Hope, expectations and recovery from illness: a narrative synthesis of qualitative research

The co-construction and emotion management of hope within psychosis services

Introduction

There is a growing acknowledgement of the salience of hope for mental health service-users, in influencing care outcomes and recovery. Understandings of the processes through which hopes are co-constructed, alongside specific conceptualisations of experiences of hoping, remain limited however.

Methods

This qualitative study explored how a range of stakeholders experienced and dealt with uncertainty within three purposively selected psychosis services in southern England. In this article we focus particularly on the co-construction of hope within participants' narratives and how this emotion work shaped experiences of hoping. In-depth interviews (n = 23) with service-users, professionals, managers and other stakeholders were analysed following a phenomenological approach.

Findings

Hope was spontaneously identified by participants as a fundamental mechanism through which service-users and professionals managed uncertainty when vulnerable. Professionals were influential in shaping users' hopes, both intentionally and unwittingly, while some professionals also referred to managing their own hopes and those of colleagues. Such management of expectations and emotions enabled motivation and coping amidst uncertainty, for users and professionals, but also entailed difficulties where hope was undermined, exaggerated, or involved tensions between desires and expectations.

Discussion

Whereas, hope is usually reflected in the caring studies literature as distinctly positive, our findings point to a more ambivalent understanding of hope, as reflected in the accounts of both service-users and professionals where elevated hopes were described as unrealistic and harmful, to the well-being of professionals as well as of service-users. It is concluded that a greater awareness within care contexts of how hopes are co-constructed by professionals and service-users, explicitly and implicitly, can assist in improving health care and healthcare outcomes.

Ponderings, Pleas and Prayer: A Qualitative Content Analysis of Danish Hospital Chapel Guest Books

In Denmark, religious behavior is usually very private. Little is known of religious and spiritual needs of patients and family during critical illness and hospitalization. We aimed to explore contemporary thoughts and prayers related to critical illness and hospitalization expressed in hospital chapel Guest Books. Qualitative content analysis of written texts was performed on Guest Books completed from 2005-2019. We identified the main themes of health and illness, life and death, and science and religion. Visitors welcomed the Guest Books as a place to express religious and spiritual thought, even in a nominally nonreligious society.

The Effects of Expectations and Worries on the Experience of COVID-19 Symptoms

Introduction

The COVID-19 pandemic has been shown to have profound effects on both mental and physical health. Distress and widespread uncertainty about global events and personal risk are associated with increased worry and negative expectations that impact physical health. Thus, the current pandemic poses a possibility for the experience of nocebo effects.

Objective

To evaluate the likelihood of nocebo-induced COVID-19 symptoms in a US sample.

Methods

An online study on the mental health impact of COVID-19 asked participants to complete a set of biweekly surveys over a 6-month period between April 2020 and May 2021. We focus on responses from 3,027 individuals who reported never testing positive for COVID-19. We assessed the association between two types of worry and self-reported symptoms of COVID-19. We used multi-level models to examine variations across and within participants over time. We further investigated the effects of pre-existing health conditions and mental health status.

Results

There was a positive association between symptoms and both general (b= 2.56, p<0.01) and personal worry (b=2.77, p<0.01). However, worry reported at one timepoint was not specifically associated with symptoms reported two weeks later (p = 0.63, p=0.56). We also found that a greater number of prior clinical comorbidities and greater mental health burden were significant predictors of symptom reporting.

Conclusions

These results suggest that increased worries during the COVID-19 pandemic were associated with greater symptoms. Further studies investigating worry and symptoms in populations with confirmed negative COVID-19 tests or isolated populations will be needed to isolate the occurrence of true nocebo effects during the pandemic.

Hope therapy in cancer patients: a systematic review

AIM

To identify the associated factors of hope therapy during treatment in cancer patients.

BACKGROUND

Hope is very important to cancer patients at all stages of the disease process. Several and different factors are associated with hope.

DESIGN

A systematic literature review of quantitative empirical studies on hope and quality of life in cancer patients.

DATA SOURCES

Search in MEDLINE, Psychinfo, and Cochrane (January 2010-December 2020).

REVIEW METHODS

A coherent search strategy was designed where MESH terms were combined with "free text" terms: hope (e.g., hope therapy, Herth Hope Index, quality of life) and cancer (e.g. neoplasm, tumor). Two authors independently screened all the studies and assessed their quality.

RESULTS

Twenty studies were included. The overall score of Herth Hope Index in cancer patients was 36.93, and the overall score of quality of life in cancer patients were 47.52. Also, the trend of quality of life and Herth Hope Index in cancer patients has been decreasing, from 2010 to 2020.

CONCLUSIONS

This systematic literature review of associated factors of hope in cancer patients receiving treatment shows that hope seems to be positively related mainly by intrinsic factors, such as perceived health, quality of life, and social support.

How is recovery defined and measured in patients with low back pain? Protocol for a mixed study systematic review

INTRODUCTION

This protocol describes the methods for a mixed study systematic review aiming to explore the definitions and measurements of recovery in patients with low back pain, and how perspectives of recovery differ between patients and providers. This review will be the first to review the concept of recovery in patients with low back pain across both quantitative and qualitative literature.

METHODS AND ANALYSIS

This protocol has been designed and reported in line with Preferred Reporting Items of Systematic Reviews and Meta-Analyses Protocols. The following databases will be electronically searched from database inception until 30 November 2021: Medline, EMBASE, CINAHL, Cochrane, PEDro. Grey literature will be searched for through targeted searching of ProQuest Dissertations and Theses and handsearching of the references of all included studies. Studies will be included if they include a patient population of >50% with low back pain (with or without leg pain), and mention the concept of recovery within the abstract, methods or results. The Mixed Methods Appraisal Tool will be used for quality assessment of both quantitative and qualitative included studies. Two independent reviewers will conduct the search, screen titles/abstracts and extract relevant data from full texts. Discrepancies between reviewers will be settled by a third reviewer with spinal pain expertise. For syntheses, thematic analysis will be used to analyse both qualitative and quantitative investigations to explore meanings, measurement and perspectives of recovery from a diverse evidence base. There is no clinical trial associated with this protocol.

