The importance of hope as a mediator of psychological distress and life satisfaction in a community sample of cancer patients. Cancer Nurs. 2010;33:258-267. [PMID: 20467303 DOI: 10.1097/NCC.0b013e3181d6fb61]

Hope, Symptoms, and Palliative Care

BACKGROUND

Hope is important to patients with cancer. Identifying factors that influence hope is important. Anxiety, depression, fatigue, and pain are reported to impair hope. The objective of this study was to determine whether age, gender, marital status, duration of cancer, symptoms, or symptom burden measured by the sum of severity scores on the Edmonton Symptom Assessment Scale (ESAS) correlated with hope measured by the Herth Hope Index (HHI).

METHODS

Patients with advanced cancer in a palliative care unit participated. Demographics including age, gender, marital status, cancer site, and duration of cancer were collected. Individuals completed the ESAS and HHI. Spearman correlation and linear regression were used to assess associations adjusting for gender (male vs female), age (< 65 vs ≥ 65 years), marital status (married or living with a partner vs other), and duration of cancer (≤ 12 vs > 12 months).

RESULTS

One hundred and ninety-seven were participated in the study, of which 55% were female with a mean age of 61 years (standard deviation 11). Hope was not associated with gender, age, marital status, or duration of cancer. In univariable analysis, hope inversely correlated with ESAS score (-0.28), lack of appetite (-0.22), shortness of breath (-0.17), depression (-0.39), anxiety (-0.32), and lack of well-being (-0.33); only depression was clinically relevant. In multivariable analysis, total symptom burden weakly correlated with hope; only depression remained clinically significant.

DISCUSSION

This study found correlation between symptom burden and hope was not clinically relevant but was so for depression.

CONCLUSION

Among 9 ESAS symptoms, only depression had a clinically relevant correlation with hope.

The Contribution of Cognitive Strategies to the Resilience of Women Survivors of Childhood Sexual Abuse and Non-Abused Women

This study examines the contribution of four strategies—self-forgiveness, realistic control, unrealistic control, and hope—to the resilience of 100 women survivors of childhood sexual abuse (CSA), as compared with 84 non-sexually abused women. The findings show that CSA survivors exhibited lower resilience, lower self-forgiveness, lower hope, and higher levels of posttraumatic symptoms (PTS). They also indicate that resilience was explained by the participants’ financial status, PTS severity, and two cognitive strategies—self-forgiveness and hope. Finally, PTS and hope mediated the relation between CSA and resilience.

Love, faith and hope - a secondary analysis of prostate cancer survivors and their partners

BACKGROUND

Men's experience of recovery from treatment for prostate cancer has been extensively researched with reports highlighting the physical side effects of treatments such as erectile dysfunction and incontinence. The psychological, emotional and spiritual burden of prostate cancer on men and their partners has received far less attention.

DESIGN

In this study, a secondary thematic analysis of data from a series of separate but related qualitative studies with prostate cancer survivors and their partners was conducted to further explore themes of love, hope and faith within this population.

RESULTS

This study identified unresolved needs related to the emotive concepts of love, hope and faith. The findings from this study can be employed to refine psychosocial assessments of men with prostate cancer, and provide a more comprehensive understanding of prostate cancer survivors supportive care needs.

The German Version of the Herth Hope Index (HHI-D): Development and Psychometric Properties

BACKGROUND

The importance of hope is evident in clinical oncological care. Hope is associated with psychological and also physical functioning. However, there is still a dearth of empirical research on hope as a multidimensional concept. The Herth Hope Index is a reliable and valid instrument for the measurement of hope and is available in many languages. Until now no authorized German translation has been published and validated.

METHODS

After translation, the questionnaire was completed by 192 patients with different tumor entities in radiation therapy. Reliability, concurrent validity, and factor structure of the questionnaire were determined.

RESULTS

Correlations were high with depression and anxiety as well as optimism and pessimism. As expected, correlations with coping styles were moderate. Internal consistency and test-retest reliability were satisfactory. We could not replicate the original 3-factor model. Application of the scree plot criterion in an exploratory factor analysis resulted in a single-factor structure.

CONCLUSIONS

The Herth Hope Index - German Version (HHI-D) is a short, reliable, and valid instrument for the assessment of hope in patient populations. We recommend using only the HHI-D total score until further research gives more insights into possible factorial solutions and subscales.

