Nursing intervention to increase hope and quality of life in newly diagnosed cancer patients

Structural equation modeling of hope, psychological distress, quality of life, and influencing factors in advanced cancer patients undergoing cancer pharmacotherapy in Japan

OBJECTIVE

The purpose of this study was to clarify the relationship between hope, psychological distress, and quality of life (QOL) of patients with advanced cancer undergoing cancer pharmacotherapy and their related factors.

METHODS

Participants were patients with advanced lung, colorectal, and breast cancer undergoing outpatient pharmacotherapy. The Herth Hope Index, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy-General were used as measurement tools in a cross-sectional survey. Data were analyzed using descriptive statistics, correlation analysis, t-test, one-way analysis of variance (ANOVA), and Structural Equation Modeling (SEM).

RESULTS

The number of valid responses to the questionnaire survey was 200 (91.7%). SEM included hope, psychological distress, QOL, social support, economic deprivation, physical symptoms, and performance status. The goodness of fit index for SEM was 0.989, adjusted goodness of fit index was 0.960, comparative fit index was 1.000, and root mean square error of approximation was 0.001. Hope had a negative impact on psychological distress (β = - 0.46) and a positive impact on QOL (β = .19).

CONCLUSION

Hope was shown to be a predictor of psychological distress and QOL in patients with advanced cancer receiving pharmacotherapy. Predictors of hope were social support and economic deprivation. The results suggest that early intervention for patients with characteristics that tend to lower levels of hope is effective in reducing patient anxiety and depression and improving QOL.

"Hope at a crossroads" - Experiences of hope in intensive care patients: A qualitative study

BACKGROUND

Hope is closely connected to experiences of health and illness. In critical illness, the future may be uncertain regarding survival, recovery, and daily functioning. More knowledge is needed on how to support hope in patients in intensive care units and during the following rehabilitation period.

OBJECTIVES

The aim of this study was to explore hope and its impacting factors among critically ill patients in the intensive care unit.

METHODS

This was an exploratory study using semistructured interviews for data collection. Thirteen patients discharged from intensive care were interviewed while still in hospital. Data were analysed using thematic analysis. The consolidated criteria for reporting qualitative research were used for reporting this study.

FINDINGS

Three themes, consisting of 8 subthemes, were generated through the analysis. The first theme presented, 'Hope at the point of uncertainty', describes the perception of hope as a phenomenon in critical illness, while the last two, 'Nourishment for hope' and 'Barriers to hope', comprise possible promoting and constraining factors affecting hope during intensive care The overarching theme 'Hope at a crossroads' reflects the overall patient experience of hope in critical illness.

CONCLUSION

To maintain or regain hope, healthcare personnel working with critically ill patients should be aware of the importance of encouraging and acknowledging physical progress even when small. Furthermore, they should attend to patients' relational needs and facilitate their ability to interact as the persons they are, not only as patients.

Patients' perception of hope in palliative care: A systematic review and narrative synthesis

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.

Effects of Psychotherapy on Hope/Hopelessness in Adults with Cancer: a Systematic Review and Meta-analysis

BACKGROUND

Although psychotherapy is a common treatment for hopelessness and hope, the effectiveness remains controversial. The purpose of this study was to quantitatively synthesize available evidence related to the effect of a broad range of psychotherapy interventions on hope/hopelessness in cancer patients.

METHOD

Eight electronic databases were searched for studies with adult cancer patients (mean age ≥ 18 years) receiving psychotherapy interventions with hope/hopelessness measured as outcomes and written in English. We used the random-effects model to compute effect size using Hedges' g and conducted moderator analyses.

RESULTS

We found 27 primary studies which included 1,998 participants who were 57.6 ± 8.0 years old across studies. The psychotherapy effect size ranged from - 0.86 to 2.92. Researchers who conducted psychotherapy at hospital/health centers showed higher effects, that is, improved hope scores (g = 0.63), than those who conducted psychotherapy in the community (g = 0.05). When researchers enrolled participants alone, psychotherapy resulted in higher effects (g = 0.62) than when partners/caregivers were involved (g = - 0.04). Researchers who included group discussion showed lower effects (g = 0.36) than without group discussion (g = 1.10). Researchers who examined fidelity found lower effects (g = 0.16) than researchers who did not examine fidelity (g = 0.66). Interestingly, researchers who studied people with breast cancer showed higher effects (g = 0.96) than those who studied people with other types of cancer (g = 0.26). Researchers who included higher percentages of women showed greater effects (slope = 0.008, Q_model = 3.99, p = 0.046). Finally, the greater the time span between psychotherapy and the measurement of hope, the lower the psychotherapy effects (slope = - 0.002, Q_model = 4.25, p = 0.039).

CONCLUSION

Psychotherapy had a solid moderate effect on reducing hopelessness and improving hope in cancer patients compared to controls.

The Effect of Educational Intervention Based on PRECEDE Model on Health Promotion Behaviors, Hope Enhancement, and Mental Health in Cancer Patients

In this experimental study, 200 cancer patients (100 subject in experimental group and 100 subjects in control group) referred to Amir Oncology Hospital in Shiraz were investigated. Educational intervention for experimental group consisted of 12 educational sessions for 50 to 55 minutes. A questionnaire including demographic information, PRECEDE constructs (knowledge, attitude, self-efficacy, enabling factors, and social support), was used to measure health promotion behaviors, patients' hope, and mental health before and 6 months after intervention. Six months after intervention, experimental group showed significant increase in knowledge, attitude, self-efficacy, enabling factors, social supports, health promotion behaviors, patients' hope, and mental health compared to the control group. This study showed the effectiveness of intervention based on PRECEDE constructs in mentioned factors 6 months after intervention. Hence, this model can act as a framework for designing and implementing educational intervention for health promotion behaviors of cancer patients.

