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Borges PJ, Hernández-Marrero P, Martins Pereira S. A bioethical perspective on the meanings behind a wish to hasten death: a meta-ethnographic review. BMC Med Ethics 2024; 25:23. [PMID: 38413954 PMCID: PMC10898028 DOI: 10.1186/s12910-024-01018-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/14/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The expressions of a "wish to hasten death" or "wish to die" raise ethical concerns and challenges. These expressions are related to ethical principles intertwined within the field of medical ethics, particularly in end-of-life care. Although some reviews were conducted about this topic, none of them provides an in-depth analysis of the meanings behind the "wish to hasten death/die" based specifically on the ethical principles of autonomy, dignity, and vulnerability. The aim of this review is to understand if and how the meanings behind the "wish to hasten death/die" relate to and are interpreted in light of ethical principles in palliative care. METHODS We conducted a meta-ethnographic review according to the PRISMA guidelines and aligned with Noblit and Hare's framework. Searches were performed in three databases, Web of Science, PubMed, CINAHL, with no time restrictions. Original qualitative studies exploring the meanings given by patients, family caregivers and healthcare professionals in any context of palliative and end-of-life care were included. A narrative synthesis was undertaken. PROSPERO registration CRD42023360330. RESULTS Out of 893 retrieved articles, 26 were included in the analysis, accounting for the meanings of a total of 2,398 participants. Several factors and meanings associated with the "wish to hasten death" and/or "wish to die" were identified and are mainly of a psychosocial and spiritual nature. The ethical principles of autonomy and dignity were the ones mostly associated with the "wish to hasten death". Ethical principles were essentially inferred from the content of included articles, although not explicitly stated as bioethical principles. CONCLUSIONS This meta-ethnographic review shows a reduced number of qualitative studies on the "wish to hasten death" and/or "wish to die" explicitly stating ethical principles. This suggests a lack of bioethical reflection and reasoning in the empirical end-of-life literature and a lack of embedded ethics in clinical practice. There is a need for healthcare professionals to address these topics compassionately and ethically, taking into account the unique perspectives of patients and family members. More qualitative studies on the meanings behind a wish to hasten death, their ethical contours, ethical reasoning, and implications for clinical practice are needed.
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Affiliation(s)
- Paulo J Borges
- Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel, Portugal.
- Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal.
| | - Pablo Hernández-Marrero
- CEGE: Research Center in Management and Economics - Ethics and Sustainability Research Area, Católica Porto Business School, Universidade Católica Portuguesa, Porto, Portugal
- Portuguese Nurses Association for Long-Term and Palliative Care (AECCP), Lisbon, Portugal
| | - Sandra Martins Pereira
- CEGE: Research Center in Management and Economics - Ethics and Sustainability Research Area, Católica Porto Business School, Universidade Católica Portuguesa, Porto, Portugal
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Ring L, Avidor S, Palgi Y. Reclaiming hope: Subjective nearness to death as a moderator between posttraumatic stress symptoms and hope among older adults. Stress Health 2024; 40:e3283. [PMID: 37329232 DOI: 10.1002/smi.3283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 06/18/2023]
Abstract
Perceiving one's remaining time until death, can serve as a source of resilience when faced with adversity in the second half of life. The current work is based on a prospective study and examines whether subjective nearness-to-death (SNtD) moderates the association between posttraumatic-stress symptoms (PTSS) and hope among adults in the second half of life. The first wave was conducted after the end of a military conflict in the south of Israel, and included 170 participants (M = 66.61, SD = 9.16; age range 51-91), 115 of whom also participated in Wave 2. Participants filled out self-reported questionnaires regarding background information, PTSS, SNtD and hope. A moderation effect was found, revealing that high levels of PTSS predicted lower levels of hope among those who felt close to their death, but not among those who felt far from their death. We suggest that one's evaluation of little time remaining to live, especially in old age, may be a significant factor exacerbating the negative consequences of PTSS on hope. The importance of the results to the research field is discussed.
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Affiliation(s)
- Lia Ring
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Sharon Avidor
- Faculty of Social and Community Sciences, The Lior Tzfati Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Yuval Palgi
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Velić S, Qama E, Diviani N, Rubinelli S. Patients' perception of hope in palliative care: A systematic review and narrative synthesis. PATIENT EDUCATION AND COUNSELING 2023; 115:107879. [PMID: 37413808 DOI: 10.1016/j.pec.2023.107879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The aim of this study was to systematically review and synthesize the literature on patients' perceptions of hope in palliative care. METHODS PubMed, Scopus, SocINDEX, Cochrane, and Web of Science were screened against the eligibility criteria. After familiarization with the data and conduction of the coding process, studies were thematically analyzed using Braun and Clarke's methodology. The research question guiding our analysis was: what is said about hope from patients in PC? RESULTS The database searches yielded 24 eligible studies. Three main themes emerged from the studies: Hope beliefs (encompassing patients' understanding of hope and characteristics assigned to it), Hope functions (including the role that hope plays for patients) and Hope work (highlighting aspects that in patients' perspective cultivate hope). CONCLUSION This review emphasizes the importance of acknowledging patients' understanding of hope, its role, and the efforts required to sustain it. In particular, it suggests that hope serves as a valuable strategy, fostering meaningful personal relationships towards end of life. PRACTICE IMPLICATIONS In order to address communication challenges in clinical practice, a potential fruitful strategy for nurturing hope could involve engaging family and friends in hope interventions facilitated by healthcare professionals.
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Affiliation(s)
- Sanda Velić
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland
| | - Enxhi Qama
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland
| | - Nicola Diviani
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland
| | - Sara Rubinelli
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
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Querido A, Laranjeira C. Hope-Based Program for Portuguese Outpatients with Advanced Chronic Illness in a Community Setting: A Randomized Control Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1566. [PMID: 36674322 PMCID: PMC9861685 DOI: 10.3390/ijerph20021566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Background: Hope is widely considered a subjective phenomenon able to bring beneficial consequences to human health and existence. Maintaining hope amid a life-threatening disease and during palliative care is critical. The study aims to examine the effectiveness of a psychosocial supportive Hope Promotion Program (HPP) in enhancing hope, comfort, and quality of life in Portuguese adult outpatients with advanced and progressive chronic illness. Method: Using a parallel Randomized Control Trial (RCT) with pre-post design, 56 cancer outpatients from two day hospitals. Participants were randomly assigned to either a control group (n = 28) or an intervention group (n = 28). The primary outcome measure was hope. Secondary measures included comfort and quality of life. Participants were assessed at baseline, day 15, and day 30 of follow-up. Results: Baseline characteristics were similar between the two groups. In the intervention group, there was a significant increase in the total hope scores after the HPP (day 15). Significant differences were still present after one month (p < 0.05). There was also a significant increase in comfort and quality of life scores in the intervention group one month after HPP (p = 0.018). Conclusions: The HPP may be an effective intervention to increase hope and improve comfort and quality of life among palliative patients. Future studies should increase sample size, diversify settings, and include longer and more detailed follow-ups.
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Affiliation(s)
- Ana Querido
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Campus 5, Rua de Santo André-66-68, 2410-541 Leiria, Portugal
- Center for Health Technology and Services Research (CINTESIS), NursID, University of Porto, 4200-450 Porto, Portugal
| | - Carlos Laranjeira
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Campus 5, Rua de Santo André-66-68, 2410-541 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
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Kodba‐Čeh H, Lunder U, Bulli F, Caswell G, van Delden JJM, Kars MC, Korfage IJ, Miccinesi G, Rietjens JAC, Seymour J, Toccafondi A, Zwakman M, Pollock K. How can advance care planning support hope in patients with advanced cancer and their families: A qualitative study as part of the international ACTION trial. Eur J Cancer Care (Engl) 2022; 31:e13719. [PMID: 36168108 PMCID: PMC9787960 DOI: 10.1111/ecc.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Clinicians' fears of taking away patients' hope is one of the barriers to advance care planning (ACP). Research on how ACP supports hope is scarce. We have taken up the challenge to specify ways in which ACP conversations may potentially support hope. METHODS In an international qualitative study, we explored ACP experiences of patients with advanced cancer and their personal representatives (PRs) within the cluster-randomised control ACTION trial. Using deductive analysis of data obtained in interviews following the ACP conversations, this substudy reports on a theme of hope. A latent thematic analysis was performed on segments of text relevant to answer the research question. RESULTS Twenty patients with advanced cancer and 17 PRs from Italy, the Netherlands, Slovenia, and the United Kingdom were participating in post-ACP interviews. Three themes reflecting elements that provide grounds for hope were constructed. ACP potentially supports hope by being (I) a meaningful activity that embraces uncertainties and difficulties; (II) an action towards an aware and empowered position; (III) an act of mutual care anchored in commitments. CONCLUSION Our findings on various potentially hope supporting elements of ACP conversations provide a constructive way of thinking about hope in relation to ACP that could inform practice.
