Does Hope Matter? Associations Among Self-Reported Hope, Anxiety, and Health-Related Quality of Life in Children and Adolescents with Cancer

A digital, coach-assisted intervention to address the psychosocial needs of young adult cancer survivors: Randomized controlled trial protocol and intervention adaptation process

BACKGROUND

Given the increasing number of young adult cancer survivors and the impacts of cancer on various life domains, interventions addressing the psychosocial needs of young adult survivors are crucial. However, such intervention research is limited, and the existing literature has often: 1) overlooked young adult survivors' psychosocial needs; 2) targeted depression, anxiety, or fear of recurrence - rather than positive outcomes like well-being; and 3) failed to consider scalable approaches, like digital health.

METHODS

This paper documents the development and refinement of an 8-week digital, coach-assisted intervention targeting hope among young adult cancer survivors (ages 18-39, within 3 years of treatment completion) and presents the protocol of the 2-arm RCT (comparing intervention vs. attention control). The intervention builds upon a 2017-2018 pilot trial (n = 56); intervention refinements were based on subsequent semi-structured interviews among young adult survivors (n = 23).

RESULTS

The pending trial design involves an increased sample size (n = 150) to increase power and diversified recruitment efforts (i.e., clinic-based, social media, community-based organizations, etc.) to facilitate intervention reach, accessibility, and scalability. The intervention was enhanced by integrating highly relevant theoretical and therapeutic frameworks, specifically the concept of hope and Acceptance and Commitment Therapy, as well as updating intervention delivery technology. Intervention outcomes include feasibility and acceptability at end-of-treatment and preliminary efficacy on hope (primary outcome) and quality of life measures (secondary outcomes) at end-of-treatment and 16-week follow-up.

CONCLUSIONS

This paper may facilitate discussion regarding approaches for addressing the significant psychosocial challenges faced by young adult survivors and catalyze dissemination of trial results.

TRIAL REGISTRATION

NCT05905250.

Young Adult Cancer Survivors' Perspectives on Cancer's Impact on Different Life Areas Post-Treatment: A Qualitative Study

Purpose: Young adult cancer survivors experience disruptions in various life domains (e.g., relationships, academic/career) during and after treatment. This study examined life disruptions and related supports to update interventions to improve psychological outcomes. Methods: In April-July 2023, young adult survivors (n = 23) were recruited (via clinics, support groups, nonprofit organizations, etc.) to complete semi-structured interviews assessing cancer's impact across life domains, how they coped with related disruptions, and facilitators to improved psychosocial well-being. We used a dual deductive-inductive approach to develop a codebook and then coded transcripts in Dedoose. Results: This sample was on average 33.7 years old (standard deviation [SD] = 4.4), 78.3% female, 73.9% non-Hispanic White, 47.8% married/cohabitating, 2.4 (SD = 1.0) years post-diagnosis, 1.4 years (SD = 0.9) post-treatment, and largely diagnosed with breast cancer (52.1%) or leukemia/lymphoma (34.7%). The most salient themes related to disruptions included mental health, feelings of isolation during survivorship, and disruptions to career and relationships with family or partners. Participants reported challenges navigating these feelings and disruptions, and difficulty understanding and conveying their needs. Many experienced limited support for navigating cancer-related trauma and life disruptions as a survivor. Participants also reported some positive impacts, like reevaluating their values and goals or feeling resilient, and emphasized the need to identify supports, accept that life had changed because of cancer, and have their needs and continued struggles validated by others during survivorship. Conclusions: Young adults experience ongoing disruptions across multiple life domains, underscoring the need for integrated, longer-term psychosocial supports to help them navigate these disruptions and reevaluate their goals.

Cultural Adaption, Translation, Preliminary Reliability and Validity of Key Psychological and Behavioural Measures for 18 to 25 Year-Olds Living with HIV in Uganda: A Multi-Stage Approach

HIV remains a significant public health issue among young adults living in Uganda. There is a need for reliable and valid measures of key psychological and behavioural constructs that are related to important outcomes for this population. We translated, adapted and tested the psychometric properties of questionnaires measuring HIV stigma, HIV disclosure cognitions and affect, antiretroviral therapy (ART) adherence, social support, personal values, and hope, using a multi-step process. This included: translation, back-translation, expert review, cognitive interviewing, readability and assessments of internal consistency with 93 young adults (18-25 years) living with perinatally acquired HIV in Uganda. Preliminary criterion validity was assessed by examining relationships between the adapted measures and wellbeing, HIV disclosure behaviour, HIV disclosure intention and viral load suppression. The measures all showed acceptable reliability and every questionnaire apart from the Agentic and Communal Value Scale was easy to read. Those scales measuring HIV disclosure affect and cognitions, social support, HIV stigma and hope showed relationships with other constructs suggestive of validity. There is preliminary evidence to support the use of these measures in research and clinical contexts for young adults living with perinatally acquired HIV in Uganda.