ETHICS AND DISSEMINATION

There are no ethical issues associated with this systematic review, and ethics approval was not required. Once completed, the results of this review will be published in a peer-reviewed journal within the realm of spinal pain to help guide future research inquiries.

PROSPERO REGISTRATION NUMBER

CRD42022295804.

Youth Attitudes Towards Their Future: the Role of Resources, Agency and Individualism in the UK

Young adults tend to be more optimistic about the future than older people, even during social and economic crises such as those created by the COVID pandemic. In this paper, we analyse survey data from a previous economic crisis to examine why young adults remain optimistic about their personal futures, and to consider what lessons, if any, this can help us with thinking about a post-COVID future. The data in question are drawn from a unique cross-sectional survey of young adults aged 22–29 in England, Scotland and Wales conducted in 2014, when youth unemployment in the UK was still extraordinarily high. Using these data, we assess the effect of resources, agency and individualism on young adults’ optimism. Multiple regression models of these data show that individual resources and individual attitudes not only have an independent effect on levels of youth optimism, but they can also interact. In particular, we argue that self-efficacy is the strongest predictor of youth optimism, together with educational resources, but we also show that some youth attitudes (namely individualism) affect youth optimism in different ways, depending on the level of individual-level resources available to the young person. These findings highlight the complexity of understanding youth optimism and point us towards possibilities for supporting young adults in post-pandemic times.

Recovery from chronic fatigue syndrome: a systematic review-heterogeneity of definition limits study comparison

BACKGROUND

Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a common illness with a major impact on quality of life. Recovery is poorly understood. Our aim was to describe definitions of recovery in paediatric CFS/ME, the rate of recovery and the time to recovery.

METHODS

This systematic review included a detailed search of MEDLINE, EMBASE, PsycInfo and Cochrane Library between 1994 and July 2018. Inclusion criteria were (1) clinical trials and observational studies, (2) participants aged <19 years with CFS/ME, (3) conducted in Western Healthcare systems and (4) studies including a measure of recovery and time taken to recover.

RESULTS

Twelve papers (10 studies) were identified, involving 826 patients (range 23-135). Recovery rates were highly varied, ranging between 4.5% and 83%.Eleven distinct definitions of recovery were used; six were composite outcomes while five used unidimensional outcomes. Outcome measures used to define recovery were highly heterogeneous. School attendance (n=8), fatigue (n=6) and physical functioning (n=4) were the most common outcomes included in definition of recovery. Only five definitions included a personal measure of recovery.

IMPLICATIONS

Definitions of recovery are highly variable, likely secondary to differences in study design, outcomes used, follow-up and study populations. Heterogeneous definitions of recovery limit meaningful comparison between studies, highlighting the need for a consensus definition going forward. Recovery is probably best defined from the child's own perspective with a single self-reported measure. If composite measures are used for research, there should be agreement on the core outcome set used.

Shared decision making in youth with brachial plexus birth injuries and their families: A qualitative study

OBJECTIVE

The objective of this study is to elucidate the decision-making experiences of youth with brachial plexus birth injuries who face preference-sensitive decisions regarding treatment options for a persistent elbow contracture.

METHODS

Transcripts, research-created drawings, and field notes from in-depth interviews with 5 young adults and 14 youth-parent dyads, and 15 participant observation sessions of families and clinicians in the clinic setting were deductively and inductively coded and thematically analyzed.

RESULTS

Youth's shared decision making was influenced by relational processes with their clinicians and parents. Youth's trust in their clinicians' recommendations for pursuing treatment and pressure from their parents to pursue or continue rehabilitation treatment affected how their voices were expressed and heard. Parental emotional adjustment to the birth injury played a role in parental perceptions of what was deemed their youth's best interest in the shared decision.

CONCLUSIONS

The decision-making experiences of youth with brachial plexus birth injury illustrate the complexity of paediatric preference-sensitive decisions and the significance of social and emotional factors on these shared decisions.

PRACTICE IMPLICATIONS

Opportunity for youth to express their voice without external pressure during shared decision making is needed to make well-informed decisions based on their own values. Interventions such as decision coaching and decision support tools may help youth and parents to formally identify and discuss these relational processes.

Patient Expectations for Synchronous Telerehabilitation Visits: A Survey Study of Telerehabilitation-Naive Patients

Background: The current study evaluated patient expectations for synchronous telerehabilitation. Because the coronavirus disease 2019 (COVID-19) pandemic decreased regulatory barriers and increased accessibility of telehealth, improved understanding of expectations may direct future educational efforts, improve implementation strategies, and inform future analyses of consumer adoption and utilization of telehealth. Methods: A cross-sectional survey design was used to measure ideal expectations (what they want to happen) and realistic expectations (what they think will happen) of telerehabilitation-naive patients for synchronous telerehabilitation. Participants were recruited through e-mail and social media and in person from seven outpatient private practice physical therapy clinics across the United States. Patients completed an online anonymous adaptation of the Patients' Expectations Questionnaire (PEQ) and were asked whether they expected synchronous telerehabilitation to benefit them personally. Open-ended responses were collected and analyzed for categories and themes. Results: Of 178 participants, the greatest mean difference between ideal and realistic expectations among PEQ subscales was for outcomes (0.49; 95% confidence interval [CI], 0.37-0.60), and the greatest mean difference among individual items was for symptom reduction (0.53; 95% CI, 0.41-0.66). Although participants appeared to appreciate the value of telerehabilitation visits, with 69.7% indicating that it would benefit them personally, many expressed a preference for face-to-face visits when possible. Discussion: Expectations were mostly positive. Lower outcomes expectations may be a potential barrier to adoption and utilization of telehealth and other types of digital physical therapy in some patients. Conclusions: To improve beliefs and address potential barriers, physical therapy clinicians should discuss expectations with patients before recommending telerehabilitation visits.

