Systematic review of factors associated with hope in family carers of persons living with chronic illness

The expected impact of a cure for HIV among people with HIV and key populations

BACKGROUND

This study explored the expected impact of two hypothetical HIV cure scenarios on quality of life, sexual satisfaction, and stigma among people with HIV and key populations (i.e., partners and communities of people with HIV and men who have sex with men without HIV) in the Netherlands.

METHODS

A cross-sectional survey was conducted among people with HIV and key populations from October 2021 until June 2022. We assessed quality of life, sexual satisfaction, and stigma using linear regression and mixed models to compare participants' current situation with two hypothetical HIV cure scenarios: HIV post-intervention control, where HIV is suppressed without the need for ongoing antiretroviral treatment, but the viral reservoir is expected to persist, and HIV elimination, where HIV is completely removed from the body.

RESULTS

Our findings show that people with HIV (n = 222) expect improved quality of life and sexual satisfaction, as well as reduced stigma, compared to their current situation following both post-intervention control and elimination. Key populations (n = 495) similarly expect improvements for both HIV cure scenarios, except no expected improvement was found for quality of life following post-intervention control. Participants aged 18 to 34 anticipate greater improvements from both cure scenarios than those over 34.

CONCLUSIONS

Both people with HIV and key populations without HIV expect an HIV cure to have a positive impact on quality of life, sexual satisfaction, and stigma. This impact is expected not only for HIV elimination but also for HIV post-intervention control, the development of which appears more feasible.

'I couldn't live without hope': A qualitative study using reflexive thematic analysis on approaches to hope and prognostic awareness among people with advanced disease

BACKGROUND

Hope plays a pivotal role in enhancing the quality of life and coping strategies of individuals living with advanced diseases. The nature of the relationship between hope and prognostic awareness is unclear.

AIM

To explore the experiences and meanings of hope and their association with prognostic awareness among people with advanced incurable diseases.

DESIGN

Qualitative phenomenological study using reflexive thematic analysis of semi-structured interviews.

SETTING/PARTICIPANTS

Interviews with 24 participants aged 30-99 years with advanced incurable disease were conducted in hospices and hospitals in the Czech Republic.

RESULTS

We generated four distinct approaches to hope and prognostic awareness: Technical, Spiritual, Minimalist and Pragmatic. Each approach exhibited unique cognitive, emotional and behavioural dimensions of hope and prognostic awareness. The Technical and Minimalist approaches showed fluctuating hope influenced by medical updates, while the Spiritual and Pragmatic approaches demonstrated stable hope resilient to prognostic information.

CONCLUSIONS

Recognizing these diverse hope approaches can guide tailored interventions in palliative care. Healthcare providers should adapt their communication strategies based on people's predominant hope orientations to support effective coping and enhance end-of-life care outcomes. This study sheds light on how different individuals navigate hope amidst terminal illnesses, providing insights into the nuanced psychological and emotional dynamics that influence their coping mechanisms.

Relationship between anxiety and fatigue in dementia family caregivers: hope as a mediator

BACKGROUND

This study investigated the mediating role of hope in the relationship between anxiety and fatigue in family caregivers of individuals with dementia.

METHODS

A cross-sectional design was employed, with data collected from 84 family members caring for a patient with dementia in Tzu Chi Hospital in eastern Taiwan. Instruments were the Herth Hope Index, fatigue, and anxiety scales.

RESULTS

The findings revealed a significant negative correlation between fatigue and hope (r = -.431, p <.01), a significant positive correlation between fatigue and anxiety (r =.584, p <.01), and a significant negative correlation between hope and anxiety (r = -.364, p <.01). Furthermore, the results indicated that anxiety indirectly predicted fatigue through hope. Hope was a mediating variable between anxiety and fatigue, accounting for 15.6% of the mediating effect.

CONCLUSIONS

Prioritizing the physical and mental health of family caregivers of individuals with dementia by fostering hope can help alleviate their caregiving fatigue and enhance their overall well-being.

Attributes and influencing factors of hope levels in breast cancer patients: A latent profile analysis

PURPOSE

This study aims to identify specific sub-types of hope levels in breast cancer (BC) patients and explore the influencing factors.