The effectiveness of hope-fostering interventions in palliative care: A systematic review and meta-analysis

BACKGROUND

The concept of hope is an important theme in chronic illness and palliative care and has been associated with increased psycho-spiritual well-being and quality of life. Psycho-spiritual interventions have been described in this population, but no systematic review of hope-enhancing interventions or hopelessness-reducing interventions has been conducted for persons with palliative care diseases.

AIM

To describe and assess the effectiveness of interventions in palliative care that measure hope and/or hopelessness as an outcome.

DESIGN

This systematic review and meta-analysis was pre-registered (Prospero ID: CRD42019119956).

DATA SOURCES

Electronic databases, journals, and references were searched. We used the Cochrane criteria to assess the risk of bias within studies.

RESULTS

Thirty-five studies (24 randomized controlled trials, 5 quasi-experimental, 6 pre-post studies) involving a total of 3296 palliative care patients were included. Compared with usual/standard cancer care alone, interventions significantly increased hope levels at a medium effect size (g = 0.61, 95% confidence interval (CI) = 0.28-0.93) but did not significantly reduce hopelessness (g = -0.08, 95% CI = -0.18 to 0.02). It was found that interventions significantly increase spirituality (g = 0.70, 95% CI = 0.02-1.37) and decrease depression (g = -0.29, 95% CI = -0.51 to -0.07), but had no significant effect over anxiety, quality of life, and symptom burden. Overall, quality of evidence across the included studies was rated as low.

CONCLUSIONS

Evidence suggests that interventions can be effective in increasing hope in palliative care patients.

Effects of a nursing care program based on the theory of human caring on women diagnosed with gynecologic cancer: a pilot study from Turkey

PURPOSE/OBJECTIVES

This pilot study aimed to determine the effects of a nursing care program based on the Theory of Human Caring (THC) on chemotherapy symptoms, hope, and meaning in life in women diagnosed with gynecologic cancer.

DESIGN/METHODS

This pilot study was conducted in a single-blinded, randomized controlled trial on 52 women diagnosed with gynecologic cancer in Turkey. In the present study, the experimental group was given a nursing care program based on the THC alongside routine nursing care for five sessions, while the control group received solely routine nursing care. Data were collected using the Chemotherapy Symptom Assessment Scale, the Herth Hope Scale, and the Life Attitude Profile.

FINDINGS

There was a statistically significant decrease in the frequency, severity, and degree of discomfort of some chemotherapy symptoms in the experimental group. In addition, the mean scores of hope and meaning in life were significantly higher in the study group compared to the control group.

CONCLUSIONS/IMPLICATIONS

This study revealed that a nursing care program based on the Theory of Human Caring might be of benefit for decreasing the frequency, intensity, and discomfort level of some chemotherapy symptoms, and also for improving the level of hope and meaning in life in women diagnosed with gynecologic cancer.

Developing a Living with Hope Program for Caregivers of Family Members with Advanced Cancer

A theory-based intervention, the Living with Hope Program (LWHP), was designed to foster hope in caregivers of family members with advanced cancer. The LWHP was developed from qualitative data and using Harding and Higginson's recommendations for family caregiver interventions as a guide. The LHWP is: a) focused specifically on the caregivers themselves, b) theory based, c) feasible, d) acceptable, and e) pilot tested. The program consists of a hope video and a hope activity titled Stories of the Present. A mixed-method, concurrent triangulation, pre- and post-test design was used to pilot test the LWHP. The results of the pilot test suggest the LWHP is easy to use, flexible, and feasible, and shows promise in increasing hope and quality of life scores in family caregivers.

Effectiveness of nursing intervention for increasing hope in patients with cancer: a meta-analysis

Objective:

to evaluate the efficacy of nursing interventions to increase the level of hope in cancer patients, in a meta-analysis.

Methods:

electronic databases were searched. Two of the authors independently extracted data from the eligible studies, and Stata 13.0 software was used to pool the data.

Results:

nine randomized controlled trials were included, and methodological quality of each randomized controlled trial (RCT) was evaluated using Cochrane handbook recommendations. A random effects model was used to combine results from eligible studies. The pooled results using the fixed effects model showed that scores to first effects increase significantly after the use of nursing intervention between the groups. Heterogeneity was observed among the studies for posttest (df = 8, P = 0.000; I² =76.1 %). The results indicated significant heterogeneity across the nine selected studies. The test for heterogeneity showed no homogeneity among studies for follow-up (df = 8, P = 0.328; I² = 12.9 %), and there was no statistical significance.

Conclusion:

the current evidence suggests that nursing intervention has a positive effect on hope in cancer patients. However, more large-scale and high-quality randomized controlled trials are needed to confirm these results.

Post-traumatic stress symptoms in family caregivers of intensive care unit patients: A longitudinal study

OBJECTIVES

To describe the prevalence and trajectory of family caregivers' post-traumatic stress symptoms during the first year after a patient's admission to the intensive care unit and identify associations between family caregivers' background characteristics, hope and post-traumatic stress symptoms.

RESEARCH METHODOLOGY/DESIGNS

Family caregivers of intensive care unit patients (n = 211) completed questionnaires at patient admission to the intensive care unit and thereafter at 1, 3, 6, and 12 months. Mixed-model analyses were performed.

