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Pinto MH, Leite ACAB, Neris RR, Kusumota L. Experience of hope in older people with chronic illness: A meta-synthesis. Int J Older People Nurs 2024; 19:e12579. [PMID: 37926905 DOI: 10.1111/opn.12579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The increase in life expectancy has contributed to an increase in the number of older people, but this population has to learn to live with at least one chronic illness. Thus, hope has become an important resource for the older adult to face the repercussions of chronic illness. OBJECTIVE To synthesise qualitative evidence on the experience of hope in older people with chronic illness. METHODS This meta-synthesis included qualitative studies which present the experiences of hope in older people diagnosed with at least one chronic illness. The searches were made from six databases, guided by the SPIDER tool. The identified articles were then independently screened by two reviewers. The results were analysed according to the thematic synthesis approach. RESULTS Eighteen articles were included, and four analytical themes were constructed. The results allow us to understand that older people live with long-term conditions and hope for an ordinary life. To react to new changes and to maintain hope, they create goals that motivate them in daily life. The treatment is initially seen as a salvation, but the information acquired with the evolution of the illness modifies this perception. In addition, the uncertainty about the success of the treatment creates conflict in their hope. In the support and care of older people in the new context of illness, meaningful relationships strengthen hope most of the time. There is still the hope of being reconciled with death, but there are times when suffering overcomes the hope of living. CONCLUSIONS This meta-synthesis highlights that the experience of hope in older people is dynamic and influenced by the context of changes related to illness, treatment, significant relationships and proximity to death. IMPLICATIONS FOR PRACTICE A better understanding of the role and characteristics of hope in older people with chronic illness may help to develop more effective interventions to promote and maintain hope.
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Affiliation(s)
| | - Ana Carolina Andrade Biaggi Leite
- Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, São Paulo, Brazil
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, Spain
| | | | - Luciana Kusumota
- Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, São Paulo, Brazil
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2
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Velić S, Qama E, Diviani N, Rubinelli S. Patients' perception of hope in palliative care: A systematic review and narrative synthesis. PATIENT EDUCATION AND COUNSELING 2023; 115:107879. [PMID: 37413808 DOI: 10.1016/j.pec.2023.107879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The aim of this study was to systematically review and synthesize the literature on patients' perceptions of hope in palliative care. METHODS PubMed, Scopus, SocINDEX, Cochrane, and Web of Science were screened against the eligibility criteria. After familiarization with the data and conduction of the coding process, studies were thematically analyzed using Braun and Clarke's methodology. The research question guiding our analysis was: what is said about hope from patients in PC? RESULTS The database searches yielded 24 eligible studies. Three main themes emerged from the studies: Hope beliefs (encompassing patients' understanding of hope and characteristics assigned to it), Hope functions (including the role that hope plays for patients) and Hope work (highlighting aspects that in patients' perspective cultivate hope). CONCLUSION This review emphasizes the importance of acknowledging patients' understanding of hope, its role, and the efforts required to sustain it. In particular, it suggests that hope serves as a valuable strategy, fostering meaningful personal relationships towards end of life. PRACTICE IMPLICATIONS In order to address communication challenges in clinical practice, a potential fruitful strategy for nurturing hope could involve engaging family and friends in hope interventions facilitated by healthcare professionals.
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Affiliation(s)
- Sanda Velić
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland
| | - Enxhi Qama
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland
| | - Nicola Diviani
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland
| | - Sara Rubinelli
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
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3
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Kyota A, Kanda K, Senuma M, Tsukagoshi N, Futawatari T, Kondo Y. The perception of life and death in patients with end-of-life stage cancer: A systematic review of qualitative research. Eur J Oncol Nurs 2023; 66:102354. [PMID: 37586291 DOI: 10.1016/j.ejon.2023.102354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/08/2023] [Accepted: 05/31/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE This study aims to clarify the perceptions on life and death among patients with the end-of-life stage cancer through a systematic review. METHODS The search strategy combined MeSH terminology with free text searches, and was applied to the PubMed, CINAHL, Embase, and ICHUSHI (Japan Medical Abstracts Society) databases covering from 2010 to 5/2022. To ensure the quality of the research included, the Critical Appraisal Skills Program Qualitative Studies Checklist was used. Data relating to the perceptions of life and death of patients with the end-of-life stage cancer was extracted and analyzed with reference to qualitative meta-synthesis methods. RESULTS Ultimately, 50 studies were included. Five themes were derived based on the perceptions of life and death of patients with the end-of-life stage cancer: despair, making sense of death, how to live the rest of life, special feelings for loved ones, and fluctuation. By making sense of death in their own way, and reconciling it with their current situation, patients with the end-of-life stage cancer, even in despair over their impending death, look ahead into the future and their surroundings and consider how they would live the remaining time they have. During this time, the special feelings they have for their loved ones make an impact. CONCLUSIONS An important new finding from this study lies in the fact that the patients' desire to live as ordinary people who were not patients were expressed as a face that they hid from their families. Further research is needed in low-income countries/regions.