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Affiliation(s)
- Hana Kodba‐Čeh
- University Clinic of Respiratory and Allergic Diseases GolnikGolnikSlovenia
- Faculty of Arts, Department of PsychologyUniversity of LjubljanaLjubljanaSlovenia
| | - Urška Lunder
- University Clinic of Respiratory and Allergic Diseases GolnikGolnikSlovenia
| | - Francesco Bulli
- Clinical Epidemiology UnitOncological network research and prevention Institute‐ISPROSienaItaly
| | - Glenys Caswell
- School of Health SciencesUniversity of NottinghamNottinghamUK
| | - Johannes J. M. van Delden
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marijke C. Kars
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Ida J. Korfage
- Department of Public HealthErasmus MC, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Guido Miccinesi
- Clinical Epidemiology UnitOncological network research and prevention Institute‐ISPROSienaItaly
| | - Judith A. C. Rietjens
- Department of Public HealthErasmus MC, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Jane Seymour
- Division of Nursing and Midwifery, Health Sciences SchoolUniversity of SheffieldSheffieldUK
| | - Alessandro Toccafondi
- Clinical Epidemiology UnitOncological network research and prevention Institute‐ISPROSienaItaly
| | - Marieke Zwakman
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
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Zhang X, Ju B, Tu J, Wang B, Liu X, Wang Z, Cheng Y, Zhang C, He Y. The possibility of impossibility: The hope for a cure among terminally ill cancer patients in China. Eur J Cancer Care (Engl) 2022; 31:e13724. [PMID: 36193852 DOI: 10.1111/ecc.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 08/31/2022] [Accepted: 09/14/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Although the medical potential of the hope for a cure has been fiercely debated within academia, few researchers have approached this topic from the perspective of terminally ill cancer patients themselves. As such, this article aims to help bridge the gap by exploring how terminally ill cancer patients in China construct the hope for a cure. METHODS Seventeen terminally ill cancer patients were recruited from the department of oncology at a tertiary hospital, where data were collected through individual interviews and participatory observation from April to December 2020 and analysed via thematic analysis. RESULTS The respondents experienced a dynamic swing between construction and denial of the hope for a cure. Furthermore, the patients negotiated between three forms of hope, including the hope for a cure, the hope for prolonged life expectancy and the hope of living in the moment. Meanwhile, family-oriented hope was centred on intergenerational relationships, which further shaped the construction of the hope for a cure. CONCLUSION Medical staff needs to be sensitive to terminally ill cancer patients' dynamic swing, negotiation and motivation during the process of constructing the hope for a cure.
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Affiliation(s)
- Xin Zhang
- Digestive Diseases Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Bei Ju
- Macau University of Science and Technology, Macau, China
| | - Jiong Tu
- Department of Sociology, School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, China
| | - Bo Wang
- Department of Oncology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xuan Liu
- Department of Oncology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zhechen Wang
- Department of Psychology, School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Yu Cheng
- Department of Medical Humanities, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.,Department of Anthropology, School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, China
| | - Changhua Zhang
- Digestive Diseases Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yulong He
- Digestive Diseases Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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Miller C, Jerosch-Herold C, Cross J. Brachial plexus injury: living with uncertainty. Disabil Rehabil 2022:1-7. [PMID: 35722825 DOI: 10.1080/09638288.2022.2080287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE A traumatic brachial plexus injury (BPI) has life-changing consequences for patients and their families. Despite advancements in treatments final outcome is unpredictable depending on factors including time to treatment, injury severity, neural regeneration, and available interventions. The final outcome may not be seen for up to four years. This study aimed to explore the impact of uncertainty on people with a traumatic BPI. METHODS Secondary qualitative analysis was conducted on data from a study exploring outcomes important to patients with a traumatic BPI. Data from semi-structured interviews with adult traumatic BPI patients (n = 13) were analyzed using reflexive thematic analysis. RESULTS Three major themes were identified in the qualitative data: (i) "I don't know what happened to me," focused on uncertainty in diagnosis. (ii) "I went to work one day… and then it all changed" centered around uncertainty in the future. (iii) Coping with uncertainty. CONCLUSION The results illustrate that people with a traumatic BPI face uncertainty regarding diagnosis, prognosis, and surrounding their roles in the future. Individuals respond to uncertainty in different ways and this needs to be understood by health care professionals. IMPLICATIONS FOR REHABILITATIONHealth professionals should consider uncertainty in all their contacts with people who have experienced a traumatic brachial plexus injury.People with a traumatic brachial plexus injury experience uncertainty in different ways therefore education and information given may be optimized if tailored to the individual rather than generic.Increasing awareness of the injury and its presentation in non-specialist acute care clinicians may accelerate diagnosis and reduce initial uncertainty.Acknowledging the presence of uncertainty is important during the shared decision-making in brachial plexus injuries.
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Affiliation(s)
- Caroline Miller
- School of Health Sciences, University of East Anglia, Norwich, UK.,Therapy Services, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK
| | | | - Jane Cross
- School of Health Sciences, University of East Anglia, Norwich, UK
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Han PKJ, Scharnetzki E, Anderson E, DiPalazzo J, Strout TD, Gutheil C, Lucas FL, Edelman E, Rueter J. Epistemic Beliefs: Relationship to Future Expectancies and Quality of Life in Cancer Patients. J Pain Symptom Manage 2022; 63:512-521. [PMID: 34952170 PMCID: PMC8930513 DOI: 10.1016/j.jpainsymman.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT Expectations about the future (future expectancies) are important determinants of psychological well-being among cancer patients, but the strategies patients use to maintain positive and cope with negative expectancies are incompletely understood. OBJECTIVES To obtain preliminary evidence on the potential role of one strategy for managing future expectancies: the adoption of "epistemic beliefs" in fundamental limits to medical knowledge. METHODS A sample of 1307 primarily advanced-stage cancer patients participating in a genomic tumor testing study in community oncology practices completed measures of epistemic beliefs, positive future expectancies, and mental and physical health-related quality of life (HRQOL). Descriptive and linear regression analyses were conducted to assess the relationships between these factors and test two hypotheses: 1) epistemic beliefs affirming fundamental limits to medical knowledge ("fallibilistic epistemic beliefs") are associated with positive future expectancies and mental HRQOL, and 2) positive future expectancies mediate this association. RESULTS Participants reported relatively high beliefs in limits to medical knowledge (M = 2.94, s.d.=.67) and positive future expectancies (M = 3.01, s.d.=.62) (range 0-4), and relatively low mental and physical HRQOL. Consistent with hypotheses, fallibilistic epistemic beliefs were associated with positive future expectancies (b = 0.11, SE=.03, P< 0.001) and greater mental HRQOL (b = 0.99, SE=.34, P = 0.004); positive expectancies also mediated the association between epistemic beliefs and mental HRQOL (Sobel Z=4.27, P<0.001). CONCLUSIONS Epistemic beliefs in limits to medical knowledge are associated with positive future expectancies and greater mental HRQOL; positive expectancies mediate the association between epistemic beliefs and HRQOL. More research is needed to confirm these relationships and elucidate their causal mechanisms.