METHODS

Between August and December 2023, 528 BC patients took part in this study. Latent Profile Analysis (LPA) was employed using the Herth Hope Index, Distress Thermometer, Hospital Anxiety and Depression Scale, Social Support Rating Scale, BC survivors' self-efficacy scale and Functional Assessment of Cancer Therapy-Breast to identify clusters of hope levels.

RESULTS

Three potential categories of hope levels were identified: Low Hope Level-Harmonious-Calm Type (33.71%); Moderate Hope Level-Isolation Fear Type (37.12%); and High Hope Level-Optimistic Coping Type (29.17%). The study established that social support, quality of life, psychological distress, self-efficacy, occupation, income, education and type of surgery are factors influencing hope levels.

CONCLUSION

Hope levels within BC patients exhibit identifiable heterogeneity. By discerning the features associated with hope levels, the focus extends beyond patients' occupations, income, education and surgical procedures. It also underscores the importance of enhancing social support, quality of life and self-efficacy while mitigating psychological distress. This targeted approach aims to formulate interventions specifically designed to effectively elevate hope levels in BC patients.

The influential factors of depression among caregivers of children with Cleft Lip and/or Palate: a path analysis based on diathesis-stress theoretical model

BACKGROUND

Depression is the most common psychological phenomenon among caregivers of children with Cleft Lip and/or Palate and affects the quality of life, treatment satisfaction, children's self-esteem and parent-child relationship. However, Existing studies have limited explanations for the mechanisms that lead to depression in caregivers of children with Cleft Lip and/or Palate. The present study aimed to identify factors influencing depression among caregivers of children with Cleft Lip and/or Palate and to provide a reference point and new ideas for future research.

METHODS

This cross-sectional study investigated 248 caregivers at two Cleft Lip and/or Palate treatment centers in China, spanning from April 2019 to July 2020. The diathesis-stress model was used to construct the model, and data analysis was conducted using SPSS 26.0 and AMOS 25.0. Path analysis was employed to test the hypothetical model, and the fit of the model was evaluated using Chi-Square/degree of freedom, Goodness-of-Fit Index, Normed Fit Index, Relative Fit Index, Incremental Fit Index, Tacker-Lewis Index, Comparative Fit Index and Root Mean Square Error of Approximation.

RESULTS

The study found that the average level of depression among caregivers of children with Cleft Lip and/or Palate was 4.83 (4.79). Additionally, 43.5% of caregivers exhibited depressive symptoms. The fit of the modified path model was found to be satisfactory, with the following indices: Chi-Square/degree of freedom = 1.881, Goodness-of-Fit Index = 0.986, Normed Fit Index = 0.973, Relative Fit Index = 0.919, Incremental Fit Index = 0.987, Tucker-Lewis Index = 0.960, Comparative Fit Index = 0.987, and Root Mean Square Error of Approximation (RMSEA) = 0.060. The results indicated that parenting stress had the greatest direct impact on depression, followed by hope. Indirect effects on depression were observed for optimism, resilience, and coping, which were mediated through perceived social support and parenting stress.

CONCLUSIONS

This study suggests that depression in caregivers of children with Cleft Lip and/or Palate was leadingly influenced by parenting stress and hope. Strategies aimed at the key factors are expected to decrease depression.

Supportive care needs and associated factors among caregivers of elderly patients with gastrointestinal cancer: an exploratory study

BACKGROUND

Gastrointestinal cancers, including gastric and colorectal cancers, are major contributors to cancer-related morbidity and mortality worldwide, placing significant burdens on patients and their informal caregivers. This study aims to evaluate the level of supportive needs among informal caregivers of patients with gastrointestinal cancer and to identify key factors influencing these needs.

METHODS

We conducted a descriptive survey involving 335 informal caregivers of patients with gastrointestinal cancer at a large hospital in Shanghai, China, from September 2023 to April 2024. Multivariate linear regression analysis was employed to examine potential factors affecting supportive needs, including demographic information, caregiver burden, and self-efficacy.

RESULTS

The average supportive needs score among the 335 caregivers was 113.59 ± 52.97. This score was positively correlated with caregiver burden (r = 0.363, P < 0.001), self-efficacy (r = 0.224, P < 0.001), and patients' Karnofsky Performance Status (KPS) score (r = 0.119, P < 0.05). Multivariate regression analysis revealed that the care experience, duration of caregiving, relationship (sibling), self-efficacy, caregiver burden, KPS score of patients, treatment duration of patients, and cancer type of patients were significant factors influencing the supportive care needs of caregivers for elderly gastrointestinal cancer patients (P < 0.05).