SETTING

Four intensive care units in a university hospital in Norway.

MAIN OUTCOME MEASURES

Impact of Event Scale-Revised and Herth Hope Index.

RESULTS

On admission, 54% of family caregivers reported high post-traumatic stress symptom levels, which decreased during the first six  months after patient discharge. Lower levels of hope, being younger, having more comorbidities and being on sick leave were associated with higher post-traumatic stress symptom levels. Being the parent of the patient was associated with decreased post-traumatic stress symptom levels.

CONCLUSIONS

Family caregivers of intensive care unit patients report high levels of post-traumatic stress symptoms. Higher levels of hope were associated with fewer post-traumatic stress symptoms.

BRACAVENIR - impact of a psychoeducational intervention on expectations and coping in young women (aged 18-30 years) exposed to a high familial breast/ovarian cancer risk: study protocol for a randomized controlled trial

Background

Young women exposed to a high hereditary breast and ovarian cancer (HBOC) risk are particularly vulnerable. They are ignored by health prevention measures but exposed to a stream of contradictory information (medicine, media, Internet). They may feel concerned about surgical prevention issues at a key moment of their identity construction (self, relationship, sexuality). We designed a special psychoeducational intervention to help these women cope better with these difficulties.

Methods/design

The BRACAVENIR study consists of a prospective, randomized superiority phase II trial with a wait list control group. Participants are childless young female counselees (aged 18–30 years) seen at the oncogenetics department of the Centre Jean Perrin and belonging to HBOC families either with or without BRCA mutations. They will be invited to attend a weekend group session at a spa resort and to participate in short expert conferences and focus group activities (group sharing, Moreno role game) supervised by a psychotherapist. Two sessions separated by a 6-month delay (wait list) will enable us to evaluate the intervention’s effect by comparing questionnaire scores between the 6-month time points. The main endpoint is an increase of the Herth Hope Index by at least 1 SD. Secondary endpoints are self-esteem, anxiety trait, anxiety state, coping, and quality of life. With a one-sided α = 0.05 and β = 0.20, 12 participants will be needed by group, plus an additional 2 in anticipation of dropouts. Participants will be randomized 1:1 to the first or the second session so that the groups will be comparable.

Discussion

The intent of this trial is to bridge the gap on a psychosocial level in these young women with HBOC. A particularity of the design is the use of a waiting list, which should allow for avoiding major bias. The intervention consists of a short session that could be proposed to other young counselees if successful. The results may bring complementary information to facilitate the intervention and also influence the contents of the oncogenetic consultation.

Trial registration

Ethics committee CPP SUD-EST-6: IRB00008526. Registered on 18 March 2016.

ClinicalTrials.gov identifier: NCT02705924. Registered on 2 March 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1642-4) contains supplementary material, which is available to authorized users.

Composing hope through collage: A community-based intervention for cancer survivors living with lymphedema

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.

Treatment of holistic suffering in cancer: A systematic literature review

BACKGROUND

Holistic suffering is a debilitating problem for cancer patients. Although many treatments have been suggested for its alleviation, they have not been compared for effectiveness.

AIM

This literature review seeks to identify what interventions are effective in treatment of holistic suffering of cancer patients.

DESIGN

A systematic review was conducted to identify and evaluate studies of interventions for holistic suffering in adult cancer patients. Search terms were generated iteratively from the literature.

DATA SOURCES

MEDLINE, EMBASE, the Cochrane Library and PsycINFO databases were searched for the years 1992-2015. Included studies were peer-reviewed, English language reports of either a controlled trial or a randomised controlled trial focusing on therapies aimed at relieving suffering in adult cancer patients. Articles were excluded if focused predominantly on spiritual or existential issues or concerns not leading to suffering. Studies were graded for quality using the QualSyst quantitative checklist. Levels of evidence were ascertained by completing the National Health and Medical Research Council criteria. Results are reported according to AMSTAR guidelines.

RESULTS

The studies represented seven intervention types. Meaning-centred, hope-centred and stress-reduction interventions were found to be effective. Results of both psycho-educational and spiritual interventions in improving spiritual well-being were mixed. Supportive-expressive interventions - with the exception of forgiveness therapy - were not efficacious. There was little or no evidence for the efficacy of creative and healing arts and other assessed interventions such as animal therapy and haptotherapy.

CONCLUSION

This systematic review found that spiritual well-being, meaning, hope and benefit finding can be positively impacted by a variety of treatment modalities.

The Relationship between Hope and Self-Esteem in Patients with Leukemia

INTRODUCTION

Patients with hematologic malignancies often experience many emotional reactions which are different based on patient's culture. Indeed culture determines the different ways that patients understand cancer. Accordingly, the aim of this study was to determine the relationship of self-esteem and hope among Iranian cancer patients.

METHODS

This descriptive-correlational study was undertaken among 85 leukemic patients admitted to Shahid Ghazi hospital in East-Azerbaijan province, Iran. They were selected using consecutive sampling method. Persian form of Hearth Hope Index and Coppersmith Self-Esteem Inventory were used to identify patients' hope and self-esteem. The data were analyzed using SPSS version 13.0.

RESULTS

The overall scores of hope and self-esteem were 33.05 (5.24) and 94.61 (11.51), respectively. There was a positive correlation between hope and self-esteem (rs = 0.73, n = 85, P < 0.001).