Theorising rehabilitation: Actors and parameters shaping normality, liminality and depersonalisation in a UK hospital

Sociological concern for rehabilitation remains limited. This paper aims to contribute to rehabilitation theory. It examines two units of a specialist rehabilitation hospital in the UK (amputee and neurological services) by focusing on the key actors involved - families, patients, staff - and the parameters shaping their relationships. The findings extend previous theoretical understandings of rehabilitation in three themes: normality, liminality and depersonalisation. We argue, first: normality is constantly negotiated amongst the different actors. This complicates existing works' critique of rehabilitation as reproducing the ideology of normality. Second, discourses produced during acute care shape the inpatient rehabilitation experience. This calls attention to the pre-rehabilitation phase and complicates existing works' emphasis on the transition from inpatient stay to the time of discharge. Finally, inpatient rehabilitation is notable in rendering the adverse effects of depersonalisation apparent. It combines the bureaucracy of a regular hospital ward, with institutionalising aspects of long-term care. These findings have a potential to enhance practice as well as knowledge. We call for a deeper sociological attention, combining theory-building with empirical data for a better understanding of inpatient rehabilitation.

Incident Reporting System in an Italian University Hospital: A New Tool for Improving Patient Safety

Clinical risk management constitutes a central element in the healthcare systems in relation to the reverberation that it establishes, and as regards the optimization of clinical outcomes for the patient. The starting point for a right clinical risk management is represented by the identification of non-conforming results. The aim of the study is to carry out a systematic analysis of all data received in the first three years of adoption of a reporting system, revealing the strengths and weaknesses. The results emerged showed an increasing trend in the number of total records. Notably, 86.0% of the records came from the medical category. Moreover, 41.0% of the records reported the possible preventive measures that could have averted the event and in 30% of the reports are hints to be put in place to avoid the repetition of the events. The second experimental phase is categorizing the events reported. Implementing the reporting system, it would guarantee a virtuous cycle of learning, training and reallocation of resources. By sensitizing health workers to a correct use of the incident reporting system, it could become a virtuous error learning system. All this would lead to a reduction in litigation and an implementation of the therapeutic doctor–patient alliance.

Hope and chronic pain-a systematic review

BACKGROUND

Hope is considered as an important therapeutic factor in health and illness. Chronic pain affects a significant proportion of the world's population and causes great emotional and physical suffering to patients.

OBJECTIVE

The aim of this systematic review is to explore the current literature on hope and chronic pain.

METHODS

A comprehensive review of current literature on hope and chronic pain was undertaken. Several databases were used (incorporating EBSCO, MEDLINE, PUBMED). Search terms included 'hope' and 'hopelessness' in conjunction with 'chronic pain, 'pain management' and 'pain reduction'. Articles were included if they reported a study (1) exploring outcomes of hope as an intervention for chronic pain, (2) reported on hope specifically and not related concepts and (3) included a measurement of hope.

RESULTS

A total of three articles were found which fit the inclusion criteria. Each article used different tools to measure hope. The review demonstrates a gap in the literature regarding hope as a therapeutic intervention for chronic pain specifically.

CONCLUSIONS

The findings of this review demonstrate that hope is influenced by several patient factors and has a positive impact on patients with chronic pain. The current literature supports the usefulness of hope as a therapeutic intervention for not only chronic pain but many chronic illnesses.

Experiences of quality of life the first year after stroke in Denmark and Norway. A qualitative analysis

Purpose: This study aims to explore quality of life (QOL) during the first year of recovery after stroke in North Norway and Central Denmark. Method: Individual in-depth interviews with 11 stroke survivors were performed twelve months after stroke onset. An interpretative, inductive approach shaped the interview process and the processing of data. Results: We found that QOL reflected the individuals' reconstruction of the embodied self, which was identified by three intertwined and negotiating processes: a familiar self, an unfamiliar self, and a recovery of self. Further, we found that reconstruction of the embodied self and QOL could be framed as an ongoing and interrelated process of "being, doing, belonging and becoming". Enriching social relations, successful return to work, and continuity and presence in professional support during recovery enhanced the experience of QOL. Fatigue and sustained reduced function hindered participation in meaningful activities and influenced the perceived QOL negatively. Conclusions: The two countries differed in descriptions of continuity and support in the professional follow-up during the recovery process, influencing the degree of encouragement in reconstructing the embodied self. Reconstruction of the embodied self is a means of understanding stroke survivors' QOL during the first year of recovery, supporting an individualized and tailored rehabilitation practice.

The experience of hope in families of children and adolescents living with chronic illness: A thematic synthesis of qualitative studies

AIM

To synthesize qualitative studies on the experience of hope in families of children and adolescents living with chronic illness.

BACKGROUND

Hope is multidimensional, dynamic, and varies according to experienced events, cultural environments and stage of life. The qualitative synthesis of the experience of hope in the paediatric population with chronic conditions is scarce.

DESIGN

Thematic synthesis of qualitative studies.

DATA SOURCES

A systematic literature search in PubMed, CINAHL, LILACS, PsycINFO, Scopus, and Web of Science was performed supplemented by manual search strategies. Thirty-one studies from fifteen countries, published between 1981-2018, were included.

FINDINGS

Findings were integrated into an analytical theme "FAMILY HOPE: KEEPING THE DAY-TO-DAY BALANCE", encompassing the following five descriptive themes: Uncertainty; Support; Information; Between "dark thoughts" and positive thoughts; and Hoping to go back to normality.