Symptom Adverse Events and Quality of Life of Children With Advanced Cancer: Results From a Longitudinal Study Using the Pediatric Patient-Reported Outcomes-Common Terminology Criteria for Adverse Events

Background: The presence of poorly controlled symptoms negatively impacts the quality of life (QoL) throughout cancer treatment. The purpose of this multisite study was to explore the relationship between QoL and symptom adverse events (AEs) in children with advanced cancer over 6 months. Method: A prospective and longitudinal descriptive study design was used to collect QoL and symptom AE data from children aged 2 to 18 with advanced cancer. QoL was measured using the Pediatric Quality of Life Inventory (PedsQLTM) Cancer Module 3.0 and symptom AEs were measured using the Pediatric Patient-Reported Outcome-Common Terminology Criteria for AEs (PRO-CTCAEs®). Descriptive statistics were used to describe QoL and symptom AE data. Correlational analyses and generalized linear mixed models were used to examine the relationship between symptom AEs and QoL. Results: Forty-nine children participated in the study. The mean total PedsQLTM score was 73.86 for the sample across all time points. Children diagnosed with a central nervous system (CNS) tumor reported poorer QoL compared to children diagnosed with a hematologic malignancy or non-CNS solid tumor. Symptom frequency AEs of anxiety, pain, nausea, insomnia, hot flashes, and fatigue severity demonstrated the strongest and most significant negative correlation with total QoL scores. Analyses of the relationship between QoL and symptom AEs over time revealed time-specific significant differences with children who experienced frequency AEs of nausea, and anxiety reporting poorer QoL at time point 4 (week 8). Discussion: The Ped PRO-CTCAE® and PedsQLTM can be used to evaluate the relationship between symptom AEs and QoL in practice and in future research.

Perceptions of children with cancer and their parents regarding illness: A qualitative study

PURPOSE

The current study aims to understand inter-generational differences and similarities in the perception of illness and the available resources employed by children with cancer and their parents.

METHODS

A qualitative descriptive research design was utilized, including face-to-face interviews with 108 parent-child dyads where the children had been diagnosed with cancer, by means of a semi-structured questionnaire. The participants were recruited from two pediatric hematology-oncology wards in two different hospitals in Israel. The data were analyzed using conventional qualitative content analysis. Debriefing and inter-rater reliability methods were utilized.

FINDINGS

Similarities were found between the coping of children and parents with the illness. Children with cancer and their parents can find bright sides and support for coping, such as different perspectives on life, faith, positive thoughts, and family assistance. Most of the differences between the perceptions of children and parents relate to the difficulties encountered. While parents are mainly concerned about the long-term impact, children contend with ordeals involving the here-and-now.

CONCLUSIONS

Parents and children demonstrate a dual process in their challenging journey. Positive and facilitating factors are intertwined with the aggravating aspects, which exist side by side.

PRACTICE IMPLICATIONS

Nursing staff should advise children and their parents to attain and use external and internal sources of support found in this study to help them deal with cancer.

A Clinical Case Study of Solution-Focused Brief Therapy for Young Adult Cancer Patients’ Psychological Distress: Focusing on Positive Emotions

Psychological distress is highly prevalent among adolescent and young adult (AYA) cancer patients, an age-defined population (15–39) disproportionately impacted by their cancer diagnosis. Solution-focused brief therapy (SFBT) is a strength-based and evidence-supported approach for youth with medical conditions. The use of SFBT in young cancer patients, however, has been rarely described. Building on the broaden-and-build theory of positive emotions, this study describes how SFBT clinicians intentionally foster positive emotions, especially hope, in an AYA cancer patient to foster therapeutic change. We found improvements in the patient’s psychological distress as well as growth in levels of hope both in the immediate post-intervention assessment and in the 2-week follow-up. The findings of the study suggested that SFBT is a promising approach to the unique challenges confronting AYAs with cancer. It was not feasible for this case study to match the sex and racial identities for a therapist with the client’s preference, which is considered a main limitation of this study.