CONCLUSION

Informal caregivers of elderly patients with gastrointestinal cancer often have increased levels of supportive needs. Clinical practice should include comprehensive assessments of these needs and the development of targeted interventions to improve caregiving skills and reduce caregiver burden, thereby enhancing the quality of life for both caregivers and patients.

The experience of hope in dyads living with advanced chronic illness in Portugal: a longitudinal mixed-methods study

BACKGROUND

Hope is an important resource that helps patients and families thrive during difficult times. Although several studies have highlighted the importance of hope in different contexts, its specific manifestations in the realm of advanced chronic illness need further exploration. In this study, we sought to elucidate the intricate interplay between the construct of hope and the lived experience of advanced chronic illness within patient-caregiver dyads. Our objectives were (a) to explore the dyadic experience of hope as a changing dynamic over time for patients living with advanced chronic illness and their informal caregivers and (b) to evaluate variations of hope and symptom burden across time.

METHODS

We conducted a longitudinal mixed-methods study with a convergent design between December 2020 and April 2021. Patients living with advanced chronic illness and informal caregivers participated as a dyad (n = 8). The Herth Hope Index scale was used to measure dyads' level of hope and the Edmonton Symptom Assessment System was used to measure patients' symptom burden. Descriptive statistics were undertaken. A thematic analysis as described by Braun and Clarke was conducted to analyze dyadic interview data. Dyads' experience of hope was described by using the six dimensions of hope in the Model of Hope of Dufault and Martocchio.

RESULTS

Dyadic scores of hope and patients' symptom burden were stable over time. The constructs of hope in dyads included "Living one day at the time," "Having inner force/strength," and "Maintaining good health." Changes in patterns of hope were captured for each dyad in their transition over time. Data converged for all dyads except one.

CONCLUSIONS

The findings of our study show a constant presence of hope even in the face of adversity. Healthcare professionals must find ways to promote hope in dyads of patients living with advanced chronic diseases. Nurses play a pivotal role; dyadic interviews should be promoted to create a safe space for both patients and informal caregivers in order to share experiences. More research is needed to address patients' and informal caregivers' hope in chronic illness because current hope-based interventions primarily target cancer diagnoses.

The mediating role of resilience between caregiver burden and hope among patients with inflammatory bowel disease

AIM

To investigate whether resilience mediates the connection between caregiver burden and hope among caregivers of patients with inflammatory bowel disease (IBD).

DESIGN

A cross-sectional study.

METHODS

Two hundred patients with IBD were conveniently sampled from two tertiary hospitals in Jiangsu Province, China. The main instruments involved the Zarit Burden Interview, the 10-item Connor-Davidson resilience scale, and the Herth Hope Index. We conducted descriptive analysis and Pearson correlations using SPSS 25.0. The PROCESS v3.3 macro analysed the mediating effect. We report the results in line with the STROBE checklist.

RESULTS

Caregiver burden was significantly negatively connected with hope and resilience, whereas resilience positively correlated with hope. The mediation role of resilience was significant in the relationship between caregiver burden and hope, with mediating effects accounting for 47.86% of the overall effect.

CONCLUSIONS

Resilience partially mediates the association between caregiver burden and hope among patients with IBD. This finding highlights the protective role of resilience in undermining caregiver burden and strengthening hope.

IMPLICATIONS FOR PRACTICE

In clinical practice, healthcare providers should perform routine psychological assessments for caregivers of patients with IBD. Furthermore, resilience training should be incorporated into interventions to alleviate caregiver burden and enhance hope.

PATIENT OR PUBLIC CONTRIBUTION

None.

Balancing on life's ladder: A meta-ethnography of the existential experiences of siblings of children with complex care needs

AIM

To synthesize and interpret existing qualitative research on the existential experiences of siblings of children with complex care needs.

DESIGN

Noblit and Hare's interpretive meta-ethnography.

METHODS

The study has been registered in the international prospective register for systematic reviews (PROSPERO). Noblit and Hare's 7-step procedure was followed and reciprocal translation was performed to analyse the data and develop a line of argument synthesis.

DATA SOURCES

A comprehensive systematic literature search of five databases, along with extensive manual searches, was completed in November 2022. The final sample comprised 18 studies published between 2010 and 2022.