CONCLUSION

This thematic synthesis brings a new dimension of hope among families of children and adolescents living with chronic illness. "Family Hope" highlights the influence of the relationships between relatives and the chronically ill child in the balance of hope. It is recommended that health professionals use a family-focused approach to support these families.

IMPACT

Shifting the focus to a family dimension of hope is a promising pursuit that has the potential to inform future nursing practices to support the experiences of families living with chronic illness in the paediatric context. A better understanding of the role and characteristics of family hope will promote the development of more effective interventions for families to adapt to long-term paediatric conditions.

Hope to hope: Experiences of older people with cancer in diverse settings

PURPOSE

The purpose of the study was to explore experiences of older people with cancer in ascertaining the attributes of a person-centred approach in sustaining hope and enabling human flourishing. This was a qualitative study comparing patients and professional experiences and perceptions of care across to ward settings.

METHODS

Methods involved 10 semi-structured interviews conducted with patients and focus groups (n = 6) and 10 semi-structured interviews with health professionals. Three dissemination focus groups (n = 14) were also carried out with professionals to allow further analysis of the data.

RESULTS

Two main themes were identified, including 'Emotional adaptations of hope: wants and expectations' and 'Hope through belittling their illness'. Findings highlight the way hope is conveyed and the emphasis' accorded to issues such as societal perceptions, knowledge, expectations of care, life stage, relationships, identity, and emotions. Findings also reinforce the importance of maintaining hope, recognising the different ways hope is used, and enabling patients to flourish.

CONCLUSION

This study highlights how hope is facilitated through the interaction between patients and professionals and that the relational interactive stance. This current study establishes that hope seemed to be temporal, contextual and dynamic in nature, involving an ongoing process. Helping older people with cancer to understand their illness considering the situation of lives and experiences is essential to address expectations and wants.

Hope and Technology: Other-Oriented Hope Related to Eye Gaze Technology for Children with Severe Disabilities

Introducing advanced assistive technology such as eye gaze controlled computers can improve a person's quality of life and awaken hope for a child's future inclusion and opportunities in society. This article explores the meanings of parents' and teachers' other-oriented hope related to eye gaze technology for children with severe disabilities. A secondary analysis of six parents' and five teachers' interview transcripts was conducted in accordance with a phenomenological-hermeneutic research method. The eye gaze controlled computer creates new imaginations of a brighter future for the child, but also becomes a source for motivation and action in the present. The other-oriented hope occurs not just in the future; it is already there in the present and opens up new alternatives and possibilities to overcome the difficulties the child is encountering today. Both the present situation and the hope for the future influence each other, and both affect the motivation for using the technology. This emphasises the importance of clinicians giving people opportunities to express how they see the future and how technology could realise this hope.

The impact of contextual factors on nursing outcomes and the role of placebo/nocebo effects: a discussion paper

INTRODUCTION

Placebo and nocebo effects represent one of the most fascinating topics in the health care field.

OBJECTIVES

the aims of this discussion paper were (1) to briefly introduce the placebo and nocebo effects, (2) to elucidate the contextual factors able to trigger placebo and nocebo effects in the nursing field, and (3) to debate the impact of contextual factors on nursing education, practice, organisation, and research.

METHODS

a narrative review was conducted based on the available evidence.

RESULTS

Placebo responses (from Latin "I shall please") are a beneficial outcome(s) triggered by a positive context. The opposite are the nocebo effects (from Latin "I shall harm"), which indicates an undesirable outcome(s) caused by a negative context. Both are complex and distinct psychoneurobiological phenomena in which behavioural and neurophysiological changes arise subsequent to an interaction between the patient and the health care context.

CONCLUSION

Placebo and nocebo concepts have been recently introduced in the nursing discipline, generating a wide debate on ethical issues; however, the impact on nursing education, clinical practice, nursing administration, and research regarding contextual factors triggering nocebo and placebo effects has not been debated to date.

Psychological adaptation to diagnostic genomic sequencing results: The role of hope fulfillment

OBJECTIVE

Psychological adaptation is an important but understudied outcome among patients who undergo DNA evaluation to identify a cause of an unexplained health condition. This longitudinal study examines the relationship between the degree to which participants' hopes for diagnostic genomic sequencing were fulfilled and their psychological adaptation to their sequencing results over time.

METHOD

Secondary analyses were conducted on data from a subset of adult participants from the North Carolina Clinical Genomic Evaluation by Next-Generation Exome Sequencing study with physical health conditions of suspected genetic etiology (such as neurological disorders or cancer; n = 192). Hope fulfillment and type of hope (hopes related to personal-family health implications vs. hoping to help others-advance science) were assessed as predictors of change in psychological adaptation (Psychological Adaptation Scale) and 4 subscales (coping efficacy, self-esteem, social integration, spiritual-existential well-being), from 2 weeks to 6 months after disclosure of genomic sequencing results.

RESULTS

Controlling for covariates, degree of hope fulfillment was associated with increased general psychological adaptation (β = .14, p = .02), social integration (β = .17, p = .01), and spiritual-existential well-being (β = .15, p = .02). Type of hope did not modify effects of degree of hope fulfillment on adaptation outcomes.

CONCLUSIONS

The degree to which patients' genomic sequencing-related hopes are fulfilled may be an important driver of long-term psychological adaptation after genomic sequencing. Evaluating the degree to which patients' hopes are fulfilled may allow clinicians to gain insight into the likely trajectory for patient adaptation after learning their results from genomic sequencing. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Patients' Hopes for Advanced Cancer Treatment

CONTEXT

Little is known about the hopes patients with advanced (incurable) cancer have for their treatment.

OBJECTIVES

The objective of this study was to describe the treatment hopes of advanced cancer patients, factors associated with expressing specific hopes, and the persons with whom hopes are discussed.