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Affiliation(s)
- Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine; Tufts University School of Medicine (P.K.J.H., E.A., T.D.S., F.L.L.), Boston, Massachusetts.
| | - Elizabeth Scharnetzki
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine
| | - Eric Anderson
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine; Tufts University School of Medicine (P.K.J.H., E.A., T.D.S., F.L.L.), Boston, Massachusetts
| | - John DiPalazzo
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine
| | - Tania D Strout
- Tufts University School of Medicine (P.K.J.H., E.A., T.D.S., F.L.L.), Boston, Massachusetts; Department of Emergency Medicine, Maine Medical Center (T.D.S.), Portland, Maine
| | - Caitlin Gutheil
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine
| | - F Lee Lucas
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine; Tufts University School of Medicine (P.K.J.H., E.A., T.D.S., F.L.L.), Boston, Massachusetts
| | - Emily Edelman
- The Jackson Laboratory (E.E., J.R.), Bar Harbor, Maine
| | - Jens Rueter
- The Jackson Laboratory (E.E., J.R.), Bar Harbor, Maine
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Lindhardt CL, Winther SB, Pfeiffer P, Ryg J. Information provision to older patients receiving palliative chemotherapy: a quality study. BMJ Support Palliat Care 2021:bmjspcare-2021-003074. [PMID: 34969697 DOI: 10.1136/bmjspcare-2021-003074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cancer treatment has become increasingly successful. However, prolonging and preserving life has become an important goal of therapy since many patients generally receive palliative chemotherapy. The perception of life changes when patients are informed, that no curative treatment is possible. This raises new dilemmas for patients with incurable cancer, but only sparse information is available about the thoughts of these patients.The aim of this study was to explore how older patients experience the information on absence of curative treatment options. METHODS Qualitative interviews were performed in eleven older patients with incurable upper gastrointestinal cancer receiving first-line palliative chemotherapy. Median age was 74 (65-76) years. We used a qualitative approach to collect data through semistructured individual interviews conducted at the hospital or by telephone interviews by an experienced researcher. The thematic analysis was conveyed by Braun and Clarke. RESULTS The interview findings were grouped around three main themes: hope of being cured, hearing but not comprehending, and desired milestones to reach. Further, it was determined that patients hid their feelings and avoided talking about the disease with the health professionals due to fear of being told the truth. CONCLUSIONS Receiving information about their incurable cancer was an ongoing dilemma for the patients. Following the message, patients shared thoughts about reaching important milestones in life, spending time with their family or hope for a cure to be found.
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Affiliation(s)
- Christina Louise Lindhardt
- Research Department of Patient Communication, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Stine Brændegaard Winther
- Department of Oncology, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Per Pfeiffer
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
- Department of Oncology, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
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Szabat M, Knox JBL. Shades of hope: Marcel's notion of hope in end-of-life care. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:529-542. [PMID: 34173124 PMCID: PMC8557168 DOI: 10.1007/s11019-021-10036-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
This article examines the compatibility and relevance of Gabriel Marcel's phenomenology of hope in interdisciplinary research on the role of hope in end-of-life (EOL) care. Our analysis is divided into three thematic topics which examine the various shades of hope observed in Marcel's phenomenology of hope and in the collection of 20 EOL studies on hope as experienced by adult palliative care (PC) patients, health care professionals (HCP) and parents of terminally ill children. The three topics defining the shades of hope are: the meaning of hope in its dynamic aspects, the dialectics of hope and despair, and the transcendent facets of hope. We analyse how Marcel's understanding of hope is reflected in EOL studies, and how this perception can enrich the philosophy of PC and significantly deepen and broaden HCPs' understanding of hope. Our findings prove that despite terminological differences between Marcelian phenomenology and the concepts of hope in the 20 EOL studies, hope emerges as a resourceful movement towards being. Implementing Marcelian hope within communication in EOL care could help in HCPs' interpersonal approach to patients as his concept harbors a holistic perception of the existential situation of a person. Equally, introducing Marcel's phenomenology of hope into the clinical encounter could play a beneficial role in improving the ability of patients to adapt to the difficult conditions of their disease and PC treatment.
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Affiliation(s)
- Marta Szabat
- Department of Philosophy and Bioethics, Faculty of Health Sciences, Medical College, Jagiellonian University, Michalowskiego 12, 31-126 Krakow, Poland
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Demonstrating the importance of cultural considerations at end of life utilizing the perspective of Indian patients with cancer. Support Care Cancer 2021; 30:2515-2525. [PMID: 34791519 DOI: 10.1007/s00520-021-06656-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to understand Indian cancer patients' hopes and beliefs about the end of life, particularly focusing on how this informed their preferences regarding end-of-life treatment. In India, individuals' lives are mainly guided by culturally driven practices of doing right by one's family and believing death is predetermined. METHODS Indian patients (25) diagnosed with advanced incurable cancer and aware of their prognosis participated in semi-structured interviews exploring their hopes as they approached the end of life. The interview also sought to understand patients' views and beliefs about do-not-resuscitate (DNR) orders and euthanasia. The interviews were transcribed and analysed using interpretative phenomenological analysis. RESULTS Two major themes were identified: (i) a desire for living or dying comprising sub-themes of perceptions of current responsibilities, and having a fighting spirit versus feelings of despair, and (ii) God was the ultimate decision-maker of life and death. Furthermore, patients understood that a do-not-resuscitate order meant euthanasia and responded accordingly. Some patients reported hoping for death due to the pain and resultant suffering. However, patients did not talk about euthanasia openly, instead choosing to describe it within a larger framework of life and death. CONCLUSIONS Indian patients reaching the end of life valued their family responsibilities which determined their desire to live or die. However, all patients believed that God decided on their life and death. It is important to consider cultural perspectives on DNR or euthanasia and to address patients' pain management needs towards the end of life.
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Kirby E, Broom A, MacArtney J, Lewis S, Good P. Hopeful dying? The meanings and practice of hope in palliative care family meetings. Soc Sci Med 2021; 291:114471. [PMID: 34663540 DOI: 10.1016/j.socscimed.2021.114471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022]
Abstract
Hope can carry considerable allure for people facing imminent mortality and for those who care for them. Yet, how hope is variously and relationally (re)produced within end-of-life care settings, remains under-researched. In this study, we aimed to better understand hope as it circulates within palliative care, drawing on video recorded family meetings and pre- and post-meeting qualitative interviews, within two hospitals in Queensland, Australia. Our findings highlight family meetings as an important site for articulations of hope and hopefulness. The results illustrate how hope is recalibrated within the transition to and through palliative care, the tensions between hope and futility, and the work of hope in discussions of goals and expectations. Through our analysis we argue that hopefulness within family meetings, and in palliative care more broadly, is collectively produced and opens up discourses of hope to the lived experience of terminality. Attending to the nuances of hope, including moving beyond the determinative (hope for more life/hope for a quick death), can elucidate the possibilities and problems of the collective negotiation of hope at the end of life, including how hope can be drawn on to express support and solidarity.
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Affiliation(s)
- Emma Kirby
- Centre for Social Research in Health, University of New South Wales, Australia; Warwick Medical School, University of Warwick, UK.
| | - Alex Broom
- Sydney Centre for Healthy Societies & School of Social and Political Sciences, University of Sydney, Australia
| | | | - Sophie Lewis
- Sydney School of Health Sciences, University of Sydney, Australia
| | - Phillip Good
- Department of Palliative Care, St Vincent's Private Hospital, Brisbane, Australia; Department of Palliative and Supportive Care Mater Health Services, Brisbane, Australia; Mater Research Institute - University of Queensland, Brisbane, Australia
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13
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Sabanciogullari S, Yilmaz FT. The Effect of Religious Coping on Hope Level of Cancer Patients Receiving Chemotherapy. JOURNAL OF RELIGION AND HEALTH 2021; 60:2756-2769. [PMID: 31701322 DOI: 10.1007/s10943-019-00944-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Religious coping and hope are among factors that affect the disease, treatment compliance, psychological health and quality of life of cancer patients. The aim of this study was to determine the level of hope and religious coping styles of cancer patients, and to determine the relationship between religious coping and hope. The study was carried out descriptively and cross-sectionally with 133 patients receiving chemotherapy in an oncology center. In the study, the level of hope and positive religious coping of the patients were high and their level of negative religious coping was low. It was determined that there was a positive relationship between positive religious coping style and hope levels of patients, and positive religious coping style was a significant predictor of hope level. While patients are dealing with cancer diagnosis and treatment, it is recommended that health care professionals primarily focus on providing these patients a service with a holistic care approach and developing their hope with practices that will strengthen their positive religious coping styles.