RESULTS

A line of argument, expressed through an overarching metaphor, "balancing on life's ladder", illustrates the core findings of siblings' fluctuating experiences of existential well-being, and encapsulates four third-order themes: the emotional turmoil of siblings, interrupted family life, siblings strive to be themselves and siblings struggle to cope.

CONCLUSION

Growing up with a sibling with complex care needs made children feel invisible, lonely and struggling to find the courage to cope. By adopting a lifeworld approach, nurses can become aware of healthy siblings' unmet needs. Future research is needed on how nurses can contribute to siblings' existential well-being, in primary - and secondary health care settings.

IMPLICATIONS

The study provides insight into siblings' existential experiences and factors improving their well-being, enabling nurses to provide a more optimized lifeworld-led clinical practice.

IMPACT

Healthcare, nursing education and practice should be informed by the knowledge of existential issues. Nurses are well-positioned to work alongside families to provide family-centered care. Our findings have implications for health policies tailored to the needs of children with chronically ill siblings.

REPORTING METHOD

This review adheres to the Equator and improving reporting of meta-ethnography (eMERGe) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution, because the data comprised previously published studies.

Hope and psychological resilience in primary caregivers of patients with a chronic mental illness followed in a community mental health center

PURPOSE

The aim of this study is to examine hope and psychological resilience in primary caregivers of patients with a chronic mental illness.

DESIGN AND METHODS

The descriptive study was conducted on 297 caregivers in community mental health centers in Turkey. Data were collected using the Introductory Information Form, Dispositional Hope Scale and the Resilience Scale for Adults.

FINDINGS

Hope and psychological resilience of primary caregivers of patients with a chronic mental illness were moderate. To sociodemographic and caregiver characteristics; caregivers who are over 40 years old, lost his/her spouse, low education level, housewife or retired, unemployed, who evaluated their incomes low, mother, living in the same house with the patient, caring for ten years or more, caring for another patient and not getting help in care had lower hope and resilience levels. Compared to patients with a diagnosis of bipolar disorder, caregivers of patients with schizophrenia had lower hope and psychological resilience levels.

CONCLUSIONS

Primary caregivers of patients with a chronic mental illness should be supported in terms of hope and psychological resilience.

Family members' perspectives of hope when supporting a relative experiencing mental health problems

Current research views hope as a process that plays a positive role in the recovery of individuals with mental health problems. However, little attention has been given to the role of hope in the lives of their families. We aimed to address that gap. We deployed a qualitative descriptive design and carried out individual interviews with nine family members who supported a relative with mental health problems. A cross-comparison of the data generated three major themes: understandings of hope; factors that diminish hope and factors that nurture hope. The participants viewed hope as a positive and productive feeling or attitude that was life-affirming, and empowering. They also associated it with behaviours and dispositions such as attentiveness and empathy and the possibility of a return to a more stable and 'normal' life. The participants experienced hope as initially eroded when their relative was first diagnosed and institutionalized. Hope was further diminished due to the poor communication practices of some mental health professionals and the stress of the caring role itself. On the other hand, hope was nurtured through the support of other family members, friends, neighbours and peers. Acquiring knowledge and understanding about the relative's state of mental health nurtured hope and enabled the participants to have a more meaningful role in their recovery process. Practices of self-care such as independent activities and counselling also strengthened hope and some mental health professionals played a positive role in supporting these. Most striking about the reports of many of the participants was their assertion of their abiding love for their relative. Their account of their ability to see beyond the illness of their relative was an insight that we did not find in other accounts of the experiences of family members. We highlight the need for family members to have timely access to relevant information about their relatives' illness. We conclude that hope is relational at its core because of the interplay of intrapersonal, interpersonal and social factors that diminish or nurture it over time. Specifically, we propose that friends, neighbours and peer support groups as key actors in nurturing the hope of both family members and their relatives.

Hope in the era of precision oncology: a qualitative study of informal caregivers' experiences

OBJECTIVES

To explore informal caregivers' perspectives on precision medicine in cancer care.

DESIGN

Semi-structured interviews with the informal caregivers of people living with cancer and receiving targeted/immunotherapies. Interview transcripts were analysed thematically using a framework approach.

SETTING

Recruitment was facilitated by two hospitals and five Australian cancer community groups.

