Is There a Problem With False Hope?

Where There's Hope, There's Life 1 : On the Importance of Hope in Health Care

It is widely supposed that it is important to ensure that patients undergoing medical procedures hope that their treatments will be successful. But why is hope so important, if indeed it is? After examining the answers currently on offer in the literature, we identify a hitherto unrecognized reason for supposing that it is important that patients possess hope for a successful treatment, which draws on prospect theory, Kahneman and Tversky's hugely influential descriptive theory about decision-making in situations of risk and uncertainty. We also consider some concerns about patient consent and the potential manipulation of patients that are raised by our account.

Understanding the factors that influence stroke survivors to begin or resume exercise: a qualitative exploration

BACKGROUND

Exercise after stroke has the potential to increase survivors' physical function and decrease disability. However, despite health professional reporting they recommend exercise to stroke survivors, the majority are physically inactive. Stroke survivors have previously expressed a lack of adequate knowledge and skills to engage in exercise.

OBJECTIVES

The aim of this study was to understand why active stroke survivors chose to (re)engage in exercise and how they went about doing so. A secondary aim was to understand if health professionals had a role in facilitating exercise engagement.

METHODS

Semi-structured interviews were conducted with stroke survivors who regularly engaged with exercise. Seven people aged between 60 and 71 years participated in the study. Time since stroke varied from 1 to 13 years. A reflexive thematic analysis approach was used to analyze interviews.

RESULTS

Exercise was spoken about in a positive light. For some, exercise had always been important, for others it became important after their stroke. The themes of Changing Support Over Time, Old and New Identity and Proactively Impacting the Future were developed. The participants felt that health professionals often facilitated engagement in exercise, although the type of support that was most valued differed at different points in the post-stroke journey.

CONCLUSIONS

Authoritative support from health professionals and family members helped participants to engage in exercise in the early stages after stroke. Collaboration and being part of a team was appreciated for ongoing exercise engagement. Exercise provided hope as participants developed their identity after stroke.

Perceived challenges in treatment decision-making for endometriosis: healthcare professional perspectives

Background

Endometriosis, a systemic chronic inflammatory condition which has no cure, has a high symptom burden that can negatively impact every facet of life. Given the absence of a gold-standard treatment, the best symptom management regimen in endometriosis is heavily reliant on a patient's values and preferences, making shared decision-making (SDM) vital. However, a comprehensive patient decision aid (PtDA) intervention that could facilitate patient decision-making and promote SDM is lacking in endometriosis, and there is little research on the decisional support needs of individuals with this condition. This qualitative study aimed to explore healthcare professional (HP) perspectives of their clients' decisional support needs when choosing treatments to manage endometriosis symptoms, with a view to evaluating the need for a PtDA.

Methods

Australian HPs identified as specialising in endometriosis care (N = 13) were invited to participate in a short interview over the Internet by phone. Questions focussed on perceived facilitators and challenges of decision-making when choosing treatments for endometriosis. Transcribed qualitative data were thematically analysed and verified by multiple coders, using the template approach.

Results

Four themes were identified: (1) Identifying and setting priorities; (2) HPs' lack of time and perceived lack of knowledge; (3) Patient-centred care and SDM, including patient capacity; and (4) Decision-making blinded by hope. This is the first known study to explore HPs' perspectives on patient decision-making challenges in endometriosis.

Discussion

Findings draw attention to the difficulties people with endometriosis experience when assessing and choosing treatments, highlighting the need for a comprehensive PtDA intervention to support this decision-making.

Post-stroke aphasia rehabilitation using an adapted visual P300 brain-computer interface training: improvement over time, but specificity remains undetermined

Introduction

This study aimed to evaluate the efficacy of visual P300 brain-computer interface use to support rehabilitation of chronic language production deficits commonly experienced by individuals with a left-sided stroke resulting in post-stroke aphasia.

Methods

The study involved twelve participants, but five dropped out. Additionally, data points were missing for three participants in the remaining sample of seven participants. The participants underwent four assessments-a baseline, pre-assessment, post-assessment, and follow-up assessment. Between the pre-and post-assessment, the participants underwent at least 14 sessions of visual spelling using a brain-computer interface. The study aimed to investigate the impact of this intervention on attention, language production, and language comprehension and to determine whether there were any potential effects on quality of life and well-being.

Results

None of the participants showed a consistent improvement in attention. All participants showed an improvement in spontaneous speech production, and three participants experienced a reduction in aphasia severity. We found an improvement in subjective quality of life and daily functioning. However, we cannot rule out the possibility of unspecific effects causing or at least contributing to these results.