A Literature Review on the Role of Hope in Promoting Positive Youth Development across Non-WEIRD Contexts

Theoretical and empirical evidence has identified hope as a key adolescent strength that is linked to positive youth developmental outcomes. Although hope must be understood from a cultural lens, most of the evidence regarding adolescent hope is derived from samples of white youth from Western, educated, industrialized, rich, and democratic (WEIRD) nations. Therefore, in order to have a more comprehensive and global understanding of the antecedents, outcomes, and processes of hope, we apply a positive youth development perspective in order to review the literature (N = 52 studies) on hope from diverse cultural and international contexts. In organizing the findings by global region, our review provides evidence of the shared function of hope in promoting positive youth developmental outcomes and the usefulness of the Child Hope Scale across contexts. Family and parental relationships were identified as key assets in promoting hope; however, there exists cultural and contextual variation in what aspects of these relationships promote hope. We conclude this review by considering the priorities for research, practice, and policy, based on these findings.

Hope and pediatric health

Snyder's Hope Theory and its application in pediatric health have been receiving increased attention recently. Within the last three years, research has primarily focused on adolescents and/or young adults, and pediatric cancer populations. Generally, higher hope scores are associated with positive outcomes in pediatric studies. There has also been increased interest in the role of hope in pediatric health interventions, with some studies indicating that hope is malleable and that changes in hope are associated with changes in health outcomes. Limitations in this research area include (1) a few longitudinal and follow-up studies assessing the stability of changes in hope, (2) the need to determine directionality regarding hope and health outcome relations, and (3) some inconsistencies in the conceptualization of hope.

The Correlation Between Quality of Life and Positive Psychological Resources in Cancer Patients: A Meta-Analysis

Purpose

This study aimed to assess the evidence of the association between positive psychological resources and quality of life in patients with cancer.

Methods

Electronic searching was performed to retrieve articles from PubMed, Web of Science, Embase, CNKI, and CBM (from inception to 7 April 2022). Summary correlation coefficient (r) values were extracted from each study, and 95% CIs were calculated by the random-effect model. Subgroup and sensitivity analyses were performed to investigate potential heterogeneity.

Results

In total, sixty-six articles were included in the present study. The pooled r for resilience was 0.71 (95%CI: 0.55, 0.87), hope 0.50 (95%CI: 0.43, 0.56), self-efficacy 0.53 (95%CI: 0.46, 0.61), self-esteem 0.46 (95%CI: 0.28, 0.63), and optimism 0.30 (95%CI: 0.19, 0.40). For subgroup analysis, no significant differences were found between minors and adults.

Conclusion

This study indicated that resilience, hope, optimism, self-esteem, and self-efficacy were positively correlated with quality of life in patients with cancers. Therefore, intervention programs should be focused on increasing state-like positive psychological resources to improve the quality of life in patients with cancer.

Prevalence of Anxiety, Depression, and Post-Traumatic Stress Disorder among Children and Adolescents with Cancer: A Systematic Review and Meta-Analysis

Assessment of psychological and emotional disorders is an important indicator of well-being among children and adolescents with cancer. This review aimed to determine the prevalence rates of three major psychological disorders in this population, including anxiety, depression, and post-traumatic stress disorder (PTSD). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Various databases were searched to identify cross-sectional studies assessing anxiety, depression, and PTSD among children and adolescents with cancer. The Joanna Briggs Institute checklist was used to assess research quality. Of the 40 studies included in the literature review, 33 measured anxiety, 28 focused on depression, and nine assessed PTSD. A total of 18 studies were incorporated into the meta-analysis, with pooled prevalence rates of anxiety, depression and PTSD found to be 13.92% (n  =  1,971; 95% confidence interval [CI]  =  10.23-18.07%), 20.43% (n  =  1,990, 95% CI  =  13.85-27.93%), and 20.90% (n  =  755, 95% CI  =  13.28-29.73%), respectively. Mental health and psychological interventions are essential for children and adolescents diagnosed with cancer. Future work should be undertaken in different regions, such as the Middle East or Africa, or South America when assessing the prevalence of psychological disorders in children and adolescents diagnosed with cancer.