CONCLUSION

Although culture determines the different ways that patients understand cancer, but it seems that the self-esteem and hope relationship could be similar in different cultures. The findings of this study indicate that nurses could be helpful through designing and implementing appropriate educational programs in order to enhance hope and self-esteem of leukemia patients.

The Relationship Between Hope and Religious Coping Among Patients With Type 2 Diabetes

Background and Purpose:

Globally, diabetes is one of the most common non-contagious diseases resulting in severe complications. Fostered hope facilitates coping and improves self-care and one of the Factors affecting hope is religious beliefs. This research investigated the level of hope and its relationship with religious coping among Type 2 diabetes patients.

Material and Methods:

This correlation, cross-sectional study was conducted on 150 patients with Type 2 diabetes, who had been referred to the Karaj Diabetes Association during the period, March–June 2011, and selected through purposive sampling. A three-part questionnaire including demographic data, the Herth Hope Index, and a short form of religious coping, was used for data collection. The data were analyzed using descriptive and analytic statistics, including Pearson’s correlation coefficient, the t-test, a one-way ANOVA, and a multiple regression analysis. The set significance level was p<0.05.

Results:

The mean hope score was 34.89 (SD±8.75); most of the subjects (46.7%) showed high levels of hope. Positive religious coping, marital status, and social support significantly affected hope fostering (r=0.897, p =0.000). A significant negative relationship was found between hope and age (r=-0.373, p=0.000), and between hope and negative religious coping (r=-0.749, p=0.000).

Conclusion:

Positive religious coping, married life, and social support significantly affected the development of hope. Moreover, there was a significant positive relationship between positive religious coping and social support. So, strengthening social support could lead to increased levels of positive religious coping and fostering of hope.

Assessment of spiritual suffering in the cancer context: A systematic literature review

OBJECTIVE

An important goal of cancer medicine is relief of patients' suffering. In view of the clinical challenges of identifying suffering patients, we sought to identify valid instruments for assessing the spiritual suffering of people diagnosed with cancer.

METHOD

A systematic review of the literature was conducted in the Medline, Embase, the Cochrane Library, and PsycINFO databases seeking assessment instruments that measure either suffering or one of its synonyms or symptoms. The psychometric properties of the identified measures were compared.

RESULTS

A total of 90 articles were identified that supplied information about 58 measures. The constructs examined were: suffering, hopelessness/demoralization, hope, meaning, spiritual well-being, quality of life where a spiritual/existential dimension was included, distress in the palliative care setting and pain, distress or struggle of a spiritual nature. The Pictorial Representation of Illness and Self Measure (PRISM) (patient completed) was the most promising measure identified for measuring the burden of suffering caused by illness due to its ease of use and the inclusion of a subjective component.

SIGNIFICANCE OF RESULTS

Although the appropriateness of any measure for the assessment of spiritual suffering in cancer patients will depend on the context in which it is intended to be utilized, the PRISM is promising for measuring the burden of suffering due to illness.

Evaluation of the living with hope program for rural women caregivers of persons with advanced cancer

BACKGROUND

Hope has been identified as a key psychosocial resource among family caregivers to manage and deal with the caregiver experience. The Living with Hope Program is a self-administered intervention that consists of watching an international award winning Living with Hope film and participating in a two week hope activity ("Stories of the Present"). The purpose of this study was to examine the effects of the Living with Hope Program on self-efficacy [General Self-Efficacy Scale], loss and grief [Non-Death Revised Grief Experience Inventory], hope [Herth Hope Index] and quality of life [Short-Form 12 version 2 (SF-12v2)] in rural women caring for persons with advanced cancer and to model potential mechanisms through which changes occurred.

METHODS

A time-series embedded mixed method design was used, with quantitative baseline outcome measures repeated at day 7, day 14, and 3, 6 and 12 months. Qualitative data from the hope activity informed the quantitative data. Thirty-six participants agreed to participate with 22 completing all data collection. General estimating equations were used to analyze the data.

RESULTS

Herth Hope Index scores (p=0.05) had increased significantly from baseline at day 7. General Self Efficacy Scale scores were significantly higher than baseline at all data time points. To determine the mechanisms of the Living with Hope Program through which changes occurred, results of the data analysis suggested that as General Self Efficacy Scale scores increased (p<0.001) and Non-death Revised Grief Experience Inventory scores decreased (p=0.01) Herth Hope Index scores increased. In addition as Herth Hope Index scores increased (p<0.001) and Non-death Revised Grief Experience Inventory scores decreased (p=0.01), SF-12v2 mental health summary scores increased. Qualitative data suggested that through the hope activity (Stories of the Present) the participants were able to find positives and hope in their experience.

CONCLUSIONS

The Living with Hope Program has potential to increase hope and improve quality of life for rural women caregivers of persons with advanced cancer. The possible mechanisms by which changes in hope and quality of life occur are by decreasing loss and grief and increasing self-efficacy.

TRIAL REGISTRATIONS

Registration ClinicalTrials.gov, NCT01081301.

Effects of Psycho-Oncologic Interventions on Emotional Distress and Quality of Life in Adult Patients With Cancer: Systematic Review and Meta-Analysis

Purpose

This study aimed to evaluate the effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer.

Methods

Literature databases were searched to identify randomized controlled trials that compared a psycho-oncologic intervention delivered face-to face with a control condition. The main outcome measures were emotional distress, anxiety, depression, and quality of life. Outcomes were evaluated for three time periods: post-treatment, ≤ 6 months, and more than 6 months. We applied standard meta-analytic techniques to analyze both published and unpublished data from the retrieved studies. Sensitivity analyses and meta-regression were used to explore reasons for heterogeneity.