PARTICIPANTS

Informal caregivers (n=28; 16 men, 12 women; aged 18-80) of people living with cancer and receiving targeted/immunotherapies.

RESULTS

Thematic analysis identified three findings, centred largely on the pervasive theme of hope in relation to precision therapies including: (1) precision as a key component of caregivers' hope; (2) hope as a collective practice between patients, caregivers, clinicians and others, which entailed work and obligation for caregivers; and (3) hope as linked to expectations of further scientific progress, even if there may be no personal, immediate benefit.

CONCLUSIONS

Innovation and change in precision oncology are rapidly reconfiguring the parameters of hope for patients and caregivers, creating new and difficult relational moments and experiences in everyday life and in clinical encounters. In the context of a shifting therapeutic landscape, caregivers' experiences illustrate the need to understand hope as collectively produced, as emotional and moral labour, and as entangled in broader cultural expectations of medical advances. Such understandings may help clinicians as they guide patients and caregivers through the complexities of diagnosis, treatment, emerging evidence and possible futures in the precision era. Developing a better understanding of informal caregivers' experiences of caring for patients receiving precision therapies is important for improving support to patients and their caregivers.

Mediating effect of anxiety and depression between family function and hope in patients receiving maintenance hemodialysis: a cross-sectional study

OBJECTIVES

This study aimed to explore the levels of hope in patients receiving maintenance hemodialysis (MHD), and whether anxiety and depression mediate the relationship between family function and hope.

METHODS

The family APGAR index, hospital anxiety and depression scale, and Herth hope index were recorded using the self-reported questionnaires completed by 227 MHD patients.

RESULTS

The family function can directly predict hope, positively predict hope through depression (β = 0.052, p = 0.001), and positively predict hope through the chain mediating of anxiety and depression (β = 0.087, p = 0.001), according to chain mediation analysis. The total effect size was 28.31%. The total indirect effect value was 0.139, and the total effect value was 0.491.

CONCLUSIONS

Our findings suggest that family function had a direct impact on MHD patients' hope, and that lowering anxiety and depression can help to feel more hopeful.

Life satisfaction and difficulties experienced by the family members of individuals with thalassemia

AIM

This study aimed to examine the life satisfaction and difficulties experienced by the family members of individuals with thalassemia.

DESIGN

This study design is mix-method research. This research adheres to the COREQ guidelines and checklist.

METHODS

The research was conducted in the Blood Diseases Polyclinic of a state hospital in a Mediterranean city in Turkey between February 2022 and April 2022.

RESULTS

The mean life satisfaction scale score was 11.18 ± 5.13, and a negative correlation was found between the mother's age and life satisfaction score (r = -0.438; p = 0.042, p < 0.05). Qualitative analysis of the experiences of the family members of individuals with thalassemia yielded 10 themes.

Impact of COVID-19 Pandemic on Caregivers of People with an Intellectual Disability, in Comparison to Carers of Those with Other Disabilities and with Mental Health Issues: A Multicountry Study

Carers supporting people with an intellectual disability often rely on others to manage the burden of care. This research aims to compare the differences between carer groups and understand the predictors of loneliness changes and burden for carers of people with an intellectual disability. Data from the international CLIC study were analysed. In total, 3930 carers responded from four groups; people who care for those with mental health difficulties (n = 491), dementia (n = 1888), physical disabilities (n = 1147), and Intellectual disabilities (n = 404). Cross tabulation and the chi-squared test were used to compare group compositions and binary logistic regression to model predictors within the intellectual disability group. A total of 65% of those caring for people with an intellectual disability experienced increased burden, and 35% of carers of people with an intellectual disability and another condition experienced more severe loneliness. Becoming severely lonely was predicted by feeling burdened by caring (AOR, 15.89) and worsening mental health (AOR, 2.13) Feeling burden was predicted by being aged between 35 and 44 (AOR, 4.24), poor mental health (AOR, 3.51), and feelings of severe loneliness prior to the pandemic (AOR, 2.45). These findings demonstrate that those who were already struggling with caring experienced the greatest difficulties during the COVID-19 lockdowns.