Hope and mood changes throughout the primary brain tumor illness trajectory

BACKGROUND

The ambiguity of defining hope impacts the level of readiness faced by health care professionals treating patients with glioma, a disease with unpredictable outcomes. This study describes the report of hope and the relationship between hope and mood in adult brain tumor patients at various points in the illness trajectory.

METHODS

This was a cross-sectional study with data collection including use of the Herth Hope Index (HHI), the Profile of Mood States-Short Form (POMS-SF), and clinical information. Descriptive statistics were used to report sample characteristics. Spearman's rho and Mann-Whitney tests were used to compare and differentiate scores.

RESULTS

Eighty-two patients ranging in age from 22 to 78 years (median, 44.5 y) participated in the study. Patients were primarily male (57.3%), married (76.8%), and had a high-grade glioma (35.4%). Nearly half had recurrence, and more than 20% were on active treatment. The overall HHI total score for the sample was 41.32 (range: 13-48). Patients with recurrence had a lower HHI interconnectedness (median = 14.00) score and higher total mood disturbance (median = 14.00) compared with patients without recurrence (median = 15.00 and median = 0.00, respectively; P < .05). All negative mood states on the POMS-SF were negatively correlated with HHI subscales.

CONCLUSIONS

Overall, patients reporting more hope also reported less overall mood disturbance As expected, patients with tumor recurrence reported lower hope and higher mood disturbance than those who were newly diagnosed or without recurrence. Targeting interventions specifically tailored to an individual's needs for improvement in quality of life throughout the disease course may include measures to address hope in order to facilitate positive coping strategies.

Hope pictured in drawings by women newly diagnosed with gynecologic cancer

BACKGROUND

In mysterious ways, hope makes life meaningful even in chaotic and uncontrolled situations. When a woman is newly diagnosed with gynecologic cancer, hope is ineffable and needs exploring. Drawings help express ineffable phenomena.

OBJECTIVE

The aim of the study was to explore how women newly diagnosed with gynecologic cancer express the meaning of hope in drawings.

METHOD

Participants were 15 women who on the same day had received the diagnosis of gynecologic cancer. They were between 24 and 87 years (median, 52 years) with a variety of gynecologic cancer diagnoses. Data from 15 drawings and postdrawing interviews with the women were analyzed using visual and hermeneutic phenomenology.

RESULTS

Three themes emerged: hope as a spirit to move on, hope as energy through nature, and hope as a communion with families.

CONCLUSION

Hope as pictured in drawings often appears through metaphors and incorporates internal, external, and relational aspects. With other words, inner willpower, experiences in open nature, and closeness to loved ones contribute to hope when newly diagnosed with gynecologic cancer.

IMPLICATION FOR PRACTICE

The use of drawings in clinical situations might give cancer nurses new perceptions of hope and other phenomena. Patients might feel threat and despair when diagnosed with cancer; they need gentle truth about reality, and they long for being together with loved ones. Nurses are in a unique position to enable hope in this situation through listening and active engagement. Drawing might be a tool in understanding the hope. Drawings picture where words come short.

Imagining the White Picket Fence

Previous research has established that individuals from a lower social class report lower relationship quality. However, to date, no studies have examined interdependence processes within the relationship as a mechanism underlying this association. The present research investigates the role of planned tangible investments as a mediator between social class and relationship quality. Across two studies, we test this hypothesis correlationally (Study 1) and experimentally (Study 2). As predicted, lower-class individuals reported fewer planned tangible investments, which in turn were associated with lower relationship satisfaction and commitment (Studies 1 and 2), as well as overall satisfaction with life (Study 2). Together, these studies suggest the importance of perceived ability to make future plans for individual and relationship well-being. This research has implications for understanding relationship quality and mental health among lower-class populations, and the findings are discussed in relation to the growing literature on social class and romantic relationships.

Hope in newly diagnosed cancer patients

CONTEXT

Hope is important to cancer patients as it helps them deal with their diagnosis. Little is known about hope in newly diagnosed cancer patients.

OBJECTIVES

Based on the Transcending Possibilities conceptual model of hope, the purpose of this study was to examine the relationship of hope with pain, energy, and psychological and demographic characteristics in newly diagnosed adult oncology outpatients.

METHODS

Data from 310 New Patient Assessment Forms from cancer outpatients' health records were collected. Health records from the first six months of 2009 were reviewed and data were collected on hope, energy, pain, depression, anxiety, feeling overwhelmed, and demographic variables. A generalized linear modeling approach was used to study the relationship of hope scores with these variables. Hypothesized variables and variables that were significant at the P = 0.01 level from the univariate analysis were entered into the multivariate model, with hope scores as the dependent variable.