Results

We retrieved 198 studies (covering 22,238 patients) that report 218 treatment-control comparisons. Significant small-to-medium effects were observed for individual and group psychotherapy and psychoeducation. These effects were sustained, in part, in the medium term (≤ 6 months) and long term (> 6 months). Short-term effects were evident for relaxation training. Studies that preselected participants according to increased distress produced large effects at post-treatment. A moderator effect was found for the moderator variable “duration of the intervention,” with longer interventions producing more sustained effects. Indicators of study quality were often not reported. Small-sample bias indicative of possible publication bias was found for some effects, particularly with individual psychotherapy and relaxation training.

Conclusion

Various types of psycho-oncologic interventions are associated with significant, small-to-medium effects on emotional distress and quality of life. These results should be interpreted with caution, however, because of the low quality of reporting in many of the trials.

Evolving definitions of hope in oncology

PURPOSE OF REVIEW

This review updates the literature on hope and oncology following a prior review of studies up until 2009. It particularly focusses on the evolution of the definition of hope in the light of the clinical experience of patients with cancer, their carers and health professionals.

RECENT FINDINGS

Hope creates meaning for patients and is an important coping mechanism. Clinicians are wary of communicating bad news because it may deprive patients of hope, but work with decision aids suggests that this communication can be managed successfully. Hope and optimism negatively correlate with anxiety and depression. Maintaining hope may result in patients with incurable cancer accepting treatments or trials with little chance of benefit. Hope also needs to be maintained by palliative care nurses who harmonize their hopes with the different degrees and constructs of hope around them. Hope interventions can be successful in increasing hope and decreasing psychological distress.

SUMMARY

More research is required into how to communicate about active anticancer treatment withdrawal and prognosis without depriving patients with cancer of hope, given how important hope is in alleviating psychological distress. The optimal intervention to increase levels of hope needs further investigation.

Hope in adults with cancer: state of the science

PURPOSE/OBJECTIVES

To synthesize the literature regarding research on hope in adults with cancer.

DATA SOURCES

CINAHL Plus® and PsycINFO databases.

DATA SYNTHESIS

Sixteen articles published from 2005-2009 met the criteria for review. The literature was organized according to Oncology Nursing Society levels of evidence. Research studies on hope in adults with cancer were analyzed, critiqued, and synthesized.

CONCLUSIONS

Research evidence continues to grow regarding descriptions of hope and hope attributes in adults with cancer. Although nursing intervention programs have demonstrated positive effects on hope in adults newly diagnosed with cancer, those with a first cancer recurrence, the terminally ill, and survivors of childhood cancer, current studies are small and additional research is indicated.

IMPLICATIONS FOR NURSING

Opportunities exist to explain the dynamic process of hope, develop hope interventions that are tailored to meet the developmental needs of adults with cancer, and study existing nursing programs that support hope using larger samples in randomized, controlled trials.

Factors affecting hope in a sample of fatigued breast cancer outpatients

OBJECTIVE

The aims of this study of women with breast cancer were: to describe the levels of hope and compare hope scores for these patients with a sample from the general Norwegian population; to describe the relationship between hope and fatigue; and finally to evaluate the effect of demographic and clinical characteristics and fatigue on hope.

METHOD

A total of 160 Norwegian outpatients with cancer and fatigue (>2.5 on a 0-10 scale) completed the Herth Hope Index (HHI), Fatigue Questionnaire (FQ), and Self-administered Comorbidity Questionnaire (SCQ).

RESULTS

The mean age of the women was 55.3 years (SD = 9.4), 81% lived with someone, and 67% were employed. The most common comorbidities were back pain (42%), osteoarthritis (26%), and headache (19%). The fatigued breast cancer patients reported significantly higher total hope scores than the general Norwegian population (p < .0001). The difference was largest in the individual item "I can see a light in the tunnel," to which the cancer sample reported the highest scores, but they also felt more "scared about the future." Total hope score was negatively correlated with total fatigue (TF), mental fatigue (MF), and chronic fatigue (CF), but not with physical fatigue (PF). Demographic and clinical characteristics were not significantly related to hope, except that patients who were married or living with someone showed significantly higher total hope scores.

SIGNIFICANCE OF RESULTS

The higher levels of hope in breast cancer patients compared with the general Norwegian population may reflect a response shift in patients after getting a cancer diagnosis. The fact that a significant relationship was found between total hope scores and living arrangements may indicate that hope is easier to establish when patients have someone to relate to or receive support from. Hope and total fatigue were significantly, but weakly correlated.

Placebo interventions for all clinical conditions

BACKGROUND

Placebo interventions are often claimed to substantially improve patient-reported and observer-reported outcomes in many clinical conditions, but most reports on effects of placebos are based on studies that have not randomised patients to placebo or no treatment. Two previous versions of this review from 2001 and 2004 found that placebo interventions in general did not have clinically important effects, but that there were possible beneficial effects on patient-reported outcomes, especially pain. Since then several relevant trials have been published.

OBJECTIVES

Our primary aims were to assess the effect of placebo interventions in general across all clinical conditions, and to investigate the effects of placebo interventions on specific clinical conditions. Our secondary aims were to assess whether the effect of placebo treatments differed for patient-reported and observer-reported outcomes, and to explore other reasons for variations in effect.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 4, 2007), MEDLINE (1966 to March 2008), EMBASE (1980 to March 2008), PsycINFO (1887 to March 2008) and Biological Abstracts (1986 to March 2008). We contacted experts on placebo research, and read references in the included trials.