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Affiliation(s)
- Selma Sabanciogullari
- Department of Psychiatric Nursing, School of Susehri Health High, Sivas Cumhuriyet University, Sivas, Turkey.
| | - Feride Taskin Yilmaz
- Department of Internal Diseases Nursing, School of Susehri Health High, Sivas Cumhuriyet University, Sivas, Turkey
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14
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McCaughan E, Semple CJ, Hanna JR. 'Don't forget the children': a qualitative study when a parent is at end of life from cancer. Support Care Cancer 2021; 29:7695-7702. [PMID: 34143326 PMCID: PMC8550711 DOI: 10.1007/s00520-021-06341-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/06/2021] [Indexed: 01/04/2023]
Abstract
Purpose Preparation for end of life is one of the greatest challenges faced by parents with cancer who have dependent children (< 18 years old), with requirement for support from professionals. The aim of this study is to explore how parents can be best supported in relation to their children, when a parent is at end of life from cancer. Methods This is an interpretive qualitative study, using 79 semi-structured interviews with parents at end of life (n3), bereaved parents (n21), health and social care professionals (HSCPs) (n32) and funeral directors (n23). Data were analysed thematically and triangulated. Results Parents are central to preparing their children for the death of a parent. Striving for everyday ordinariness, maximising social networks, maintaining hope and making preparations for the future are helpful for families when a parent is at end of life. Most HSCPs were unaware of the challenges faced by parents at end of life, and psychosocial support was often left outside the caring realm. As a result, funeral directors noted complexities faced by the families after the death. Results are discussed under four themes: (1) communication with the children as a process, (2) coping throughout the unfolding end of life experience, (3) tension and complexities at end of life and (4) preparing for the future. Conclusions Parents should be reassured that by involving the children early in the end of life experience when the ill-parent is ‘well enough’ to parent enables them to be actively involved in supporting their child through one of the greatest life changing event. A number of recommendations are discussed for professionals. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06341-3.
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Affiliation(s)
- Eilís McCaughan
- School of Nursing, Ulster University, Cromore Road, Coleraine, BT52 1SA, Co. L'Derry, UK
| | - Cherith J Semple
- School of Nursing, Ulster University, Shore Road, Newtownabbey, BT37 0QB, Co, Antrim, UK.,South Eastern Health and Social Care Trust, Cancer Services, Ulster Hospital, Upper Newtownards Road, Belfast, BT16 1RH, UK
| | - Jeffrey R Hanna
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK.
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15
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Abstract
Introduction The COVID-19 pandemic has changed daily life in unexpected ways including strict lockdowns periods that may shape hope. Method This study compared hope levels among an online sample of 584 adults in late April 2020 during the COVID-19 lockdown (2020 survey) to 884 adult internet users who participated in the 2019 Hope Barometer survey which was performed six months prior to the COVID-19 pandemic (2019 survey). Both surveys used identical validated hope and depression measures. Results Despite high degrees of depression, hope levels slightly but significantly increased in the 2020 survey compared to the 2019 survey. Differences between the 2019 and 2020 surveys appeared across all demographic groups, with no differences related to age, sex, or education. Conclusions Despite the increased depression, the COVID-19 lockdown was associated with significantly higher hope levels.
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Affiliation(s)
- Dorit Redlich Amirav
- Rehabilitation Medicine, University of Alberta, Edmonton, CAN.,Occupational Therapy, Tel Aviv university, Tel Aviv, ISR
| | - Omri Besor
- Pediatrics, Ichilov Hospital, Tel Aviv, ISR
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16
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Hope of Recovery in Patients in the Terminal Phase of Cancer under Palliative and Hospice Care in Poland. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7529718. [PMID: 32884944 PMCID: PMC7455812 DOI: 10.1155/2020/7529718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/03/2020] [Indexed: 12/01/2022]
Abstract
Introduction The objective of the presented research is to characterize hope in the situational dimension, i.e., health, in the patients with cancer in the terminal phase of the disease, being treated in hospices and palliative care centers. Hope is very important for all the patients, especially for patients with cancer in various phases of the disease. Giving up on oncologic therapy and causal treatment is often associated with a transition into palliative care. When death and a loss of values become a threat, the individual has got hope to rely on. Material and Methods. The study relies on the Test to Measure Hope in the Health Context (NCN-36) by B.L. Block. 246 patients in the terminal phase of cancer participated in the study. Results The internal structure of hope of recovery in the patients' group was varied. The patients showed low levels of hope of recovery since they do not believe in the effectiveness of treatment. They were also not convinced of the effectiveness of modifications in dieting, lifestyle, or the use of nonconventional medicine. They trusted the doctor in charge and were moderately satisfied with the therapy in use. The intensity of hope of recovery was on the low level in the patients in the terminal phase of cancer. Age, sex, place of living, and marital status had a significant influence on the level of hope of recovery. Variables such as living on one's own or living with one's family, socioeconomic status, education, or profession did not affect the level of hope of recovery. Conclusions The presented results allowed as to conclude that the assessment of hope in terminally ill cancer patients can be considered as one of the important tools enabling the personalization and the improvement of palliative care.
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17
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Contingent hope theory: The developmental exploration of hope and identity reconciliation among young adults with advanced cancers. Palliat Support Care 2020; 19:437-446. [PMID: 32729458 PMCID: PMC7856215 DOI: 10.1017/s1478951520000656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The diagnosis of an advanced cancer in young adulthood can bring one's life to an abrupt halt, calling attention to the present moment and creating anguish about an uncertain future. There is seldom time or physical stamina to focus on forward-thinking, social roles, relationships, or dreams. As a result, young adults (YAs) with advanced cancer frequently encounter existential distress, despair, and question the purpose of their life. We sought to investigate the meaning and function of hope throughout YAs' disease trajectory; to discern the psychosocial processes YAs employ to engage hope; and to develop a substantive theory of hope of YAs diagnosed with advanced cancer. METHOD Thirteen YAs (ages 23-38) diagnosed with a stage III or IV cancer were recruited throughout the eastern and southeastern United States. Participants completed one semi-structured interview in-person, by phone, or Skype, that incorporated an original timeline instrument assessing fluctuations in hope and an online socio-demographic survey. Glaser's grounded theory methodology informed constant comparative methods of data collection, analysis, and interpretation. RESULTS Findings from this study informed the development of the novel contingent hope theoretical framework, which describes the pattern of psychosocial behaviors YAs with advanced cancer employ to reconcile identities and strive for a life of meaning. The ability to cultivate the necessary agency and pathways to reconcile identities became contingent on the YAs' participation in each of the psychosocial processes of the contingent hope theoretical framework: navigating uncertainty, feeling broken, disorienting grief, finding bearings, and identity reconciliation. SIGNIFICANCE OF RESULTS Study findings portray the influential role of hope in motivating YAs with advanced cancer through disorienting grief toward an integrated sense of self that marries cherished aspects of multiple identities. The contingent hope theoretical framework details psychosocial behaviors to inform assessments and interventions fostering hope and identity reconciliation.
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18
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Ghinea N, Wiersma M, Kerridge I, Olver I, Pearson S, Day R, Liauw W, Lipworth W. "Some sort of fantasy land": A qualitative investigation of appropriate prescribing in cancer care. J Eval Clin Pract 2020; 26:747-754. [PMID: 31512353 DOI: 10.1111/jep.13278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Increasing the appropriateness of prescribing has long been a focus of government, non-government, and professional organizations. Progress towards this is made difficult by the fact appropriate prescribing remains inconsistently defined and is the subject of ongoing intense disagreement. In this study, we attempted to understand why this is the case within the context of oncology and haematology. METHODS We performed a qualitative empirical analysis of semi-structured interviews with 16 Australian oncologists and haematologists. RESULTS We found that oncologists framed appropriate prescribing in terms of the following inter-related, and at times opposed, values: civic mindedness, hope and compassion, realism, and virtue in motivation. CONCLUSIONS These values cannot be ranked a priori, and therefore, any definition of appropriate prescribing must be aligned with what communities want from their health system. When one value is privileged over another in any specific context, a compelling argument must be provided to justify the choice. In an era of shared decision making, patient rights, and high-cost medicines, we need to reassess what we mean by appropriate prescribing in cancer care.