METHODS

We surveyed 265 advanced cancer patients in the U.S. about their hopes for treatment at the baseline and after three months. We developed a taxonomy of hopes for treatment, which two investigators used to independently code patient responses. We explored associations between hopes for cure and patient covariates.

RESULTS

We developed eight categories of hopes. We were able to apply these codes reliably, and 95% of the patient's responses fit at least one hope category. The hope categories in order of descending baseline prevalence were as follows: quality of life, life extension, tumor stabilization, remission, milestone, unqualified cure, control not otherwise specified, and cure tempered by realism. Most patients reported discussing hopes with partners, family/friends, and oncologists; a minority reported discussing hopes with nurses, primary care physicians, clergy, or support groups. In logistic regression analysis, unqualified hopes for cure were more likely in younger patients and in those who did not endorse discussing their hopes with primary care physicians.

CONCLUSION

Advanced cancer patients harbor a range of treatment hopes. These hopes often are not discussed with key members of the health care team. Younger age and lack of discussion of hopes with primary care physicians may lead to less realistic hopes for cure.

Certified Peer Specialists and Older Adults With Serious Mental Illness' Perspectives of the Impact of a Peer-Delivered and Technology-Supported Self-Management Intervention

We explored the perspectives of certified peer specialists and older adults with serious mental illness on the impact of a peer-delivered medical and psychiatric self-management intervention, "PeerTECH." Transcripts from interviews with consumers with serious mental illness and a focus group with certified peer specialists who were engaged in PeerTECH were analyzed. Consumer participants (n = 8) had a mean age of 68.8 years (SD = 4.9) and included individuals diagnosed with major depressive disorder (five people), schizophrenia spectrum disorders (two people), and bipolar disorder (one person). Certified peer specialists (n = 3) were aged 55 years or more. Themes included internal and external forces of accountability, confidence, internal and external locus of hope, human bonding, and peer support. This exploratory qualitative study found that human support from peers can potentially influence health behavioral change in a combined peer and technology-based medical and psychiatric illness self-management intervention.

Rehabilitation in dementia care

Multidisciplinary rehabilitation is increasingly accepted as valuable in the management of chronic disease. Whereas traditional rehabilitation models focussed on recovery, maintaining independence and delaying functional decline are now considered worthwhile aims even where full recovery is not feasible. Despite this, rehabilitation is notably absent from dementia care literature and practice. People with dementia report frustration with the lack of availability of structured post-diagnosis pathways like those offered for other conditions. Alternative terms such as 're-ablement' are used to refer to rehabilitation-like services, but lack an evidence-base to guide care. This commentary will discuss possible reasons for the resistance to accept multidisciplinary rehabilitation as part of dementia care, and identifies the value of doing so for people with dementia, their families, and for health professionals.

Nurses' preparedness for infectious disease outbreaks: A literature review and narrative synthesis of qualitative evidence

AIMS AND OBJECTIVES

To explore the core components that constitute nurses' preparedness in an epidemic event.

BACKGROUND

Healthcare service providers have worked to augment efforts to protect the public from the impact of epidemic events. While constituting the major healthcare taskforce, nurses are frequently tasked with fronting the response to an infectious disease outbreak. Given the crucial role of nurses in the management of prevailing epidemics, the constituents of their preparedness in epidemic events should be identified.

DESIGN

A systematic search was undertaken to identify eligible studies from the literature. A narrative synthesis approach was employed to extract and synthesise findings of the reviewed qualitative studies.

METHODS

Seven qualitative studies on nurses' experience and perceptions of epidemic events were examined for scientific quality using the Critical Appraisal Skills Programme Qualitative Checklist. Findings of these studies were synthesised adopting a narrative synthesis approach.

RESULTS

Three interplaying themes were identified as follows: (i) personal resources, (ii) workplace resources and (iii) situational influences. The findings suggest that an effective epidemic outbreak response would require further effort to reinforce the interplay between individual nurses, healthcare institutions and the governments.

CONCLUSIONS

The practical interplay among individual nurses, healthcare institutions and the governments is crucial in establishing an effective epidemic response. Further research on the understanding of the dynamic process of preparedness development is recommended to set future directions in research.

RELEVANCE TO CLINICAL PRACTICE

This study offers important insights for devising future strategies in enhancing nurses' preparedness and response to an epidemic event. These include recommendations on providing education and training to nurses regarding infectious diseases, fostering institutional assistance and support in an outbreak and revising government policies and planning.

Expectations towards participation in easily accessible pain management interventions: a qualitative study

BACKGROUND

People with chronic pain use a range of healthcare services, but they also report a high degree of dissatisfaction with treatments. One reason for dissatisfaction might be participants' expectations towards treatments. The aim of this study was to explore expectations of people with chronic pain towards participation in easily accessible pain management interventions delivered in public primary care.

METHODS

A qualitative study using semi-structured individual face-to-face interviews with 21 informants. The informants were recruited among participants enrolled in a randomised controlled trial on the effect of an easily accessible self-management course for people with chronic pain. The data were analysed thematically using Systematic Text Condensation.

RESULTS

Having experienced pain for a long time, there was no specific expectation of a cure or a significant alleviation of the pain. The informants' expectations mainly concerned a hope that participation could lead to a better everyday life. The informants said that hope was important as it motivated them to keep going and continue self-care activities. The hope acted as a driving force towards trying new interventions and maintaining motivation to do activities they experienced as beneficial. Both concrete aspects of the current intervention and an understanding of what interventions in general could offer contributed to the informants hope. The expectations centred about the interventions being something new, as they had not previously tried this service, an opportunity to gain and reinforce skills, to help them continue to grow as a person, to meet others in similar situations, and to access professional support in an easy manner. Participating in interventions provided by healthcare services was seen by some as an act of self-care, where they did something active to manage their health.