Conclusion

Due to challenges in assessing the patient population, resulting in a small sample size and missing data points, the results of using visual P300 brain-computer interfaces for chronic post-stroke aphasia rehabilitation are preliminary. Thus, we cannot decisively judge the potential of this approach.

'False hope' in assisted reproduction: the normative significance of the external outlook and moral negotiation

Despite the frequent invocation of 'false hope' and possible related moral concerns in the context of assisted reproduction technologies, a focused ethical and conceptual problematisation of this concept seems to be lacking. We argue that an invocation of 'false hope' only makes sense if the fulfilment of a desired outcome (eg, a successful fertility treatment) is impossible, and if it is attributed from an external perspective. The evaluation incurred by this third party may foreclose a given perspective from being an object of hope. However, this evaluation is not a mere statistical calculation or observation based on probabilities but is dependent on several factors that should be acknowledgeable as morally relevant. This is important because it allows room for, and encourages, reasoned disagreement and moral negotiation. Accordingly, the object of hope itself, whether or not based on socially embedded desires or practices, can be a topic of debate.

Cross-Cultural Adaptation and Psychometric Properties of the Children's Hope Scale in Indonesia: Adapting a Positive Psychosocial Tool for Adolescents With Thalassemia

Background: Hope is regarded positively as a factor in achieving a higher quality of life, particularly in chronic disease patients. Objectives: This study aims to adapt, validate, and establish the reliability of the Children's Hope Scale (CHS) questionnaire in Indonesian adolescents with thalassemia. Methods: The current study used iterative mixed methods. The data collection procedure was divided into three stages: instrument translation and cultural adaptation, validation, and reliability. The Content Validity Index (CVI) was used to assess the translated instrument's content validity, importance, contextual relevance, and acceptability of wording. Confirmatory factor analysis (CFA) was used to determine the factor structure of the CHS. Pearson correlation analyses were used to determine the associations between the two hope subscales. Cronbach's alpha coefficient and test-retest data were used to determine its reliability. Results: The CVI values ranged from 0.80 to 1.00. The CFA has shown that the two-factor model has adequate fitness factors. The Cronbach's alpha for the Indonesian CHS was 0.705, and the test reliability rate (CI 95%) was 0.81 (.73-.91). Conclusion: The CHS is a valid and reliable instrument for assessing hope in Indonesia. Additional research should be conducted to adapt and evaluate the CHS in other samples and social context in order to verify the factor consistency.

Hope over fear: The interplay between threat information and hope appeal corrections in debunking early COVID-19 misinformation

The spreading of COVID-19 misinformation paralleled increasing fear towards the pandemic reported worldwide in its early stages. Yet research on the emotional basis for misinformation susceptibility and how emotional appeals may help reduce COVID-19 related misperceptions remains limited. To address this gap, we conducted a 2 (threat from COVID-19: yes vs. no) × 4 (correction conditions: none vs. factual correction vs. factual correction + words of optimistic outlook & individual efficacy vs. factual correction + words of optimistic outlook & collective efficacy) between-participant factorial experiment among an online sample of Chinese residents (N = 836) in June 2020. Misinformation about COVID-19 treatments and mitigation was presented in all conditions. Across five misinformation topics, threat information induced more misperceptions while all three types of corrections mitigated threat information's deleterious impact and improved belief accuracy. Importantly, corrections incorporating hope appeals showed enhanced effectiveness in improving belief accuracy when threat information was present whereas factual corrections absent hope appeals did not show similar sensitivity towards threat information. For hope appeal corrections, their indirect effects on desirable downstream behavioral intentions through corrected beliefs were stronger with than without preceding threat information. Our study thus demonstrated the potential of deploying hope appeals to fight the COVID-19 infodemic in China and beyond when threat information is prevalent, while highlighting the importance of studying the roles of emotional appeals in health misperception formation and correction.