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Affiliation(s)
- Narcyz Ghinea
- School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia.,Sydney Law School, The University of Sydney, Sydney, NSW, Australia
| | - Miriam Wiersma
- School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
| | - Ian Kerridge
- School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia.,Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ian Olver
- University of South Australia Cancer Research Institute (UniSA CRI), University of South Australia, Adelaide, SA, Australia
| | - Sallie Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Richard Day
- Faculty of Medicine, Department of Clinical Pharmacology & Toxicology Therapeutics Centre, St Vincent's Hospital Sydney and University of New South Wales, Darlinghurst, NSW, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Winston Liauw
- Translational Cancer Research Network, University of New South Wales, Sydney, NSW, Australia.,Cancer Care Centre, St George Hospital and St Georgeand Sutherland Clinical Schools, UNSW, Kogarah, NSW, Australia
| | - Wendy Lipworth
- School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
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19
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Nierop‐van Baalen C, Grypdonck M, Hecke A, Verhaeghe S. Associated factors of hope in cancer patients during treatment: A systematic literature review. J Adv Nurs 2020; 76:1520-1537. [DOI: 10.1111/jan.14344] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/17/2020] [Accepted: 02/24/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Corine Nierop‐van Baalen
- Haaglanden Medical Center The Hague The Netherlands
- Department of Public Health and Primary Care University Hospital Ghent University Ghent Belgium
| | - Maria Grypdonck
- Department of Public Health and Primary Care University Hospital Ghent University Ghent Belgium
| | - Ann Hecke
- Department of Public Health and Primary Care University Hospital Ghent University Ghent Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care University Hospital Ghent University Ghent Belgium
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20
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Musavi Ghahfarokhi M, Mohammadian S, Mohammadi Nezhad B, Kiarsi M. Relationship between spiritual health and hope by dietary adherence in haemodialysis patients in 2018. Nurs Open 2020; 7:503-511. [PMID: 32089846 PMCID: PMC7024621 DOI: 10.1002/nop2.412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 10/05/2019] [Accepted: 10/10/2019] [Indexed: 11/06/2022] Open
Abstract
Aim The present study aimed to determine the relationship between spiritual well-being and hope through adherence to diet in haemodialysis patients referred to the dialysis centre. Design This research was a cross-sectional study of a descriptive-analytical type conducted on 120 patients undergoing haemodialysis in a haemodialysis centre of a hospital affiliated to Dezful University of Medical Sciences using the census method. Method The data were collected using a questionnaire and through the laboratory information included in the patient's records. The data collection tools were a demographic information questionnaire, the Ellison and Paloutzian spiritual well-being scale (SWBS), the Hope-Herth questionnaire and the objective laboratory criteria (phosphorus, potassium). This included the weight difference between the two dialysis sessions from the record to examine the adherence to the diet. Results The results indicate there to be a significant relationship between hope and spiritual well-being with the objective criteria of the adherence to the diet in dialysis patients (p = .001).
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Affiliation(s)
| | - Sara Mohammadian
- Nursing Faculty of Medical SciencesUniversity of DezfulDezfulIran
| | | | - Maryam Kiarsi
- Nursing Faculty of Medical SciencesUniversity of DezfulDezfulIran
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21
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Back AL. Patient-Clinician Communication Issues in Palliative Care for Patients With Advanced Cancer. J Clin Oncol 2020; 38:866-876. [PMID: 32023153 DOI: 10.1200/jco.19.00128] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The delivery of palliative care to patients with advanced cancer and their families, whether done by oncology clinicians or palliative care clinicians, requires patient-centered communication. Excellent communication can introduce patients and families to palliative care in a nonthreatening way, build patient trust, enable symptom control, strengthen coping, and guide decision making. This review covers deficiencies in the current state of communication, patient preferences for communication about palliative care topics, best practices for communication, and the roles of education and system intervention. Communication is a two-way, relational process that is influenced by context, culture, words, and gestures, and it is one of the most important ways that clinicians influence the quality of medical care that patients and their families receive.
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22
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Ozen B, Ceyhan O, Büyükcelik A. Hope and perspective on death in patients with cancer. DEATH STUDIES 2019; 44:412-418. [PMID: 31204898 DOI: 10.1080/07481187.2019.1626942] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study was conducted to determine the relationship between various attitudes and hope levels of cancer patients. The study was conducted in an observational and cross-sectional design with 106 cancer patients who were followed in the oncology clinic of a hospital. In the study, it was found that women had lower hope levels than men, and as age decreased, hope levels increased and as educational level increased, hope levels increased. It was found that the patients who said "I have fear/worry/anxiety and think about my family as they will be left behind" had lower total scores and subscale scores of hope. The results of the study showed that individuals with cancer had relatively higher hope levels. It was determined that the patients' thoughts about death affected their hope both directly and indirectly.
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Affiliation(s)
- Betül Ozen
- Department of Community Health Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Ozlem Ceyhan
- Department of Internal Diseases Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
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23
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Littooij E, Widdershoven GAM, Leget CJW, Dekker J. Inner posture as aspect of global meaning in healthcare: a conceptual analysis. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:201-209. [PMID: 30054860 DOI: 10.1007/s11019-018-9853-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Based on our empirical research on global meaning in people with spinal cord injury and people with stroke, we formulated 'inner posture' as a concept in rehabilitation. Inner posture, as we concluded from our empirical data, refers to the way in which people bear what cannot be changed. It helps them to live with their injury. Considering that much has already been written about meaning from a variety of disciplines, the question arises whether the concept of inner posture adds something new to the existing literature, or is just another name for a phenomenon that has already been described before in different terms. In this paper, we aim to investigate this and to clarify our conceptualization, by comparing the concept of inner posture with influential concepts in healthcare literature which seem to be more or less related. In the work of Puchalski regarding spirituality, Pargament regarding religion, Eliott regarding hope and Frankl regarding attitude, we found definitions and descriptions that seemed to come close to the phenomenon we refer to as inner posture. Because these concepts have various theoretical backgrounds, the comparison can help to better understand our concept of inner posture, through a process of dialogue between traditions, following Gadamer's notion of dialogue as fusion of horizons of understanding. We conclude that inner posture differs from the other concepts in several ways. Some of these differences are more fundamental, other are partial. This suggests that we identified a new perspective on a phenomenon partially described earlier. The comparison also inspired us to slightly adjust our definition and to formulate new research questions.
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Affiliation(s)
- Elsbeth Littooij
- Amsterdam Rehabilitation Research Center Reade, PO Box 58271, 1040 HG, Amsterdam, The Netherlands.
| | - Guy A M Widdershoven
- Department of Medical Humanities, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands
| | - Carlo J W Leget
- Department of Care Ethics, University of Humanistic Studies, PO Box 797, 3500 AT, Utrecht, The Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine and Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
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24
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Bergqvist J, Strang P. Breast Cancer Patients' Preferences for Truth Versus Hope Are Dynamic and Change During Late Lines of Palliative Chemotherapy. J Pain Symptom Manage 2019; 57:746-752. [PMID: 30639732 DOI: 10.1016/j.jpainsymman.2018.12.336] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
CONTEXT Women with metastatic breast cancer often receive many lines of palliative chemotherapy, which might be beneficial but also harmful. Still, little is known about the patients' perception of the patient-doctor communication regarding late lines of noncurative treatment. OBJECTIVES Our aim was to explore breast cancer patients' preferences and perceptions of patient-doctor communication regarding continuous late lines of palliative chemotherapy. PATIENTS AND METHODS A qualitative study was conducted with semiguided face-to-face interviews with 20 women, 40-80 years old, on at least their second line of palliative chemotherapy (second to eighth line). We used a qualitative conventional content analysis. RESULTS All women knew they had incurable breast cancer but expressed hope for cure. Patients' definition of a good compassionate doctor was one who gives positive news and leaves room for hope. Ongoing chemotherapy, positive news from the doctors, and support from relatives encouraged hope. The women often expressed they accepted chemotherapy to please their doctor and relatives. The informants appreciated the doctor to be honest, but within positive limits. Over time, they stopped asking questions afraid of getting bad news, and left more and more treatment decisions to the doctor. CONCLUSIONS The women's preferences for truth versus hope in patient-doctor communication changed over time, which increase the risk for continuous late lines of palliative chemotherapy by common collusion. Doctors need to individualize information, help patients make sense of their life, and allow hope to endure without further chemotherapy.