CONCLUSIONS

Expectations towards the interventions were related to a hope for participation leading to a better everyday life. The role of hope for peoples' motivation to self-care implies that service providers should be aware of and help to maintain hope for a better everyday life. The importance of social support as part of self-care should be acknowledged when developing interventions targeting chronic pain.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02531282 . Registered on August 21 2015.

Communicatively Constructing the Bright and Dark Sides of Hope: Family Caregivers' Experiences during End of Life Cancer Care

(1) Background: The communication of hope is complicated, particularly for family caregivers in the context of cancer who struggle to maintain hope for themselves and their loved ones in the face of terminality. In order to understand these complexities, the current study examines the bright and dark sides of how hope is communicated across the cancer journey from the vantage point of bereaved family caregivers; (2) Methods: We analyzed interviews with bereaved family caregivers using qualitative thematic and case oriented strategies to identify patterns in the positive and negative lived experiences when communicating about hope at the end of life; (3) Results: Two overarching patterns of hope emerged. Those who experienced hope as particularized (focused on cure) cited communication about false hope, performing (faking it), and avoidance. Those who transitioned from particularized to generalized hope (hope for a good death) reported acceptance, the communication of hope as social support, prioritizing family, and balancing hope and honesty; (4) Conclusion: Family caregivers face myriad complexities in managing the bright and dark sides of hope. Interventions should encourage concurrent oncological and palliative care, increased perspective-taking among family members, and encourage the transition from particularized to generalized hope.

Patient-defined desired outcome, success criteria, and expectation in outpatient physical therapy: a longitudinal assessment

BACKGROUND

Patient-centered approaches offer an alternative method in evaluating treatment outcomes. This study investigated; 1) if patient's criteria for success (satisfaction of clinical outcomes) changes from pre to post treatment, 2) whether patients who met their success criteria also meet minimal clinical important difference scores (MCIDs), and 3) if patient's success criteria differed from their expected (what the patient believes will occur) and desired (what the patient wants to occur) outcomes following intervention.

METHODS

A consecutive sample of 225 subjects with complaints of musculoskeletal pain was referred to an outpatient, sports medicine physical therapy clinic. Participants completed the Patient Centered Outcome Questionnaire (PCOQ) prior to their initial evaluation session and a follow-up PCOQ at discharge. The PCOQ asks subjects to rate their pain, fatigue, emotional distress, and interference with daily activities for usual, desired, successful, and expected levels, and how important improvement is for each domain on a 101-point numerical rating scale. Paired-sample T-test were used to determine patient's pre and post success criterion and whether success criteria differed from desired and expected outcomes following intervention. Chi-squared were used to determine if individuals desired, expected, and success criteria for treatment outcome differed from established MCIDs.

RESULTS

The results revealed no change in success criteria pre to post treatment for all domains. Chi-square test revealed patients desired, expected, and success criteria were independent of established MCIDs (P > .01). There were no differences between patients expected outcomes and success criteria. However, there were differences between patient's desired outcomes and expected and success outcomes, with patients reporting lower desired levels of pain, emotional distress, fatigue, and interference with daily activities following physical therapy intervention (P < .01).

CONCLUSION

Patients in this setting do not appear to modify their success criteria throughout the course of outpatient physical therapy. Additionally, individually defined success criterion differs from established clinically important changes. Clinicians interested in a broader assessment of outcome need to consider patient determined criterion in addition MCIDs. Furthermore, desired outcomes are lower than both expectation and success criteria. In this setting, outcomes following physical therapy episodes were likely to meet patient's expectations and success criteria but not desired criterion.

Ways of Hoping: Navigating the Paradox of Hope and Despair in Chronic Pain

In this paper, we explore hope in the context of living with chronic pain. Individuals with chronic pain from temporomandibular disorder(s) were interviewed four to five times over the course of their 18-month participation in a clinical trial investigating the effectiveness of Traditional Chinese Medicine. We sought to understand shifts in participants' descriptions of expectations and hopefulness, particularly with regard to the work involved in counterbalancing positive thinking with buffers against disappointment. We found hope to be a dynamic and multifaceted mindset as distinct from being a single entity to be measured. Drawing upon Polanyi's concept of tacit knowing, we explore how different ways of hoping emerge and index one another in participant narratives. We offer a working typology of hope and raise as an issue the manner in which the paradox of hope--hoping enough to carry on while keeping hopes in check to avoid the ever-present possibility of despair--complicates simplistic notions of the relationship between positive thinking and the placebo response.

Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes

Background:

There is a growing interest in linking aspects of patient-provider communication to rehabilitation outcomes. However, the field lacks a conceptual understanding on: (a) ‘how’ rehabilitation outcomes can be improved by communication; and (b) through ‘which’ elements in particular. This article elaborates on the conceptual developments toward informing further practice and research.

Methods:

Existing models of communication in healthcare were adapted to rehabilitation, and its outcomes through a comprehensive literature review.

Results:

After depicting mediating mechanisms and variables (e.g. therapeutic engagement, adjustment toward disability), this article presents the ‘4 Rehab Communication Elements’ deemed likely to underpin rehabilitation outcomes. The four elements are: (a) knowing the person and building a supportive relationship; (b) effective information exchange and education; (c) shared goal-setting and action planning; and (d) fostering a more positive, yet realistic, cognitive and self-reframing.

Discussion:

This article describes an unprecedented, outcomes-oriented approach toward the design of rehabilitation communication, which has resulted in the development of a new intervention model: the ‘4 Rehab Communication Elements’. Further trials are needed to evaluate the impact of this whole intervention model on rehabilitation outcomes.