SELECTION CRITERIA

We included randomised placebo trials with a no-treatment control group investigating any health problem.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Trials with binary data were summarised using relative risk (a value of less than 1 indicates a beneficial effect of placebo), and trials with continuous outcomes were summarised using standardised mean difference (a negative value indicates a beneficial effect of placebo).

MAIN RESULTS

Outcome data were available in 202 out of 234 included trials, investigating 60 clinical conditions. We regarded the risk of bias as low in only 16 trials (8%), five of which had binary outcomes.In 44 studies with binary outcomes (6041 patients), there was moderate heterogeneity (P < 0.001; I(2) 45%) but no clear difference in effects between small and large trials (symmetrical funnel plot). The overall pooled effect of placebo was a relative risk of 0.93 (95% confidence interval (CI) 0.88 to 0.99). The pooled relative risk for patient-reported outcomes was 0.93 (95% CI 0.86 to 1.00) and for observer-reported outcomes 0.93 (95% CI 0.85 to 1.02). We found no statistically significant effect of placebo interventions in four clinical conditions that had been investigated in three trials or more: pain, nausea, smoking, and depression, but confidence intervals were wide. The effect on pain varied considerably, even among trials with low risk of bias.In 158 trials with continuous outcomes (10,525 patients), there was moderate heterogeneity (P < 0.001; I(2) 42%), and considerable variation in effects between small and large trials (asymmetrical funnel plot). It is therefore a questionable procedure to pool all the trials, and we did so mainly as a basis for exploring causes for heterogeneity. We found an overall effect of placebo treatments, standardised mean difference (SMD) -0.23 (95% CI -0.28 to -0.17). The SMD for patient-reported outcomes was -0.26 (95% CI -0.32 to -0.19), and for observer-reported outcomes, SMD -0.13 (95% CI -0.24 to -0.02). We found an effect on pain, SMD -0.28 (95% CI -0.36 to -0.19)); nausea, SMD -0.25 (-0.46 to -0.04)), asthma (-0.35 (-0.70 to -0.01)), and phobia (SMD -0.63 (95% CI -1.17 to -0.08)). The effect on pain was very variable, also among trials with low risk of bias. Four similarly-designed acupuncture trials conducted by an overlapping group of authors reported large effects (SMD -0.68 (-0.85 to -0.50)) whereas three other pain trials reported low or no effect (SMD -0.13 (-0.28 to 0.03)). The pooled effect on nausea was small, but consistent. The effects on phobia and asthma were very uncertain due to high risk of bias. There was no statistically significant effect of placebo interventions in the seven other clinical conditions investigated in three trials or more: smoking, dementia, depression, obesity, hypertension, insomnia and anxiety, but confidence intervals were wide.Meta-regression analyses showed that larger effects of placebo interventions were associated with physical placebo interventions (e.g. sham acupuncture), patient-involved outcomes (patient-reported outcomes and observer-reported outcomes involving patient cooperation), small trials, and trials with the explicit purpose of studying placebo. Larger effects of placebo were also found in trials that did not inform patients about the possible placebo intervention.

AUTHORS' CONCLUSIONS

We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed.

[Herth Hope Index--instrument adapted and validated to Portuguese]

This study was aimed at making available the Herth Hope Index adapted and validated into Portuguese in a study carried out with chronic disease patients. The scale is based on the original American instrument, and made possible the existence of an instrument to measure hope, something that did not exist previously in Brazil. For the cultural adaptation and validation were followed the methods that the literature recommends. The sample was comprised of 131 patients divided into 3 groups, of which 47 were oncology patients, 40 2-type diabetes patients, and 44 caretakers of these patients. The instrument consists of 12 statements with Likert-type answers with scores from 1 to 4 each; the higher the score, the higher the hope. The adapted Herth Hope Index has demonstrated suitable psychometric properties and for that reason is available for use.

Cancer survivors' views of work 3 years post diagnosis: a UK perspective

The impact of cancer on people's working lives is an increasingly important concern but knowledge on this issue is very limited in the UK. Forty-one people of working age were purposively selected from the North Western Cancer Intelligence Service and interviewed by telephone to describe their experiences to returning to work following diagnosis and treatment. The data was subject to qualitative thematic analysis using NVIVO software. The results indicated the importance of returning to work from diagnosis and through treatment which was then followed by a re-assessment of work-life balance when people recovered from primary treatment and were back in employment. The principle motivations for returning to work were a quest for normality and financial pressures. One barrier to returning to work was the lack of medical advice from cancer specialists and general practitioners regarding the appropriate time to get back to work. A good relationship with their employer/manager was a major influence on returning to work and appeared to be related to duration of service rather than occupational status. These findings demonstrate the importance of paid work to people diagnosed with cancer and highlight the need to improve the support from medical professionals, especially oncology nurses.

The Role of Hope in Patients With Cancer

PURPOSE/OBJECTIVES

To synthesize the literature, develop generalizations, and identify issues that should be evaluated in the future in regard to hope and patients with cancer.

DATA SOURCES

MEDLINE, CINAHL, and PsycINFO databases.

DATA SYNTHESIS

Twenty-six research articles published from 1982-2005 met the criteria for review. Four major themes emerged: (a) exploring the level of hope in patients with cancer, (b) discovering how patients cope with a cancer diagnosis, (c) identifying strategies that patients with cancer commonly use to maintain hope, and (d) identifying nursing interventions used to assist patients with cancer in maintaining and fostering hope.