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Affiliation(s)
- Jenny Bergqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Capio St Görans Sjukhus, Stockholm, Sweden.
| | - Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Research and Development, Stockholms Sjukhem Foundation, Stockholm, Sweden
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25
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Cesaro Lora CA. Esperanza en Pacientes Oncológicos Paliativos hacia una revisión sistemática. PSICOONCOLOGIA 2018. [DOI: 10.5209/psic.61435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo. Revisión sobre el término esperanza. Método. Estudio sistemático, en el que se han seleccionado 31 artículos con población oncológica adulta, en estadio terminal, de edades entre 20 a 88 años, de ambos géneros. Resultado. La esperanza, es inherente para la vida del ser humano, es una expectativa del futuro, dinámica, cambiante, fluctuante, medible y multifacética; presenta dos connotaciones como verbo y como sustantivo. La esperanza se puede mantener y fomentar mediante estrategias personales del paciente, del entorno social y de los profesionales de la salud; además, existen herramientas, técnicas, programas y psicoterapias que facilitan dichos resultados. Conclusión. La esperanza se puede fomentar, mantener y fortalecer y es fundamental para esta etapa de enfermedad. No existe un protocolo de intervención específico, lo principal es escuchar al paciente.
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26
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Nierop-van Baalen C, Grypdonck M, van Hecke A, Verhaeghe S. Health professionals’ dealing with hope in palliative patients with cancer, an explorative qualitative research. Eur J Cancer Care (Engl) 2018; 28:e12889. [DOI: 10.1111/ecc.12889] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 04/12/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Corine Nierop-van Baalen
- Haaglanden Medical Centre; The Hague The Netherlands
- Department of Public Health; University Hospital; Ghent University; Ghent Belgium
| | - Mieke Grypdonck
- Department of Public Health; University Hospital; Ghent University; Ghent Belgium
| | - Ann van Hecke
- Department of Public Health; University Hospital; Ghent University; Ghent Belgium
| | - Sofie Verhaeghe
- Department of Public Health; University Hospital; Ghent University; Ghent Belgium
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27
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Robieux L, Zenasni F, Flahault C, Tavani JL. L’espoir dans la maladie chronique : représentations sociales de l’espoir chez les patients et soignants. PSYCHOLOGIE FRANCAISE 2018. [DOI: 10.1016/j.psfr.2016.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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28
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Ethical Challenges When Caring for Orthodox Jewish Patients at the End of Life. J Hosp Palliat Nurs 2018; 20:36-44. [DOI: 10.1097/njh.0000000000000402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Wentlandt K, Weiss A, O'Connor E, Kaya E. Palliative and end of life care in solid organ transplantation. Am J Transplant 2017; 17:3008-3019. [PMID: 28976070 DOI: 10.1111/ajt.14522] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 09/17/2017] [Accepted: 09/22/2017] [Indexed: 01/25/2023]
Abstract
Palliative care is an interprofessional approach that focuses on quality of life of patients who are facing life-threatening illness. Palliative care is consistently associated with improvements in advance care planning, patient and caregiver satisfaction, quality of life, symptom burden, and lower healthcare utilization. Most transplant patients have advanced chronic disease, significant symptom burden, and mortality awaiting transplant. Transplantation introduces new risks including perioperative death, organ rejection, infection, renal insufficiency, and malignancy. Numerous publications over the last decade identify that palliative care is well-suited to support these patients and their caregivers, yet access to palliative care and research within this population are lacking. This review describes palliative care and summarizes existing research supporting palliative intervention in advanced organ failure and transplant populations. A proposed model to provide palliative care in parallel with disease-directed therapy in a transplant program has the potential to improve symptom burden, quality of life, and healthcare utilization. Further studies are needed to elucidate specific benefits of palliative care for this population. In addition, there is a tremendous need for education, specifically for clinicians, patients, and families, to improve understanding of palliative care and its benefits for patients with advanced disease.
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Affiliation(s)
- K Wentlandt
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - A Weiss
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - E O'Connor
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - E Kaya
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Park EY, Kim JH. The factor structure of the Dispositional Hope Scale in hemiplegic stroke patients. J Ment Health 2017; 26:556-561. [PMID: 28994346 DOI: 10.1080/09638237.2017.1385735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hope is an important coping strategy and psychological resource for patients with a chronic illness. Stroke patients are exposed to stressful situations such as limited daily life activities, cognitive impairments and financial burdens. AIM This study investigated the factor structure of the Dispositional Hope Scale (DHS) and verified its validity when examining stroke patients. METHODS This methodological study used secondary, cross-sectional data analysis to investigate the factors related to participation restriction in chronic stroke patients. The DHS's reliability was assessed by calculating the internal consistency of Cronbach's α. The structure of the DHS was analyzed by confirmatory factor analysis. The one-factor model (Korean version), two-factor model (original version) and bifactor models were compared. RESULTS The fit indices provided evidence for the two-factor DHS model among hemiplegic stroke patients. Although the two-factor model was identified as superior by the Akaike information criterion value, both models had strong goodness-of-fit indices. The DHS had an adequate level of internal consistency in measuring hope in stroke patients. CONCLUSIONS The DHS is a valid, reliable and useful tool for examining hemiplegic stroke patients. Identifying the psychometric properties of the DHS can help health professionals implement program development for stroke patients.
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Affiliation(s)
- Eun-Young Park
- a Department of Secondary Special Education , College of Education, Jeonju University , Jeonju , Korea and
| | - Jung-Hee Kim
- b Department of Clinical Nursing, College of Nursing , The Catholic University of Korea , Seoul , Korea
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Bergqvist J, Strang P. The will to live - breast cancer patients perceptions' of palliative chemotherapy. Acta Oncol 2017; 56:1168-1174. [PMID: 28524711 DOI: 10.1080/0284186x.2017.1327719] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND For women with metastatic breast cancer, late lines of chemotherapy might be beneficial but also harmful. Ongoing chemotherapy late in life increase the risk of late or absent discussions of palliative care and access to symptom relief by other options than chemotherapy. Our aim was, therefore, to investigate breast cancer patients' motives, perceptions, and experiences of late lines of palliative oncologic treatment. MATERIAL AND METHODS A qualitative study with semi-guided face-to-face interviews with 20 women on at least their second line of palliative chemotherapy (second-eighth line). All women had breast cancer and were 40-80 years old. The interviews were analyzed by a phenomenographical approach according to seven steps, which uses a second-order perspective, i.e., how the informants experience the world. RESULTS The categories that surrounded the decision to continue with palliative chemotherapy were: The decision, Personal motives and goals and The treatment. All women acknowledged that they knew they had incurable breast cancer and that the treatment goal was to slow down cancer growth. Fear of death was a strong motive for all women in addition to experience of new values of life, still they preferred the doctor to make the decision. Cancer symptoms, especially pain triggered death anxiety, whereas the patients patiently accepted similar side effects from the treatment. There were also external motives for treatment like wishes from family, friends, but also health care staff. CONCLUSIONS All women knew they had disseminated breast cancer, still they expressed hopes for cure, therefore, death was more of a threat than a reality of an imminent death. None of the women had perceived there was an option to stop treatment. They felt both their families and doctors expected them to continue. Death threat was their main motive for accepting treatment.