Living with constant suffering: a different life following the diagnosis of HIV

We used grounded theory in semi-structured interviews with 32 persons living with HIV (PLWH) in Barcelona, Spain, and found that PLWH live with constant suffering, a core category combining four realities: I need help; My life is constantly controlled; I have a new imposed life; and I have an uncertain reality. Participants described being constantly controlled by health policies and medications. They thought their lives were in the hands of others and that a new life, characterized by the constant fear of stigma, had been imposed on them. They felt they were losing freedom and vitality, as many questions remained unanswered, causing uncertainty related to health and public life. Emotional help was obtained mainly from peers and social networks. Our emergent theory shows a disruptive experience, with serious consequences to individual and social development. Health care has to focus on the real needs of PLWH to reduce suffering and uncertainty.

Evaluation of expectations and expectation fulfillment in patients treated for trapeziometacarpal osteoarthritis

PURPOSE

To determine the main reasons why patients with trapeziometacarpal osteoarthritis (TMC OA) seek treatment, their pretreatment expectations for the final outcome, fulfillment after one year, and predictors of fulfillment of the expectation.

METHODS

We included 163 patients with TMC OA. They filled out questionnaires assessing expectations and functional status before and at 3, 6, and 12 months after treatment.

RESULTS

Pain reduction was the most important reason why 65% of all patients sought treatment, whereas 17% and 13% requested treatment to improve hand function and activities of daily living, respectively. No patients considered improved appearance of the hand to be the main reason for undertaking treatment. Expectations before treatment were anticipated to be totally or mostly fulfilled by 93% of surgically treated patients and 59% of patients treated with corticosteroid injection. After one year, 77% of surgically treated patients rated their expectations as completely or mostly fulfilled, compared with 24% of patients treated with corticosteroid injections. Including all variables before treatment in a best-fit regression model, fulfillment of patients' expectations could not be sufficiently predicted. However, with addition to the model of the outcome of pain at one year, 48% of the variance of fulfilled expectations could be accounted for.

CONCLUSIONS

Patients with TMC OA predominantly visit hand surgeons seeking treatment to reduce pain, whereas function and aesthetics have minor roles. Based on variables before treatment, no prediction can be made regarding whether expectations will be fulfilled after treatment because residual pain at one year contributes considerably to the variance in fulfilled expectations. Clinicians should assess patients' expectations before treatment and explain realistic treatment outcomes to obtain best treatment results.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic II.

The interweaving of pharmaceutical and medical expectations as dynamics of micro-pharmaceuticalisation: advanced-stage cancer patients' hope in medicines alongside trust in professionals

Existing pharmaceuticalisation research denotes the salience of expectations in novel medicines and in the medical contexts through which these may be accessed. Specific processes of expectation such as hope and trust, alongside their shaping of patients' lifeworlds around pharmaceutical use, remain neglected however. Considering data from in-depth interviews and observations involving thirteen patients with advanced-stage cancer diagnoses who were or had recently been involved in clinical trials, we develop an interpretative phenomenological analysis of the influence of hope and trust upon the accessing of novel medicines through trials, illuminating the depth and texture of pharmaceuticalisation at the micro-level. Trust in clinicians and hope in trial medicines, for self and future patients, were important in the reconfiguring of patients' horizon of possibilities when accessing new medicines. Interwoven processes of trust and hope, embedded within heightened vulnerability, sustained the bracketing out of doubts regarding medicines, trials and professionals. The need to maintain hopes, and trusting relations with professionals who facilitated these hopes, generated meaning and momentum of medicines use which inhibited disengagement from trials. Findings indicate the taken-for-granted, as well as more reflexive, pursuit of solutions through medicines, which in this case-study enabled the generation of evidence through trial involvement. Analyses of micro-level dynamics within both downstream-consumption and upstream-substantiation of pharmaceutical solutions assist more nuanced accounts of interests, agency and expectations within pharmaceuticalisation.

The experience of Parkinson's disease: a systematic review and meta-ethnography

There has been little attempt to summarise and synthesise qualitative studies concerning the experience and perception of living with Parkinson's disease. Bringing this information together would provide a background to understand the importance of an individual's social identity on their well-being and hope. Three primary aims were identified (a) understanding the importance of social identity and meaningful activities on individuals' well-being, (b) identifying factors and strategies that influence well-being and hope, and (c) establishing a model that relates to an individual's hope and well-being. Three stages were undertaken including a traditional electronic search, a critical appraisal of articles, and a synthesis of studies. Qualitative articles were included that considered the experience of living with Parkinson's disease. Thirty seven articles were located and included in the review. Five themes were identified and the themes were used to inform development of a new model of hope enablement. The current review furthered understanding of how physical symptoms and the experience of Parkinson's disease affect the individual's well-being and hope. Social identity was established as a key factor that influenced an individual's well-being. Being able to maintain, retain, or develop social identities was essential for the well-being and hope of individuals with Parkinson's disease. Understanding the factors which prevent or can facilitate this is essential.

The inherent tensions and ambiguities of hope: towards a post-formal analysis of experiences of advanced-cancer patients

Sociological and anthropological analyses of hope in health-care contexts have tended to address institutional processes, especially the power dynamics that function through such systems or political economies of hope, which in turn shape interactions through which hopes are managed. This article extends this approach through a more detailed consideration of the experience of hoping itself. Our post-formal analysis denotes the tensions that are intrinsic and defining features of lifeworlds around hope, emphasising the dissonance and fragility of hoping. Drawing upon interview and observational data involving patients with advanced-cancer diagnoses who were taking part in clinical trials, we explore three main tensions which emerged within the analysis: tensions involving time and liminality between future and present; ontological tensions involving the concrete and the possible, the 'realistic' and the positive; and tensions in taken-for-grantedness between the reflective and the mundane, the specific and the ambiguous. Rather than three separate sets of tensions, those involving time, ontology and taken-for-grantedness are very much interwoven. In denoting the influence of social processes in engendering tensions, we bridge sociological and anthropological approaches with a more definition-oriented literature, developing understandings of hoping and its key characteristics in relation to other processes of coping amidst vulnerability and uncertainty.

