. Patients may accept
anticancer treatments or early phase trials with a
low chance of benefit, in order to maintain hope.
Clinicians are reluctant to deprive patients of hope.
Interventions are being tested to increase hope as
part of improving quality of life.
Acknowledgements
None.
Conflicts of interest
The author declares no conflicts of interest.
This study was written as part of the authors role at
Cancer Council Australia and there are no additional
sources of funding to be disclosed.
REFERENCES AND RECOMMENDED
READING
Papers of particular interest, published within the annual period of review, have
been highlighted as:
&
of special interest
&&
of outstanding interest
Additional references related to this topic can also be found in the Current
World Literature section in this issue (pp. 295296).
1. Dufault K, Martocchio BC. Symposium on compassionate care and the dying
experience. Hope: its spheres and dimensions. Nurs Clin North Am 1985;
20:379391.
2. Eliott JA, Olver IN. Hope and hoping in the talk of dying cancer patients. Soc
Sci Med 2007; 64:138149.
3. Olver IN. Bioethical implications of hope. In: Eliott JA, editor. Interdisciplinary
perspectives on hope. New York: Nova Science Publishers Inc; 2005.
pp. 231246.
4.
&&
Butt CM. Hope in adults with cancer: state of the science. Oncol Nurs Forum
2011; 38:E341E350.
A synthesis of 16 articles from 2005 to 2009 on hope in adults with cancer. This
study demonstrates the opportunities for clinical trials of interventions to increase
hope and explores the evolving denition of hope.
5. Chi GC. The role of hope in patients with cancer. Oncol Nurs Forum 2007;
34:415424.
6.
&
Browall M, Melin-Johansson C, Strang S, et al. Healthcare staffs opinions
about existential issue among patients with cancer. Palliat Support Care
2010; 8:5968.
Healthcare staff identify that hope is important in allowing meaning in the life of
dying patients.
7. Herth K. Abbreviated instrument to measure hope: development and psycho-
metric evaluation. J Adv Nurs 1992; 17:12511259.
8.
&
Otani H, Morita C, Esaki T, et al. Burden on oncologists when communicating
the discontinuation of anticancer treatment. Jpn J Clin Oncol 2011; 41:999
1006.
The burden on oncologists of breaking bad news is associated with a feeling of
depriving patients of hope.
9.
&&
Smith TJ, DowLA, Virago EA, et al. A pilot trial of decision aids to give truthful
prognosis and treatment information to chemotherapy patients with
advanced cancer. J Support Oncol 2011; 9:7986.
This study developed a decision aid for palliative patients with cancer and showed
that accurate prognostic and anticancer treatment withdrawal decisions could be
made without decreasing the patients levels of hope.
10. Falloweld L, Jenkins V. Communicating sad, bad, and difcult news in
medicine. Lancet 2004; 363:312319.
11.
&
Olson RE. Managing hope, denial or temporal anomie? Informal cancer carers
accounts of spouses cancer diagnoses. Soc Sci Med 2011; 73:904911.
This study suggests that instead of managing hope physicians should seek to
manage carers disrupted orientation in time.
12.
&
Grant M, Sun V. Advances in quality of life at the end of life. Semin Oncol Nurs
2010; 26:2635.
Hope is part of the spiritual domain which together with the physical, psychological
and social is a component of quality of life.
13.
&
Gumus AB, Cam O, Malak AT. Relationships between psychosocial adjust-
ment and hopelessness in women with breast cancer. Asian Pac J Cancer
Prev 2011; 12:433438.
Psychosocial adjustment worsens as hopelessness increases in a group of women
with breast cancer.
14.
&
Denewar A, Farouk O, Mostafa W, Elshamy K. Social support and hope
among Egyptian women with breast cancer after mastectomy. Breast Cancer
(Auckl) 2011; 5:93103.
Social support can predict hope, but no relationship between sociodemographic
features and support and hope was found in this study.
15.
&
Rustoen T, Cooper BA, Miaskowski C. The importance of hope as a mediator
of psychological distress and life satisfaction in a community sample of cancer
patients. Cancer Nurs 2010; 33:258267.
Using the baseline data of a hope intervention in 94 patients, hope is found to
mediate the relationship between psychological distress and health status and
partially mediate the association between psychological distress and life satisfac-
tion.
16.