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Affiliation(s)
- Jenny Bergqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Capio St. Görans Sjukhus, Stockholm, Sweden
| | - Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Research and Development, Stockholms Sjukhem Foundation, Stockholm, Sweden
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Eun Y, Hong IW, Bruera E, Kang JH. Qualitative Study on the Perceptions of Terminally Ill Cancer Patients and Their Family Members Regarding End-of-Life Experiences Focusing on Palliative Sedation. J Pain Symptom Manage 2017; 53:1010-1016. [PMID: 28192224 DOI: 10.1016/j.jpainsymman.2016.12.353] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 10/23/2016] [Accepted: 12/29/2016] [Indexed: 11/29/2022]
Abstract
CONTEXT Patients with terminal cancer experience refractory symptoms in the last days of life. Although palliative sedation (PS) is recommended for patients suffering unbearable symptoms with imminent death, it requires clear communication between physicians and patients/caregivers. Understanding the demands and perceptions of patients and caregivers in the end-of-life phase are needed for effective communication. OBJECTIVE To explore patient experiences regarding end-of-life status and PS. METHODS The study was performed between October and December, 2013 with eligible terminal cancer patients and their families in a non-religious, tertiary healthcare facility in Korea. Eligibility criteria were a hospitalized cancer patient with a life expectancy of less than three months and who had never experienced PS. Data were collected via face-to-face in-depth interviews and analyzed using the constant comparative method of qualitative analysis. Saturation was achieved after conducting interviews with 13 patients or care-giving family members. RESULTS Enrolled patients raised the following issues: 1) simultaneously harboring the hope of prolonging life and wishing for a peaceful death, 2) experiencing difficulties in having honest conversations with caregivers regarding death, 3) possessing insufficient knowledge and information regarding PS, and 4) hoping for the decision on PS to be made before suffering becomes too great. CONCLUSION Terminally ill cancer patients and their caregivers expressed conflicting desires in hoping to prolong life and simultaneously wishing to experience a peaceful death. Improvements in the communications that occur among physicians, patients, and caregivers on the issues of prognosis and PS are needed.
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Affiliation(s)
- Young Eun
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Korea
| | - In-Wha Hong
- Department of Nursing, Gyeongnam Provincial Geochang College, Korea
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jung Hun Kang
- Department of Internal Medicine, School of Medicine, Institute of Health Sciences, Gyeongsang National University, Korea.
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Tae YS, Choi YS, Nam GH, Bae JY. Development of the Hope Scale for Korean Cancer Patients. ACTA ACUST UNITED AC 2017. [DOI: 10.7475/kjan.2017.29.2.211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Young Sook Tae
- Professor, College of Nursing, Kosin University, Busan, Korea
| | - Yooun Sook Choi
- Head Nurse, Dongnam Institute of Radiological · Medical Sciences, Busan, Korea
| | - Gum Hee Nam
- Researcher, Research Institute of Wholistic Nursing Science, Kosin University, Busan, Korea
| | - Ju Young Bae
- Nurse, Kosin University Gospel Hospital, Busan, Korea
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Han CY, Lin CC, Goopy S, Hsiao YC, Barnard A, Wang LH. Waiting and hoping: a phenomenographic study of the experiences of boarded patients in the emergency department. J Clin Nurs 2016; 26:840-848. [PMID: 27805751 DOI: 10.1111/jocn.13621] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To understand the experiences and concerns of patients in the emergency department during inpatient boarding. BACKGROUND Boarding in the emergency department is an increasingly common phenomenon worldwide. Emergency department staff, patients and their families become more stressed as the duration of boarding in the emergency department increases. Yet, there is limited knowledge of the experiences and concerns of boarded patients. DESIGN The qualitative approach of phenomenography was used in the study. METHODS The phenomenographic study was conducted in one emergency department that treats approximately 15,000 patients each month. Twenty emergency department boarding patients were recruited between July-September 2014. Semi-structured interviews were used for data collection. The seven steps of qualitative data analysis for a phenomenographic study - familiarisation, articulation, condensation, grouping, comparison, labelling and contrasting - were employed to develop an understanding of participants' experiences and concerns during their inpatient boarding in the emergency department. RESULTS The perceptions that emerged from the data were collected into four categories of description of the phenomenon of emergency department boarding patients: a helpless choice; loyalty to specific hospitals and doctors; an inevitable challenge of life; and distrust of the healthcare system. The outcome space for the emergency department boarding patients was waiting and hoping for a cure. CONCLUSION The experiences and concerns of emergency department boarding patients include physical, psychological, spiritual and health system dimensions. It is necessary to develop an integrated model of care for these patients. RELEVANCE TO CLINICAL PRACTICE Understanding the experiences and concerns of patients who are placed on boarding status in the ED will help emergency healthcare professionals to improve the quality of emergency care. There is a need to develop a care model and associated intervention measures for emergency department patients during the boarding process. The results of this study will help health regulatory authorities to develop an appropriate emergency department boarding system so that patients receive better emergency care.
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Affiliation(s)
- Chin-Yen Han
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Chun-Chih Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Suzanne Goopy
- Faculty of Nursing, University of Calgary, Calgary, Canada
| | - Ya-Chu Hsiao
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Alan Barnard
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Li-Hsiang Wang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
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Thomas R, Hamilton R. Composing hope through collage: A community-based intervention for cancer survivors living with lymphedema. Health Psychol Open 2016; 3:2055102916657674. [PMID: 35223070 PMCID: PMC8867492 DOI: 10.1177/2055102916657674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Secondary lymphedema after cancer may result in distress, yet few interventions exist to support coping skills in this population. As part of a community-based intervention, we piloted the use of creative practices to promote active orientations to hope. A total of 19 participants completed the workshops; 11 collaged. The main themes address the collage processes as well as their content. The former addresses sub-themes such as selecting/composing. The latter includes sub-themes related to movement depicted in the collages. Collages and their associated discussions concretized hoping as an active and accessible process for participants living with two chronic illnesses.
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Davis MP, Lagman R, Parala A, Patel C, Sanford T, Fielding F, Brumbaugh A, Gross J, Rao A, Majeed S, Shinde S, Rybicki LA. Hope, Symptoms, and Palliative Care. Am J Hosp Palliat Care 2016; 34:223-232. [PMID: 26809826 DOI: 10.1177/1049909115627772] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Mellar P Davis
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ruth Lagman
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Armida Parala
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chirag Patel
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tanya Sanford
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Flannery Fielding
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anita Brumbaugh
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Gross
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Archana Rao
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sumreen Majeed
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shivani Shinde
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa A Rybicki
- 1 Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Nierop-van Baalen C, Grypdonck M, van Hecke A, Verhaeghe S. Hope dies last … A qualitative study into the meaning of hope for people with cancer in the palliative phase. Eur J Cancer Care (Engl) 2016; 25:570-9. [DOI: 10.1111/ecc.12500] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/26/2022]
Affiliation(s)
- C. Nierop-van Baalen
- Alrijne Ziekenhuis; Leiden The Netherlands
- Department of Public Health; University Hospital; Ghent University; Ghent Belgium
| | - M. Grypdonck
- Department of Public Health; University Hospital; Ghent University; Ghent Belgium
| | - A. van Hecke
- Department of Public Health; University Hospital; Ghent University; Ghent Belgium
| | - S. Verhaeghe
- Department of Public Health; University Hospital; Ghent University; Ghent Belgium
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The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care 2016; 14:672-679. [PMID: 27586308 DOI: 10.1017/s1478951516000183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:Several studies have reported the effectiveness of a variety of psychosocial interventions in increasing levels of hope in palliative care patients. The experience of palliative patients while participating in these interventions is unknown. Understanding these experiences would provide a rich understanding of how the interventions work to foster hope. The purpose of the present study was to describe the psychosocial processes that participants with advanced cancer receiving palliative care experienced when taking part in a Living with Hope Program (LWHP).Method:In the context of a study evaluating the LWHP, data were collected from 13 dyads (persons with advanced cancer and their caregivers) at two timepoints (one week apart). A thematic qualitative analysis of 52 open-ended audiotaped interviews was conducted that focused on the psychosocial processes that occurred during the LWHP.Results:The average age of palliative participants was 67 (SD = 6.6) and of their family caregivers 61 years of age (SD = 13.9). A thematic analysis suggested that the participants experienced the following psychosocial processes while participating in the LWHP: (1) reminiscing, (2) leaving a legacy, (3) positive reappraisal, and (4) motivational processes. These processes are the mechanisms by which the LWHP fosters the positive outcomes of increasing hope and improving quality of life. As well, the finding of motivational processes suggested that the LWHP may also increase life satisfaction, which is an outcome of motivational processes.Significance of the results:The findings from our study underscore the importance of uncovering the psychosocial processes through which the LWHP works to foster hope. They will assist in making revisions to the intervention that will increase its effectiveness, as well as providing a better understanding of hope in persons with advanced cancer.