CONCLUSIONS

The concept of hope should be developed systematically to extend knowledge and build a logical program of research based on previous studies.

IMPLICATIONS FOR NURSING

Nurses need to develop new interventions to foster patients' hope and new instruments that can be used to measure outcomes.

Living with hope: initial evaluation of a psychosocial hope intervention for older palliative home care patients

The overall purpose of this study was to evaluate the effectiveness of a psychosocial supportive intervention called the "Living with Hope Program" (LWHP) in increasing hope and quality of life for older adult, community-living, terminally ill cancer patients. Using a mixed method concurrent nested experimental design, 60 terminally ill cancer patients over the age of 60 years were randomly assigned to a treatment group and a control group. Baseline hope (Herth Hope Index [HHI]) and quality-of-life scores (McGill Quality of Life Questionnaire [MQOL]) were collected at the first visit in the patients' homes by trained research assistants. Those in the treatment group received the LWHP, which consisted of viewing an international award-winning video on hope and a choice of one of three hope activities to work on over a one-week period. The control group received standard care. Hope and quality-of-life data were collected one week later from both groups. Qualitative data using open-ended hope questions were collected from the treatment group. Patients receiving the LWHP had statistically significant higher hope (U=255, P=0.005) and quality-of-life scores at Visit 2 (U=294.5, P=0.027) than those in the control group. Qualitative data confirmed this finding, with the majority (61.5%) of patients in the treatment group reporting the LWHP increased their hope. This preliminary evaluation of the effectiveness of the LWHP suggests that it may increase hope and quality of life for older terminally ill cancer patients at home.

Hope: a construct central to nursing

PURPOSE

To enhance understanding of the concept of hope from a synthesis of varied perspectives.

SOURCE

Published literature.

CONCLUSIONS

Conceptualizations of hope influence one's view of "false hope." Critical dimensions of hope as well as hope antecedents and threats provide direction for nursing intervention. Specific challenges to nurses related to hope inspiration are present at the end of life. Hope-inspiring strategies for persons at the end of life are summarized.

Editorial: Brain tumour treatment: the concept of inter- and multidisciplinary treatment

The treatment of brain tumors has improved in recent years. The principles of treatment are accurate diagnosis by imaging and neuropathology, treatment by neurosurgery, neurooncology, medical oncology, radiotherapy and optimal care and supportive strategies in a multidisciplinary setting. The development of multidisciplinary neurooncologic teams and of centers of excellence will further improve treatment quality and care. The multidisciplinary team is not confined to medical treatment alone, but needs the expertise of specially trained nurses, psychologists, occupational therapists, speech therapists and social workers to meet the needs of patients and carers.

Hope promoting strategies of Registered Nurses

AIM

This paper describes self-reported hope-promoting strategies used by Registered Nurses whilst providing care for older patients in acute and long-term care settings.

BACKGROUND

The literature is replete with claims that Registered Nurses engage in hope facilitation with their patients. However, these claims are largely conjecture, with few studies empirically identifying the extent to which Registered Nurses use hope interventions with their patients. Further, some authors have questioned whether nurses have the necessary skills to undertake this vital aspect of care.

METHODS

In this Gadamerian hermeneutic phenomenological study, undertaken in 2003 in Australia, we used in-depth audiotaped interviews to collect data with 14 Registered Nurses. The interviews were transcribed verbatim and analysed using the Turner method.

FINDINGS

Whilst participants clearly reported that they engaged in hope facilitation with older patients, there were differences between the reported strategies used by Registered Nurses in acute and long-term care settings. Further, the strategies reported were not unique to hope promotion and have been variously described in the literature on caring, presencing, holistic nursing and therapeutic nursing.

CONCLUSION

It is clear that participants considered hope promotion to be a vital aspect of their care. However, the strategies that they reported were limited and not inclusive of many and varied suggestions emerging from published studies on hope promotion. Therefore, we recommend that nursing curricula, professional development and in-service education programmes place hope facilitation on their agenda and foster a culture in which promoting hope is seen as a vital aspect of nursing care.

Hope and Related Variables in Italian Cancer Patients

Hope, long considered an essential element for life, has been shown to be important among cancer patients in coping, perceived control over the illness, and psychologic adjustment to the illness. The purpose of this study was (a) to describe the level of hope in Italian cancer patients; (b) to compare the levels of hope during and after hospitalization; (c) to determine whether hope was correlated with quality of life and several symptoms; and (d) to determine whether the variables from the international literature also pertain to Italian cancer patients. A descriptive correlational design using repeated measures was chosen to study 80 Italian cancer patients during hospitalization and then at home. The following instruments were used: a Sociodemographic Questionnaire, the Hope Related Variable Questionnaire, the Nowotny Hope Scale, the Rotterdam Symptom Checklist, and the Hospital Anxiety and Depression Scale. Overall, patients were moderately hopeful and the level of hopefulness was similar in the hospital and at home. Hope was positively correlated with quality of life, self-esteem, coping, adjustment to the illness, well-being, comfort in the hospital, satisfaction with information received, relationship with, and support from family, healthcare professional, and friends. Hope was negatively correlated with anxiety, depression, and boredom during hospitalization. Time since diagnosis, illness stage, and knowing or not knowing the diagnosis and treatment were not correlated with hope. Similarities and differences with the international literature are discussed, and implications for caring for Italian cancer patients are drawn.