Associations of Spiritual Well-Being and Hope with Health Anxiety Severity in Patients with Advanced Coronary Artery Disease

Background and Objectives: Health anxiety is one of the most common problems in patients with coronary artery disease. The present study tested whether health anxiety severity could be predicted by spiritual well-being and hope in patients with advanced coronary artery disease. Materials and Methods: In a cross-sectional study, 100 patients with advanced coronary artery disease were recruited from hospitals and healthcare centers in Iran. Patients completed self-report scales, including the Spiritual Well-Being Scale, Adult Hope Scale, and Short Health Anxiety Inventory. Hierarchical multiple regression analyses were used to empirically explore the relations among variables. Results: Results indicated that patients who reported higher levels of hope (β = 0.42, p < 0.01) and spiritual well-being (β = 0.20, p < 0.05) reported lower levels of health anxiety. Agency (β = 0.58, p < 0.01) scores were a significant negative predictor of health anxiety severity. Additionally, religious spirituality scores (β = 0.28, p < 0.01) were shown to significantly negatively predict health anxiety level. However, the pathways components of hope and existential spirituality were not significant predictors. Conclusion: The findings of the present study indicate that spiritual well-being and hope could be important factors in determining health anxiety for adults with coronary artery disease, and their role is worthy of further exploration to help improve health anxiety for patients with coronary artery disease.

"Suddenly we have hope that there is a future": two families' narratives when a child with spinal muscular atrophy receives a new drug

Purpose: This study aims to explore negotiations of hope in everyday life for families where a child with spinal muscular atrophy (SMA) has received a new drug treatment.Methods: A narrative design was used, drawing on interviews and participant observations in two families with children with SMA, types 1-2, to situate family experiences of hope in everyday life. Narrative analysis was used on the data.Results: Results are presented as stories, with details about situations and contexts, to illustrate how hope was used by families to reconstruct their own family narratives.Conclusions: Hope was negotiated and struggled with in different ways by different family members, but contributed to each person's own way of dealing with the disease and outlook for the future.

A Systematic Review of Self-Report Instruments for the Measurement of Anxiety in Hospitalized Children with Cancer

Anxiety has been identified as one of the most severe and long-lasting symptoms experienced by hospitalized children with cancer. Self-reports are especially important for documenting emotional and abstract concepts, such as anxiety. Children may not always be able to communicate their symptoms due to language difficulties, a lack of developmental language skills, or the severity of their illness. Instruments with sufficient psychometric quality and pictorial support may address this communication challenge. The purpose of this review was to systematically search the published literature and identify validated and reliable self-report instruments available for children aged 5–18 years to use in the assessment of their anxiety to ensure they receive appropriate anxiety-relief intervention in hospital. What validated self-report instruments can children with cancer use to self-report anxiety in the hospital setting? Which of these instruments offer pictorial support? Eight instruments were identified, but most of the instruments lacked pictorial support. The Visual Analogue Scale (VAS) and Pediatric Quality of Life (PedsQL™) 3.0 Brain Tumor Module and Cancer Module proved to be useful in hospitalized children with cancer, as they provide pictorial support. It is recommended that faces or symbols be used along with the VAS, as pictures are easily understood by younger children. Future studies could include the adaptation of existing instruments in digital e-health tools.

Coping behavior of children undergoing chemotherapy

Abstract The diagnosis of childhood cancer, the treatment itself and its sequelae can be considered as stressful events in the child’s life, requiring the use of coping strategies. The aim of this study was to describe the coping behaviors used by children and adolescents with cancer undergoing chemotherapy treatment, separated by sex, age and type of cancer. A total of 15 children and adolescents, from 6 to 12 years old, of both sexes, answered the Hospitalization Coping Strategies instrument regarding coping behaviors. Participants referred to behaviors with greater chances of an adaptive outcome: watching TV, talking, and taking their medicines. There were differences in the coping behaviors regarding sex, age, and types of cancer. These differences highlight the need for personalized interventions that include specific characteristics to facilitate the child’s adaptation to the treatment.