The 'false hope' argument in discussions on expanded access to investigational drugs: a critical assessment

When seriously ill patients reach the end of the standard treatment trajectory for their condition, they may qualify for the use of unapproved, investigational drugs regulated via expanded access programs. In medical-ethical discourse, it is often argued that expanded access to investigational drugs raises 'false hope' among patients and is therefore undesirable. We set out to investigate what is meant by the false hope argument in this discourse. In this paper, we identify and analyze five versions of the false hope argument which we call: (1) the limited chance at benefit argument, (2) the side effects outweighing benefits argument, (3) the opportunity costs argument, (4) the impossibility of making informed decisions argument, and (5) the difficulty of gaining access argument. We argue that the majority of these five versions do not provide normative ground for disqualifying patients' hopes as false. Only when hope is rooted in a mistaken belief, for example, about the likelihood of benefits or chances on medical risks, or when hope is directed at something that cannot possibly be obtained, should it be considered false. If patients are adequately informed about their odds of obtaining medical benefit, however small, and about the risks associated with an investigational treatment, it is unjustified to consider patients' hopes to be false, and hence, to deny them access to investigational drug based on that argument.

The possibility of impossibility: The hope for a cure among terminally ill cancer patients in China

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.

The impact of the euthanasia assessment procedure: a qualitative interview study among adults with psychiatric conditions

BACKGROUND

Assisted dying for adults with psychiatric conditions (APC) is highly controversial but legally possible in a few countries, including Belgium. Previous research has suggested that the complex euthanasia assessment procedure may cause additional suffering in APC but may also induce positive experiences. This study reports on the impact of the euthanasia assessment procedure as experienced by APC on three counts: 1) their mental state, including death ideation; 2) their treatment trajectory; 3) their social relationships.

METHODS

We performed an in-depth qualitative interview study with 16 APC in Flanders, Belgium, who had voiced a euthanasia request between 2016-2020. Thematic coding was used.

FINDINGS

We interviewed 16 APC. Euthanasia assessment procedures brought out a plethora of experiences in APC, both favourable and unfavourable. Whereas thoughts of suicide remain present to a certain extent, being in the assessment procedure allows some APC to reconsider alternatives towards life, and also to attempt new treatment options. However, many APC experience ambivalence about the supposedly inherent desirability and dignity in euthanasia. Worries also surfaced about the rationale behind and effects of involvement of APCs' social circle, and about the impact it could have on them.

CONCLUSION

Further research, including other stakeholder perspectives, is recommended with a view to maximising favourable and minimising unfavourable impacts for all involved. In clinical practice attention to these impacts is paramount, and clear communication and management of expectations between physician and patient, seems appropriate to address the many ambivalent experiences that accompany APC during the euthanasia assessment procedure. Policy attention could in this regard go to clarifying certain sources of ambivalence and issues that are insufficiently addressed, such as modalities of relatives' involvement.

Palliative care and its own identity, through an autoethnography: do you recognize these patterns?

Introduction:

After more than 25 years working in palliative care (PC) observing thousands of patients and family behaviors, I use my long experience and notes as a source of data for a qualitative research study. The aim is to identify frequent families’ behavior patterns in PC and better describe the culture in PC.

Methods:

This article is part of a larger project, using autoethnography as methodology, with the aim of helping doctors and interested health professionals better understand the culture and reality of PC. The focus is not the author but patients and families’ patterns of social behavior – the social context – within the end-of-life period and how to deal with these professionally. Confidentiality and privacy of patients’ data were guaranteed.

Results:

The vast number of treated cases, the regular observation and recording, and the continuous reflection and analysis over many years have led to these results. Due to editorial restrictions, in this article I only describe four of at least eight typical scenarios I have identified. Each is given a short title and I explore some of their inside-issues, integrating previous knowledge, research, and explanations, with practical suggestions on how to deal with them.

Significance:

As far as we know, these scenarios/patterns have never been described in this way. This work expands knowledge, innovates, and contributes to better describing PC culture. The final goal is to create a set of scripts that can be used to help clinicians quickly identify the clinical situation and how to deal with it in clinical practice. Reflecting on how patients and families frequently behave in PC can be very useful and then teach other professionals to better deal with these challenges.

To be alive when dying: moral catharsis and hope in patients with limited life prognosis

The Stoics considered that in order to die well, one must previously have lived (well) and not merely existed, an assertion which will not be contested in this paper. The question raised here is whether an individual whose life expectancy is jeopardized by serious illness or whose life has not been lived to the 'full' for whatever reason should have to abandon all hope or, alternately, whether that life could still somehow be saved (in an ethical sense). One clear obstacle to achieving this stems from (bad) moral character, given that moral character is an element which conditions an individual's moral behaviour, as pointed out by Beauchamp and Childress and particularly Pellegrino and Thomasma. The transformation of moral character requires time and effort but the testimonies of patients who have given their lives a radical new direction upon being diagnosed with a serious illness seem to show the existence of a peculiar phenomenon of moral catharsis. In this paper we attempt to illustrate that this alleged phenomenon is not the result of a kind of cataleptic impression but rather the result of a dialectic and narrative process, during which a first hope of healing is dashed, unveiling a new sense in the illness. Its fulfillment provides the patient with a final hope.