The experienced positive and negative influence of HIV on quality of life of people with HIV and vulnerable to HIV in the Netherlands

This qualitative study aimed to explore the experienced influence of HIV on the quality of life (QoL) of people with HIV (PHIV) and key populations without but are vulnerable to HIV in the Netherlands. We conducted and thematically analyzed interviews with 29 PHIV and 13 participants from key populations without HIV (i.e., men who have sex with men). PHIV and key populations shared positive meaningful experiences regarding HIV, i.e., feeling grateful for ART, life, and the availability of PrEP, being loved and supported in the light of HIV, and providing support to the community. Negative predominant experiences regarding HIV were described by both PHIV and key populations as the negative effects of ART, challenges with regards to disclosing HIV, social stigmatization, and self-stigma. It remains important to support HIV community organizations in their efforts to reduce social stigmatization and to continue improving biomedical interventions for HIV.

The meaning and experience of hope by people living with dementia as expressed through poetry

Background

Narratives of dementia can undermine the ability of people to live well. Positive psychology, concerned with the cultivation of personal strengths, is a model through which people’s capacity to have positive experiences can be researched. This study explored the meanings and experiences of hope, a positive psychological construct found to facilitate well-being, in people with dementia.

Methods

People with dementia submitted poems about the meanings and their experiences of hope through an online platform. The submitted poems ( n = 29) underwent thematic analysis.

Findings

There were three main themes: (1) “ hope is light in the darkness” encapsulated the meaning ascribed to hope as a resource that spotlights what is still possible, (2) “ poetry gives voice to experiences of hope” captured the role of poetry in communicating the otherwise elusive concept of hope, and (3 )“peers uphold hope and cast away the darkness” captured that participants’ hope was blocked by stigmatising views held and expressed by others but facilitated through positive social interactions.

Conclusions

People are capable of having hope in the context of dementia, with hope being a uniquely functional strength that supports wellbeing. Health professionals, family and society have a clear role in supporting people with dementia to maintain their hope.

The perceived impact of an HIV cure by people living with HIV and key populations vulnerable to HIV in the Netherlands: A qualitative study

Introduction

When an HIV cure becomes available, it will have consequences for people living with HIV (PLHIV) and key populations who are vulnerable to HIV. This qualitative study aimed to explore the perceived impact of two HIV cure scenarios (post-treatment control when HIV is suppressed without the need for ongoing antiretroviral treatment (ART) and complete HIV elimination) on the quality of life of PLHIV and key populations living without HIV in the Netherlands.

Methods

Participants were purposefully sampled from the Amsterdam Cohort Studies, the AGEhIV Cohort Study, the outpatient clinic of the University Medical Centre Utrecht and the Dutch HIV Association to increase variability. Semi-structured in-depth interviews were conducted between October 2020 and March 2021 and thematically analysed.

Results

Of the 42 interviewed participants, 29 were PLHIV and 13 represented key populations (i.e., men who have sex with men and people injecting drugs). Both PLHIV and participants from vulnerable key populations hoped that a cure would result in normalization of their lives by removing the need to disclose HIV, reducing stigma and guilt, increasing independence of ART, and liberating sexual behaviour. Both groups believed only HIV elimination could accomplish this desired impact.

Conclusions

While the post-treatment control scenario seems a more plausible outcome of current HIV cure research, our findings highlight that participants may not perceive it as a true cure. Involvement of PLHIV and vulnerable key populations in devising acceptable and feasible experimental approaches to HIV cure is essential to ensure their future successful implementation.

“Keeping the Light On”: A Qualitative Study on Hope Perceptions at the End of Life in Portuguese Family Dyads

Hope performs an important role in how patients and their families cope with suffering and stressful events. To better inform practice and theory on hope, palliative care research should include both patients and their family carers, given their strong interdependence. The aim of this study was to explore how hope is experienced in dyads formed by end-of-life patients and their family carers. In this qualitative study, data were collected by in-depth interviews with seven Portuguese family dyads. Analysis followed a thematic analysis approach. The analysis of the interviews shed light on the importance of hope for all participants, and the challenges involved. Family dyads noted several barriers and facilitators to perceptions of hope. Barriers to hope included limitations imposed by illness, feelings of anguish and helplessness, and poor communication with clinicians. Hope facilitators included supportive others, positive thinking and sense of humour, connection with nature, faith in religion and science, and a sense of compassion with others and altruism. Given the multidimensional scope of hope, the main challenge for family dyads is to look beyond the disease itself. Thus, palliative care teams should be encouraged to support and foster realistic hope, helping families prepare for death, in the context of advanced cancer.