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Tahory H, Mohammadian R, Rahmani A, Seyedrasooli A, Lackdezajy S, Heidarzadeh M. Viewpoints of Family Caregivers about Posttraumatic Growth in Cancer Patients. Asian Pac J Cancer Prev 2016; 17:755-8. [PMID: 26925675 DOI: 10.7314/apjcp.2016.17.2.755] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hale Tahory
- Medical andSurgical Department, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran E-mail :
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Edwards TM, Jovanovski A. Hope as a Therapeutic Target in Counselling – In General and in Relation to Christian Clients. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2016. [DOI: 10.1007/s10447-016-9257-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Shosha GMA. Keep on Striving: The Impact of Psychosocial Support on Jordanian Adolescents with Cancer. Health (London) 2016. [DOI: 10.4236/health.2016.810095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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O'Shaughnessy PK, Laws TA, Esterman AJ. Love, faith and hope - a secondary analysis of prostate cancer survivors and their partners. Contemp Nurse 2015; 50:149-68. [PMID: 26503326 DOI: 10.1080/10376178.2015.1101352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- P K O'Shaughnessy
- a School of Nursing and Midwifery, Division of Health Sciences , University of South Australia , City East Campus GPO Box 2471, Adelaide 5001 , South Australia
| | - T A Laws
- a School of Nursing and Midwifery, Division of Health Sciences , University of South Australia , City East Campus GPO Box 2471, Adelaide 5001 , South Australia
| | - A J Esterman
- a School of Nursing and Midwifery, Division of Health Sciences , University of South Australia , City East Campus GPO Box 2471, Adelaide 5001 , South Australia
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Hamilton R, Thomas R. Renegotiating hope while living with lymphoedema after cancer: a qualitative study. Eur J Cancer Care (Engl) 2015; 25:822-31. [DOI: 10.1111/ecc.12382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 11/29/2022]
Affiliation(s)
- R. Hamilton
- Department of Psychology; University of New Brunswick; Fredericton NB Canada
| | - R. Thomas
- Faculty of Health Sciences; University of Ottawa; Ottawa ON Canada
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Testoni I, Ancona D, Ronconi L. The Ontological Representation of Death: A Scale to Measure the Idea of Annihilation Versus Passage. OMEGA-JOURNAL OF DEATH AND DYING 2015; 71:60-81. [PMID: 26152027 DOI: 10.1177/0030222814568289] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the borders between natural life and death have been blurred by technique, in Western societies discussions and practices regarding death have became infinite. The studies in this area include all the most important topics of psychology, sociology, and philosophy. From a psychological point of view, the research has created many instruments for measuring death anxiety, fear, threat, depression, meaning of life, and among them, the profiles on death attitude are innumerable. This research presents the validation of a new attitude scale, which conjoins psychological dimensions and philosophical ones. This scale may be useful because the ontological idea of death has not yet been considered in research. The hypothesis is that it is different to believe that death is absolute annihilation than to be sure that it is a passage or a transformation of one's personal identity. The hypothetical difference results in a greater inner suffering caused by the former idea. In order to measure this possibility, we analyzed the correlation between Testoni Death Representation Scale and Beck Hopelessness Scale, Suicide Resilience Inventory-25, and Reasons for Living Inventory. The results confirm the hypothesis, showing that the representation of death as total annihilation is positively correlated to hopelessness and negatively correlated to resilience.
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Larsen DJ, King RL, Stege R, Egeli NA. Hope in a strengths-based group activity for individuals with chronic pain. COUNSELLING PSYCHOLOGY QUARTERLY 2015. [DOI: 10.1080/09515070.2015.1007444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chen H, Komaromy C, Valentine C. From hope to hope: the experience of older Chinese people with advanced cancer. Health (London) 2014; 19:154-71. [PMID: 25331647 DOI: 10.1177/1363459314555238] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In our study that explored the current end-of-life care provision for Chinese older people with advanced/terminal cancer, hope emerged as a significant aspect of coping with their condition. Drawing on data from in-depth interviews with a group of older people, their family carers and health professionals, this article explores participants' constructions of hope in terms of what they were hoping for, how their hopes helped them cope with their illness and what sociocultural resources they drew on to build and sustain these hopes. While acknowledging similarities to Western studies of hope in terminal illness, this article identifies significant divergences in terms of the impact of different sociocultural values and their implications for clinical practice in light of an unfavourable health care environment for patients with advanced cancer and a social support system sustained mainly by Chinese families. It argues that hope represents an important resource for coping with terminal illness among these patients.
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Borneman T, Irish T, Sidhu R, Koczywas M, Cristea M. Death awareness, feelings of uncertainty, and hope in advanced lung cancer patients: can they coexist? Int J Palliat Nurs 2014; 20:271-7. [PMID: 25040862 DOI: 10.12968/ijpn.2014.20.6.271] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients diagnosed with stage-IV lung cancer are forced to quickly transition from a cancer-free and perhaps healthy life to one of serious illness, uncertainty, and anticipation of a premature death. Health professionals may be too quick to label the patient as being in denial if they hope for healing. Hope may not be lost when reality is accepted. Studies have investigated what it is like to live with awareness of impending death. Using a patient case study this paper discusses the concepts of death awareness, uncertainty, and hope. The aim is to provide a deeper understanding of how these seemingly antithetical emotions can coexist to the benefit of the patient, and to provide clinicians with practical considerations for supporting patients' hope throughout their terminal illness.
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Affiliation(s)
- Tami Borneman
- Oncology Clinical Nurse Specialist and Senior Research Specialist
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Seyedrasooli A, Rahmani A, Howard F, Zamanzadeh V, Mohammadpoorasl A, Aliashrafi R, Pakpour V. Iranian Cancer Patient Perceptions of Prognosis and the Relationship to Hope. Asian Pac J Cancer Prev 2014; 15:6205-10. [DOI: 10.7314/apjcp.2014.15.15.6205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Klafke N, Eliott JA, Olver IN, Wittert GA. Australian men with cancer practice complementary therapies (CTs) as a coping strategy. Psychooncology 2014; 23:1236-42. [PMID: 24737651 DOI: 10.1002/pon.3550] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 03/20/2014] [Accepted: 03/24/2014] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to explore how and why Australian men with cancer practice complementary therapies (CTs) and how their significant others (SOs) contribute to the regular uptake of CTs. METHODS This qualitative study employed semi-structured interviews with 26 male cancer patients and 24 SOs. Participants were purposefully sampled from a preceding Australian survey investigating the use of CTs in men with cancer (94% response rate and 86% consent rate for follow-up interview). Interviews were conducted in a metropolitan location, and the 43 interview transcripts were analyzed thematically. RESULTS Three core themes were identified: men used CTs as (a) problem-focused coping (e.g., diet modification), (b) emotion-focused coping (e.g., meditation), and (c) meaning-based coping (e.g., prayer). Practicing CTs helped men to cope with physical, emotional, and spiritual concerns, although some men spoke of difficulties with practicing meditation to regulate their emotions. SOs were supportive of men's coping strategies but were only rarely involved in men's emotion-focused coping. CONCLUSIONS Complementary therapies have the potential to facilitate coping with cancer, independent of any measurable physiological benefit. Our findings suggest that when clinicians engage in conversations about CTs use, they should consider the type of coping strategy employed by their patient. Such information may enhance the efficacy of some interventions (e.g., meditation) and also provide for an opportunity to discuss patients' expectations concerning CTs.
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Affiliation(s)
- Nadja Klafke
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
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Larsen DJ, Stege R, Edey W, Ewasiw J. Working with unrealistic or unshared hope in the counselling session. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2014. [DOI: 10.1080/03069885.2014.895798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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