&
Rajandram RK, Ho SMY, Samman N, et al. Interaction of hope and optimism
with anxiety and depression in a specic group of cancer survivors: a
preliminary study. BMC Res Notes 2011; 4:519425.
Hope and optimism impact on depression and anxiety.
17. Snyder CR, Harris C, Anderson JR, et al. The will and the ways: development
and validation of an individual differences measure of hope. J Pers Soc
Psychol 1991; 60:570585.
Psychosocial care in patients with metastatic cancers
240 www.supportiveandpalliativecare.com Volume 6 Number 2 June 2012
Copyright Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
18. Ho SMY, Ho JWC, Bonanno GA, et al. Hopefulness predicts resilience after
hereditary colorectal cancer genetic testing: a prospective outcome trajec-
tories study. BMC Cancer 2010; 10:279289.
19.
&
Schjolberg TK, Dodd M, Henriksen N, Rutoen T. Factors affecting hope in a
sample of fatigued breast cancer outpatients. Palliat Support Care 2011;
9:6372.
Hope and total fatigue are related, but this study shows that it is easier to be
hopeful when you are living with a spouse or partner for support.
20.
&
Shun SC, Hsiao FH, Lai YH. Relationship between hope and fatigue charac-
teristics in newly diagnosed outpatients with cancer. Oncol Nurs Forum
2011; 38:E81E86.
It is more the duration of fatigue and its interference with mood and relationships
that are associated with hope, than its intensity.
21.
&
Daneault S, Dion D, Sicotte C, et al. Hope and noncurative chemotherapies:
which affects the other? J Clin Oncol 2010; 28:23102313.
This study distinguishes between general hope which can give life a meaning and
particular hopes, such as for a cure, which may be false.
22.
&
Sulmasy DP, Astrow AB, He MK. The culture of faith and hope: patients
justications of expected therapeutic benet when enrolling in early phase
oncology trials. Cancer 2010; 116:37023711.
Patients opting for low-benet treatment do so as an expression of hope and
optimism, not of their knowledge of the treatment.
23.
&
Catt S, Langridge C, Falloweld L, et al. Reasons given for participating, or
not, in phase 1 cancer trials. Eur J Cancer 2011; 47:14901497.
Fifteen percentage of patients opt for Phase 1 trials to maintain hope, while very
few are purely altruistic.
24.
&
Toh HC. Providing hope in terminal cancer: when is it appropriate and when is
it not? Ann Acad Med Singapore 2011; 40:5056.
Is the problemof false hope of treatment efcacy near the end of life because of the
medicalization of dying?
25.
&
Buiting HM, Rurup ML, Wijsbek H, et al. Understanding provision of chemo-
therapy to patients with end stage cancer: qualitative interview study. BMJ
2011; 342:d1933. doi: 10.1136/bmj.d1933.
Nurses are less likely than doctors to approve of chemotherapy towards the end-of-
life, whereas doctors are concerned about removing the patients hope and more in
favour of giving chemotherapy.
26.
&
Tomlinson D, Bartels U, Gammon J, et al. Chemotherapy versus supportive
care alone in pediatric palliative care for cancer: comparing the preferences of
parents and healthcare professionals. CMAJ 2011; 183:E1252E1258.
Parents rank hope rst when deciding whether to use chemotherapy to palliate
children with cancer, whereas healthcare professionals ranked hope fourth.
27.
&
Penz K, Duggleby W. harmonizing hope: a grounded theory study of the hope
experience of registered nurses who provided palliative care in community
settings. Palliat Support Care 2011; 9:281291.
The new information here is that when their levels of hope differ from others,
palliative care nurses use harmonization, which is not consensus but allowing the
different levels of hope to co-exist.
28.
&&
Rustoen T, Cooper BA, Miaskowski C. A longitudinal study of the effects of a
hope intervention on levels of hope and psychological distress in a commu-
nity-based sample of oncology patients. Eur J Nurs 2011; 15:351357.
An intervention to increase hope with a group programme, HOPE-IN, was
successful in increasing the level of hope after 8 weeks and also decreased
psychological distress. Further trials should aim to optimize the intervention.
29. Rustoen T, Wiklund I, Hanestad BR, MoumT. Nursing intervention to increase
hope and quality of life in newly diagnosed cancer patients. Cancer Nurs
1998; 21:235245.
Evolving definitions of hope in oncology Olver
1751-4258 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins www.supportiveandpalliativecare.com 241