Hope, uncertainty, and control: A theoretical integration in the context of serious illness

BACKGROUND

Hope has been a topic of interest across many centuries and among diverse cultures, gaining particular relevance in crisis and change-seeking times. Research has shown that hope plays an important role in both the context of everyday life as well as in the context of illness. This paper presents an integrative theory of hope, which incorporates uncertainty and control as key drivers of the hope process and also includes appraisal and meaning.

DISCUSSION

This new hope theory states that hope emerges when a specific situation is appraised as uncertain and involves the discernment of the utility of primary and secondary control. For example, in the context of high uncertainty and low control, importance is given to the meaning-making and transcendence in maintaining hope. In the context of low uncertainty and high control, importance is given to the agency and self-efficacy components of hope.

CONCLUSIONS

Although this integrative theory is based on current theory and evidence, it awaits empirical evidence for the integration of hope, uncertainty, and control in a process-oriented model of hope. The integrative theory may have clinical utility, particularly for serious illness and palliative care where uncertainty, hope and control transform with the trajectory of the illness.

Oncology patients' experiences in experimental medicine cancer trials: a qualitative study

OBJECTIVES

The study aimed to explore patients' experiences of experimental cancer medicine (ECM) clinical trials.

DESIGN

The study's design was qualitative. Two focus groups with patients were undertaken followed by semistructured interviews, to explore patients' experiences of ECM clinical trials. Interviews and focus groups were audiorecorded and transcribed verbatim. Data were analysed using thematic analysis.

SETTING

A regional cancer centre (tertiary care) in North-West England.

PARTICIPANTS

Twelve patients (aged 52-79) participated in one of the two focus groups and 22 patients (aged 42-83) participated in interviews.

PRIMARY OUTCOME MEASURE

Patients' experiences of an ECM trial.

RESULTS

Four main themes were identified from the analysis: decision making, information needs, the experience of trial participation and impact of trial participation. Subthemes are presented in the manuscript.

CONCLUSION

To make fully informed decisions about trial participation, patients required the simplification of trial information and wanted more information about side effects, their response to trial treatment and the overall trial progress throughout the trial. Patients highlighted the need for improvement for the support provided to their family and friends.

Hope and therapeutic privilege: time for shared prognosis communication

Communicating an unfavourable prognosis while maintaining patient hope represents a critical challenge for healthcare professionals (HPs). Duty requires respect for the right to patient autonomy while at the same time not doing harm by causing hopelessness and demoralisation. In some cases, the need for therapeutic privilege is discussed. The primary objectives of this study were to explore HPs' perceptions of hope in the prognosis communication and investigate how they interpret and operationalise key ethical principles. Sixteen qualitative semistructured interviews with HPs from different positions and experience, including doctors and nurses in four different departments (intensive care, oncology, palliative care, rehabilitation), were conducted in the Ticino Cantonal Hospital, Switzerland. The interviews were recorded, transcribed verbatim and analysed using thematic analysis. HPs defined prognosis and patient hope as interdependent concepts related to future perspectives for subjective quality of life. Two main factors allow HPs to maximise the benefits and minimise the harm of their communication: respecting the patient's timing and sharing the patient's wishes. Time is required to reframe needs and expectations. Furthermore, communication needs to be shared by HPs, patients and their relatives to build common awareness and promote a person-centred approach to prognosis. In this process, interprofessional collaboration is key: doctors and nurses are complementary and can together guarantee that patients and relatives receive information in the most appropriate form when they need it. Organisational aspects and the HPs' emotional difficulties, particularly in coping with their own despair, are barriers to effective communication that need further investigation.

Ontological Classifications and Human Rationality in Bioethics

Metaphysics often has an important role in deciding ethical questions. Specifically, in the realm of bioethics, metaphysical questions such as the nature of persons, diseases, and properties in general can be crucial to determining what is right or wrong. In this article, I tie together various metaphysical themes that recur throughout the rest of the issue: rationality as an element of human nature, ontological classifications, and kinds of action. I will explain that each has ethical implications. Actions that contravene reason will be morally problematic, whereas our classification of illnesses will have important implications for how we ought to respond to ill persons. Metaphysical questions appear, or are at least suggested, in each article, pointing to the need for metaphysics in answering bioethical questions.