The Role of Hope to Alleviate Anxiety in COVID-19 Outbreak among Community Dwellers: An Online Cross-sectional Survey

Introduction: The worldwide emergence of COVID-19 has been associated with diverse consequences, including anxiety. Hope is believed to act as a motivation to enable one to cope with the anxiety. This study was conducted to identify the role of hope in alleviating anxiety due to the COVID-19 outbreak during the primary phase among community dwellers in Iran. Methods: This cross-sectional study recruited 3,565 subjects with the convenience sampling method. Data collection tools used included the COVID-19 knowledge checklist, Generalised Anxiety Disorder (GAD-7) questionnaires and Snyder Hope Scale. Participants were asked to fill in the questionnaires online. The data were analysed using descriptive and inferential statistics (multivariate linear regression analysis). Results: Participants’ mean scores of anxiety and hope were 6.06±4.52 and 31.27±4.52, respectively. The results indicated that 27.1% of the changes in the anxiety scores were predictable with some of the variables examined in this study. A high score of hope was directly associated with a lower level of anxiety. In addition, the number of hours spent following news and information on COVID-19 was significantly related to anxiety level. Moreover, female gender, urban residence, and having relatives suffering from COVID-19 were significantly related to a higher level of anxiety (P<0.05). Conclusion: The morbidity and mortality associated with the COVID-19 outbreak had brought a lot of anxiety among community dwellers. Hope, potentially, can contribute to overcoming anxiety. Therefore, health policymakers can introduce appropriate social interventions to enable the community to cope with stress and anxiety. Keywords: Generalised anxiety disorder, hope, mental health, pandemic

The Association between Hope and Quality of Life among Adolescents with Chronic Diseases: A Systematic Review

Purpose

Hope has been identified as a protective factor that contributes to achieving a better quality to life, especially in patients with chronic disease. The purpose of this review was to synthesize current knowledge about the relationship between hope and quality of life among adolescents living with chronic illnesses.

Methods

We searched major English-language databases (PsycINFO, PubMed, and CINAHL) for studies from January 1, 2002 to July 12, 2019. Studies were included if they provided data on hope and its relationship with quality of life among adolescents with chronic diseases.

Results

In total, five articles were selected from the 336 studies that were retrieved. All five studies reported a positive correlation between hope and quality of life, such that people with a higher level of hope had a better quality of life. Hope was found to have direct and indirect effects on quality of life in adolescents with chronic diseases.

Conclusion

Healthcare professionals should make more efforts to enhance hope in adolescents with chronic diseases in order to improve their quality of life. Future studies exploring how hope develops in adolescents with chronic diseases and the long-term impact of hope on quality of life are necessary.

Children's Hope in South Africa: A Population-Based Study

A growing body of research has provided evidence for the cognitive motivational construct of hope as a psychological strength, particularly for children in adverse social circumstances. In children, hope is defined as a set of cognitions focused on children's agency to contemplate workable goals, to identify pathways to achieve those goals and the intrinsic beliefs about their capacity to activate sustained movement toward those goals. Using data from the third wave of the Children's Worlds International Survey on Children's Well-Being, the study aimed to explore children's hope amongst a random population-based sample of children in South Africa. The study further aimed to explore children's level of hope across the nine provincial regions of South Africa. Data were collected using Snyder et al.'s (1997) Children's Hope Scale (CHS). Confirmatory factor analysis (CFA) was used to analyze the data, with multi-group CFA used to analyze the data across provincial regions. The study found an appropriate fit structure for the CHS using the overall pooled sample. The mean score on the CHS for the national sample was of 4.781 (SD = 1.082). Measurement invariance demonstrated the tenability of scalar invariance, which indicates comparability across correlations, regressions and mean scores. Mean scores ranged from 4.511 (SD = 1.163) for the Northern Cape to 4.982. (SD = 0.974) for the Western Cape. Five provinces (Eastern Cape, Northern Cape, Free State, Mpumalanga, and KwaZulu Natal) scored below the national mean, while four provinces (North West, Western Cape, Limpopo, and Gauteng) scored above.

Does Posttraumatic Growth Buffer the Association Between Death Anxiety and Quality of Life Among People living with HIV/AIDS?