RESULTS

Hope scores were significantly negatively related to age (P = 0.02). More specifically, oncology patients who were 65 years of age or older had significantly less hope than those under the age of 65 years (P = 0.01). Gender (P = 0.009) also was a significant factor, with men having higher hope scores than women. No other variables were significant.

CONCLUSION

Older adults comprise the majority of persons in Canada with cancer. The lower hope scores found in this age group compared with their younger counterparts underscore the importance of further research. This study provides a foundation for future research in this important area for oncology patients.

Nurse–Patient Interaction

Background: Nursing home care increasingly targets those elderly with the greatest needs in terms of personal daily activities, whereas services supporting spiritual needs such as hope tend to be ignored. Hope is seen to be a dynamic life force vital to well-being. Nursing home patients are frail, vulnerable, and dependent, which may lead to their hope being intimately related to the nurse–patient interaction. Purpose: The purpose of this study was to investigate the relationship between nurse–patient interaction and hope among cognitively intact nursing home patients. Design and method: Cross-sectional data were obtained by means of one-on-one interviews; 202 cognitively intact nursinghome patients representing 44 Norwegian nursing homes responded to the Herth Hope Index and the Nurse–Patient Interaction Scale. The hypothesized relationships between a two-factor construct of hope and nurse–patient interaction were assessed by means of structural equation modelling. Results: The structural equation model revealed a good fit to the data, showing significant influence of nurse–patient interaction on nursing home patients’ level of hope. Conclusion and implications: Nurse–patient interaction significantly influences hope in cognitively intact nursing home patients. Offering connectedness should be a central and integral aspect of holistic nursing home care. Providing continuing educational programs for caregivers focusing on how to interact with patients in a health-promoting and hopeful manner seems essential.

The Herth Hope Index—A Psychometric Study Among Cognitively Intact Nursing Home Patients

Background and Purpose: Hope is seen as the act by which the temptation of despair is actively overcome and has thus been interpreted as an inner strength and an available resource for living in the present. An understanding of hope and its meaning in the lives of institutionalized older adults may aid in developing interventions to enhance hope and well-being in the nursing home setting. This study aimed to investigate the psychometric properties of the Norwegian version of the Herth Hope Index among cognitively intact nursing home patients. Methods: Cross-sectional data was obtained in 2008 and 2009 from 202 of 250 patients who met the inclusion criteria in 44 different nursing homes. Results: Exploratory factor analysis revealed 3 internal consistent dimensions of hope, explaining 51.2% of the variance. The 1-factor, 2-factor, and the originally 3-factor solutions of the Herth Hope Index were tested by means of confirmatory factor analysis. A 2-factor construct comprising 11 items came out with the best model fit. Conclusions: The Herth Hope Index was found to be a reliable and valid instrument for assessing hope in nursing home patients. The 2-factor structure was psychometrically superior the original 3-factor construct of hope in this particular sample. The Herth Hope Index might be used to assess hope and changes in the hope process during long-term nursing home care. An enhanced understanding of hope in this population might contribute to increased quality of nursing home care.

Evolving definitions of hope in oncology

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.

Hope in people with cancer: a multivariate analysis from Turkey

AIM

The study was planned to determine the hope levels of people with cancer and the variables affecting hope.

BACKGROUND

Hope is essential for patient well-being and positively correlated with improved coping skill.

DESIGN

A descriptive and exploratory design.

METHODS

The study sample included 240 consecutive patients treated with chemotherapy and attending the Day Chemotherapy Unit of a University Hospital in Turkey. The study was conducted between December 2009-January 2010. Personal Information Form and Herth Hope Scale were used for data collection. The determinants and subscales of hope were evaluated with univariate and multivariate regression analyses.

RESULTS

These mean scores showed high levels of hope among the patients included in the study. It was found that net family income, knowledge level about the disease, feeling of improvement, perception of satisfactory family support by the patient, mouth ulcers, feeling anxious or worried and presence of fear were independently related with the total hope score.

CONCLUSIONS

The study results showed high levels of hope among the participating patients. It is concluded that physical, financial and psychological well-being and information and support needs are directly and independently related with hope in people with cancer. These findings support the need for clinicians to continue to practise and implement hope fostering/hindering interventions among their patients.