Modes of hoping: understanding hope and expectation in the context of a clinical trial of complementary and alternative medicine for chronic pain

This article explores the role of hope in participants' assessments of their expectations, experiences and treatment outcomes. Data analysis focused on semi-structured, open-ended interviews with 44 participants, interviewed 3-5 times each over the course of a study evaluating Traditional Chinese Medicine (TCM) for temporomandibular disorders (TMD), a form of chronic orofacial pain. Transcripts were coded and analyzed using qualitative and ethnographic methods. A "Modes of Hoping" (Webb, 2007)(1) framework informed our analysis. Five modes of hoping emerged from participant narratives: Realistic Hope, Wishful Hope, Utopian Hope, Technoscience Hope, and Transcendent Hope. Using this framework, hope is demonstrated as exerting a profound influence over how participants assess and report their expectations. This suggests that researchers interested in measuring expectations and understanding their role in treatment outcomes should consider hope as exercising a multi-faceted and dynamic influence on participants' reporting of expectations and their experience and evaluation of treatment.

Identifying a Framework for Hope in Order to Establish the Importance of Generalised Hopes for Individuals Who Have Suffered a Stroke

Hope and hopelessness are important psychological constructs that physiotherapists should consider when working with patients who have experienced a stroke. The view of hope in rehabilitation is often focused around the concept of goals and how hope works within this framework. However, the current paper proposes a broader framework for hope and the importance of a more generalised view of understanding why a certain hope exists or is identified by a patient. A narrative review using an a priori thematic analysis was undertaken to consider how more generalised hopes are expressed by individuals who have suffered a stroke. An electronic search of 4 databases from inception until April 2014 was undertaken. Qualitative articles were included if they considered the concept of hope for patients who had suffered a stroke. The results identified three themes which included (1) consideration of the patient's identity/identities, (2) meaningful activities, experiences, and interactions, and (3) the experience of suffering and need for relief. An awareness of patients' generalised hopes should be a priority for HCPs. Detailed implications for HCPs are identified within the discussion.

Hope language in patients undergoing epilepsy surgery

Candidates for epilepsy surgery often use the word "hope" to express their attitudes and beliefs about surgery. However, studies suggest that hope has a multiplicity of meanings that are not well understood. The goal of this analysis was to evaluate whether Candidates for epilepsy surgery use hope language to express a traditional, expected optimism during presurgery interviews. We examined patients' uses of the word "hope" and its derivatives (hoping, hopeful, hopefully) through a secondary analysis of 37 interviews of adult patients prior to epilepsy surgery. Approximately 1/3 of all hope statements were coded as expressions of optimism, while 1/3 were not optimistic, and 1/3 had unclear meanings. In addition to traditionally optimistic uses of the term, other themes surrounding use of this word included ideas of dread, worry, uncertainty, and temporizing language. This information may help clinicians communicate more effectively with patients, enhancing the informed consent process for epilepsy surgery.

A systematic review of qualitative studies on adjusting after stroke: lessons for the study of resilience

PURPOSE

To synthesize qualitative studies on adjusting after stroke, from stroke survivors' and carers' perspectives, and to outline their potential contribution to an understanding of resilience.

METHODS

A systematic review of qualitative studies in peer reviewed journals from 1990 to 2011 was undertaken. Findings from selected studies were summarized and synthesized and then considered alongside studies of resilience.

RESULTS

Forty studies were identified as suitable. These suggested that the impact of stroke was felt on many dimensions of experience, and that the boundaries between these were permeable. Nor was stroke as an adverse "event" temporally bounded. Adjustment was often marked by setbacks and new challenges over time. Participants identified personal characteristics as key, but also employed practical and mental strategies in their efforts to adjust. Relationships and structural factors also influenced adjustment after stroke.

CONCLUSIONS

The impacts of stroke and the processes of adjusting to it unfold over time. This presents a new challenge for resilience research. Processes of adjustment, like resilience, draw on personal, inter-personal and structural resources. But the reviewed studies point to the importance of an emic perspective on adversity, social support, and what constitutes a "good" outcome when researching resilience, and to a greater focus on embodiment. Implications for Rehabilitation Stroke is a sudden onset condition which for around a third of people has long-term consequences. Stroke can cause a variety of physical and cognitive impairments, some of which may not be obvious to an outsider. As well as physical functioning, stroke can have a profound effect on survivors' sense of self and on their relationships. Stroke survivors' accounts suggest that relationships (including relationships with health care professionals) and structural factors (such as access to health services, employment possibilities and welfare systems) mediate efforts to adjust after stroke. While there is considerable overlap between notions of adjustment and resilience, the experiences of stroke survivors suggest further issues that need to be addressed in order to gain a more comprehensive understanding of resilience.

Preparation and Support of Patients through the Transplant Process: Understanding the Recipients' Perspectives

Preparation for heart transplant commonly includes booklets, instructional videos, personalized teaching sessions, and mentorship. This paper explores heart transplant recipients' thoughts on their preparation and support through the transplant process. Twenty-five interviews were audio-/videotaped capturing voice and body language and transcribed verbatim. Coding addressed language, bodily gesture, volume, and tone in keeping with our visual methodology. Recipients reported that only someone who had a transplant truly understands the experience. As participants face illness and life-altering experiences, maintaining a positive attitude and hope is essential to coping well. Healthcare professionals provide ongoing care and reassurance about recipients' medical status. Mentors, family members, and close friends play vital roles in supporting recipients. Participants reported that only heart transplant recipients understood the experience, the hope, and ultimately the suffering associated with living with another persons' heart. Attention needs to be focused not solely on the use of teaching modalities, but also on the development of innovative support networks. This will promote patient and caregiver engagement in self-management. Enhancing clinicians' knowledge of the existential aspects of transplantation will provide them with a nuanced understanding of the patients' experience, which will ultimately enhance their ability to better prepare and support patients and their caregivers.