People living with HIV (PLWH) may experience death anxiety (DA), which can be detrimental to quality of life. Posttraumatic growth (PTG), however, is antithetical to DA, with its positive attributes at odds with negative psychosocial outcomes. Previous research has not examined the buffering effect of PTG on the association between DA and quality of life. Therefore, in addition to the direct effects of DA and PTG on health-related quality of life (HRQoL), we investigated the moderating role of PTG on the relationship between DA and HRQoL among people living with HIV/AIDS (PLWH) in Nigeria. Using cross-sectional design and availability sampling method, we selected 201 outpatients (men, n = 63, 31.3%, women, n = 138, 68.7%, mean age = 40.1, SD = 10.5) managed for HIV/AIDS in a Nigerian tertiary healthcare institution. Death Anxiety Inventory-Revised, Posttraumatic Growth Inventory-Short Form, and Patient-Reported Outcome Quality of Life-HIV were used to access DA, PTG and HRQoL, respectively. Results showed that while adjusting for socio-demographic factors (age, gender, time since diagnosis and educational status), DA was associated with physical health, mental health and social relationships domains of HRQoL as well as overall HRQoL. In contrast, PTG did not evidence significant association with HRQoL dimensions and overall HRQoL. The moderation effect of PTG on the association between DA and HRQoL was not supported. Independent of PTG, alleviating DA may be an important target in terms of therapeutic intervention towards improving quality life of PLWH.

Can helping others strengthen teens? Character strengths as mediators between prosocial behavior and adolescents' internalizing symptoms

INTRODUCTION

Identifying protective factors against internalizing behaviors during adolescence is a public health priority, as rates of depression and anxiety are rising. As such, the purpose of this study was to examine whether prosocial engagement toward strangers and family members is protective against depressive and anxiety symptoms, and whether this link is mediated by character strengths (i.e., hope, persistence, gratitude, and self-esteem).

METHOD

The sample consisted of 500 US adolescents (52% female; 66% European American; 33% from single-parent families). Data across three consecutive yearly waves were utilized in the current study (M_age Time 1 = 13.32).

RESULTS

Results of a longitudinal structural equation model revealed prosocial behavior toward strangers and family members were differentially related to character strengths, and that prosocial behavior toward strangers was indirectly associated with depressive symptoms via self-esteem.

CONCLUSION

Taken together, findings extend the Developmental Cascades model and suggest that prosocial behavior and character strengths protect against depressive symptoms during the adolescent period. Findings are discussed in the context of relevant research and theory, and implications for future research and intervention programs are presented.

Hope Across Socioeconomic Status: Examining Measurement Invariance of the Children's Hope Scale Across Socioeconomic Status Groups

There has been a growing interest in research on hope in recent years. The Children’s Hope Scale (CHS) is the most commonly used scale to evaluate goal-related hopeful thinking in children and adolescents. Socioeconomic status (SES) strongly influences an individual’s experiences from childhood and throughout adult life. This study aimed to evaluate the measurement invariance of the CHS across SES. The sample consisted of 1934 Chinese youths (50.4% females) with a mean age of 12.96 (SD = 2.686). An overall family SES score was obtained by totaling the Z scores for family monthly income and parents’ education level. The results supported the single-factor model as the baseline model across each SES group. Multi-group confirmatory factor analysis revealed that full measurement invariance did not hold. One factor loading and one intercept were non-invariant. There were also significant differences in latent factor means and raw scores of the CHS across the two groups. The CHS had a stronger convergent validation in the higher SES group than lower SES group. The results suggest that researchers and practitioners should exercise caution when comparing differences in hope measured by the CHS between groups with different SES. We provide more robust statistical evidence in terms of SES differences, indicating that children and adolescents from higher SES backgrounds shower greater hopeful thinking compared with those from lower SES backgrounds.

Nursing student perceptions of hope in children: A qualitative descriptive study

Hope has been linked to positive health outcomes in the literature. Hope is abstract, multidimensional, future oriented, and occurs cognitively making it difficult to assess in children. Most of the research on hope has been conducted with adults and adolescents. Therefore, it is essential to analyze the concept of hope in children to provide nurses with tools to identify hope behaviors in children. The aim of this qualitative descriptive study was to describe hope behaviors in children from a nursing student perspective. Data were gathered from three focus groups (N = 19) of nursing students enrolled in a pediatric clinical rotation using a semistructured interview technique. Three themes of hope behaviors emerged from the three focus groups and were (a) future oriented, (b) goal oriented-getting up and doing things, and (c) pathways thinking processes-getting from point A to point B. Health care providers should consider hope behavioral cues, which can warrant interventions to increase hope in their young patients. Current findings demonstrate the need for the development of hope interventions that involve younger patients, thereby making their effects more sustainable across the lifespan.