Changes in hope and health-related quality of life in couples following acute myocardial infarction: a quantitative longitudinal study

BACKGROUND

Acute myocardial infarction (AMI) is a life-changing event that affects both the patient and the family and can have an influence on hope as well as HRQoL during the recovery period.

AIMS

To compare self-rated scores of hope and health-related quality of life (HRQoL) 1, 7, 13 and 25 months, after an AMI with regard to (i) differences across time, and (ii) differences between patients and their partners.

DESIGN

Explorative and longitudinal study.

METHODS

In this nonrandomized study, Short Form 36 Health Questionnaire (SF-36) and Herth Hope Index-Swedish (HHI-S) questionnaires were completed by thirteen post-AMI patients and their partners. Data were collected on four occasions.

RESULTS

In general, hope as well as HRQoL scores increased over time. A 2 (groups) × 4 (times) anova for mixed design showed significant changes in mental as well as in physical health over time but no significant effect of group on mental or physical health. Calculation of the minimum detectable change (MDC-index) for HHI-S and SF-36 revealed that scores between data collection points were not stable. conclusion: Our results show that although hope and HRQoL scores increased, only a few of the changes were statistically significant. Neither HHI-S nor SF-36 seems to measure stable states. Changes in hope and HRQoL levels may be due to participants striving to adapt to the current situation.

RELEVANCE TO CLINICAL PRACTICE

These results can be used in the training of nursing staff to enhance their understanding of the significance of a family-centred approach after an AMI.

Hope modified the association between distress and incidence of self-perceived medical errors among practicing physicians: prospective cohort study

The presence of hope has been found to influence an individual's ability to cope with stressful situations. The objective of this study is to evaluate the relationship between medical errors, hope and burnout among practicing physicians using validated metrics. Prospective cohort study was conducted among hospital based physicians practicing in Japan (N = 836). Measures included the validated Burnout Scale, self-assessment of medical errors and Herth Hope Index (HHI). The main outcome measure was the frequency of self-perceived medical errors, and Poisson regression analysis was used to evaluate the association between hope and medical error. A total of 361 errors were reported in 836 physician-years. We observed a significant association between hope and self-report of medical errors. Compared with the lowest tertile category of HHI, incidence rate ratios (IRRs) of self-perceived medical errors of physicians in the highest category were 0.44 (95%CI, 0.34 to 0.58) and 0.54 (95%CI, 0.42 to 0.70) respectively, for the 2^nd and 3^rd tertile. In stratified analysis by hope score, among physicians with a low hope score, those who experienced higher burnout reported higher incidence of errors; physicians with high hope scores did not report high incidences of errors, even if they experienced high burnout. Self-perceived medical errors showed a strong association with physicians' hope, and hope modified the association between physicians' burnout and self-perceived medical errors.

Dignity and deferral narratives as strategies in facilitated technology-based support groups for people with advanced cancer

This paper examines the value of facilitated telephone and online support groups for palliative care. Telephone interviews were conducted with twenty people living with advanced cancer who had participated in either a telephone or online support group facilitated by the Cancer Council Victoria, Melbourne, Australia. Two dominant participant narratives emerged: a focus on dying with dignity or an interest in deferring discussion of death and dying to focus on the present. Despite the different approaches, participants found the technology-based support groups to be accessible and safe environments in which to discuss difficult topics in privacy. Technology-based strategies provide opportunities for health professionals to provide social and emotional care to more people by moving beyond individualised care and facilitate peer-to-peer support at the end of life, especially to those with specific needs. Such options are feasible for palliative care services to set up and acceptable to a group of clients, especially for younger clients or those socially or geographically isolated.

The virtue of uncertainty in health care

Uncertainty is unavoidable in health care, yet frequently tacit. When uncertainty is acknowledged, it tends to be defined in terms of the unpredictable nature of the care, and limits to human knowledge. It is cast as a problem that evidence-based health care can minimize. Challenging that simplistic perspective, this paper reconstructs uncertainty as a property whose meaning derives from how people are relationally disposed to perceive it in the social context in which they are embedded. Five conditions are suggested to define a need to protect and cultivate uncertainty as a virtue or positive disposition. These conditions are that uncertainty is natural, promotes creativity and a critical attitude, can signify wisdom, nurtures safety, sustains hope and protects against excess. In contrast, certainty is a delusion. Believing in certainty is unscientific and antiscientific because it can obscure and devalue critique in scientific practice.