Admiring courage: Nurses' perceptions of caring for patients with cancer

This paper details one of the findings of a large phenomenological study into the effects of nurse-patient encounters on clinical learning and practice. Every nurse faces the challenge of caring for a patient with cancer at some point in his or her nursing career. The participants, 392 nurses, were asked to provide an account of a care episode from their practice. These narrative/clinical exemplars were for a patient with a diagnosis of cancer and participants were asked to discuss the impact this encounter had on clinical learning and clinical practice. Each day nurses work through the daily grind of the job and occasionally encounter a person, who inspires them, someone they admire because of their courage. Responses from the participants identified a number of such people. Nurses used powerful language, brave, strong, courageous, to describe these patients. The diagnosis of cancer is a daunting prospect and is seen as a challenge physically and emotionally. Participants spoke of their admiration, affection and their sadness when describing the nurse-patient encounters. The life-threatening potential of cancer for the patient and the perception of potential and actual suffering does impact on nurses, their learning and their clinical practice. The struggle against such a daunting adversary places patients diagnosed with cancer in a position to be seen by nurses as people with immense courage. Participants clearly felt the influence of patients' courage, personally and professionally. Many spoke of the inspirational qualities of their patients. Participants detailed learning from the encounters and reflected with great insight on themselves and their practice. The identified nurse-patient encounters were seen to have changed their clinical practice forever.

The professional role of breast cancer nurses in multi-disciplinary breast cancer care teams

Since the 1970s breast cancer services have witnessed considerable changes in the management of patients. One significant change was the introduction of specialist core personnel, including the breast care nurse (BCN). The role of the BCN has been gaining credence rapidly in the British NHS and this service is perhaps the paradigm of care for other services. With the lack of specific evidence of the role of specialist nurses in the breast care team, the current study aims to explore this area by in-depth interviews with core team members, and observations of 16 multi-disciplinary teams in England. The study explores the following themes: Nurses' unique informal management leadership role in ensuring the co-ordination, communication and planning of the team work; nurses' innovatory role in making the bureaucracy respond to patients and their relatives needs; nurses supportive role in the provision of expert advice and guidance to other members of the team; nurses confidence and humour in well-performing teams; and the limitations of the professional role of the breast cancer nurse. This study indicates that there is evidence that the BCN is practicing at an advanced level of practice. However, there is a severe lack of evidence-based description of that advanced practice. Cancer nurses including the BCNs should develop and participate in programmes of research in line with cancer legislation in order to build an evidence base that ultimately supports their unique role.

Hope, health work and quality of life in families of stroke survivors

AIM

This paper reports a study to examine the relationships among hope, family health promotion, and quality of life after stroke, by testing hypotheses derived from the Developmental Model of Health and Nursing.

BACKGROUND

Little attention has been given to the influences of family strengths on health promotion behaviours and quality of life after stroke. The majority of studies have focused on stroke survivors, not their spouses.

METHOD

A descriptive, correlational study was carried out with 40 families of stroke survivors with moderate to severe functional impairments and their spouses. Both partners completed the Herth Hope Index (measure of hope), the Health Options Scale (measure of health work), the Reintegration to Normal Living Index (measure of quality of life) and a demographic questionnaire.

RESULTS

For both partners, moderate, positive relationships were found between hope and health work (r = 0.52, r = 0.39, P < 0.01) and between hope and quality of life (r = 0.59, r = 0.32, P < 0.05). Family health work was positively associated with quality of life of stroke survivors (r = 0.50, P </= 0.001), but not their spouses. Spouses' employment status, number of supports and functional independence at discharge predicted 40.6% and 46.3% of the variance in quality of life for stroke survivors and spouses, respectively, with the combination of hope and health work contributing an additional 17.8% in predicting stroke survivors' quality of life but no additional variance to the prediction of spouses' quality of life.

CONCLUSION

Theoretical relationships of the Developmental Model of Health and Nursing were supported for stroke survivors, but the model was less useful in explaining spouses' experiences of hope, health work and quality of life. Findings provide direction for identifying 'at risk' families and raise awareness of the contribution of caregiver burden to quality of life in families of stroke survivors.

Comparison of quality of life between urban and rural gastric cancer patients and analysis of influencing factors

AIM: The conception of quality of life has been widely accepted by clinic doctors. Evaluations of the treatment effect of chronic diseases have been changed to depend not only on the survival time, but also on the quality of life of the patients. Fuzhou City and Changle County are high-incidence areas of the gastric cancer in Fujian Province. The aims of this research were to compare the quality of life of urban patients with that of rural patients and analyze the factors influencing quality of life of gastric cancer patients in Fujian Province.

METHODS: The samples were drawn with cluster sampling. The urban sample consisted of 162 patients aged 25 to 75 with 143 males and 19 females. The rural sample consisted of 200 patients aged 32 to 78 with 166 males and 34 females. The patients in both the urban and rural areas were investigated, and their scores on 21 items reflecting the quality of life were measured. The methods of t test and stepwise regression were used to analyze the data.

RESULTS: The average total scores of quality of life of the urban patients and rural patients were 64.11 and 68.69 respectively. There was a significant difference between the means of two samples (P = 0.0004). Seven variables in the regression model estimated by the urban sample and 4 variables in the model by the rural sample were at the level of significance α = 0.05. Family income, nutrition and rehabilitating exercise were selected into both the urban and rural regression models.

CONCLUSION: Most of the gastric cancer patients have poor quality of life in Fujian Province and the rural patients have lower quality of life than that of urban patients. The patients having more family income have better quality of life, and enhanced nutrition and doing rehabilitating exercise are helpful in improving the quality of life of the gastric cancer patients.