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Affiliation(s)
- Ayumi Kyota
- Department of Nursing, Gunma University Graduate School of Health Sciences, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan.
| | - Kiyoko Kanda
- Niigata College of Nursing, 240 Shinnan-cho, Joetsu, Niigata, 943-0147, Japan.
| | - Maiko Senuma
- Department of Nursing, Gunma University Graduate School of Health Sciences, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan.
| | - Noriko Tsukagoshi
- Department of Nursing, Gunma University Graduate School of Health Sciences, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan.
| | - Tamae Futawatari
- Department of Nursing, Gunma University Graduate School of Health Sciences, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan.
| | - Yuka Kondo
- Department of Nursing, Gunma University Graduate School of Health Sciences, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan.
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Hammer K, Højgaard HS, Á Steig B, Wang AG, Bergenholtz HM, Rosted EE. Hope pictured in drawings by patients newly diagnosed with advanced cancer. J Clin Nurs 2023; 32:1262-1275. [PMID: 35277902 DOI: 10.1111/jocn.16274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hope is an integral part of a dying person's needs and an important phenomenon that has not been satisfactorily explored. The tension between hope for a cure and the reality of being terminally ill is a paradox, which in the context of palliative cancer care, nurses and health care professionals must take into consideration. OBJECTIVE The purpose of this study was to elucidate the phenomenon of hope and to investigate the lived experiences of hope among newly diagnosed patients with advanced cancer. METHOD The study used a phenomenological-visual method where drawings and post-drawing interviews were used. The participants were six patients who recently had been offered specialised palliative care treatment. They were five women and one man with different cancer diagnoses and between 30 and 82 years of age (median 65 years). The data consisted of six drawings and individual post-drawing interviews with the participants. The study was reported using the COREQ checklist. RESULTS The study revealed one main concern 'Being in hope' and hope appeared in four different dimensions; internal, external, relational and transcendental. Hopelessness was present at all times. CONCLUSION Hope pictured in drawings was expressed through colour, shape, lines, symbols and metaphors, and hope incorporated internal, external, relational and transcendental aspects. Hope was constantly fighting against hopelessness and hope integrated with past, present and future. RELEVANCE TO CLINICAL PRACTICE Drawings, as well as other visual representations, are suitable tools when trying to understand an ineffable phenomenon such as hope experienced by people newly diagnosed with cancer.
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Affiliation(s)
- Kristianna Hammer
- Department of Palliative Care, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | | | - Bjarni Á Steig
- Department of Hematology and Palliative Care, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | - August G Wang
- Faculty of Health, University of Faroe Islands, Tórshavn, Faroe Islands.,Centre of Psychiatry, Copenhagen University Hospital Amager, Copenhagen S, Denmark
| | - Heidi M Bergenholtz
- Department of Surgery, Holbaek Hospital, Holbaek, Denmark.,REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, UK
| | - Elizabeth E Rosted
- Department of Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark.,University of Southern Denmark, Odense, Denmark
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The decision-making process of transferring patients home to die from an intensive care unit in mainland China: A qualitative study of family members' experiences. Intensive Crit Care Nurs 2023; 76:103399. [PMID: 36731266 DOI: 10.1016/j.iccn.2023.103399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To map the decision-making process of family members involved in transferring a critically ill patient home to die from an intensive care unit in mainland China and to explore the experiences of those family members. DESIGN A constructivist qualitative study. SETTING One hospitals intensive care unit in Southeast China. METHODS Thirteen adult family members (of ten patients) who participated in decision-making related to transferring a relative home to die from the intensive care unit were purposively selected. Data were collected via interviews and analysed applying thematic analysis. FINDINGS A two-stage decision-making process was identified. Family decision-making was mediated by factors including: accepting the impending death and hope that the patient would not die; time pressures in which decisions had to be made, and the challenges of meeting cultural expectations of a home death. Transfer home was a family-centred decision constrained by a gender-based hierarchy restricting the involvement of different family members. CONCLUSION The stages and key factors in the decision-making process of family members when involved in transferring a patient home to die from an intensive care unit in China are rooted and informed by cultural expectations and limits in the current healthcare system regarding end-of-life care options. Understanding the climate in which family members must make decisions will facilitate supportive interventions to be implemented by healthcare professionals. Further empirical research is needed to explore family members' needs when the patient has been transferred and dies at home in mainland China. IMPLICATIONS FOR CLINICAL PRACTICE Healthcare professionals need to understand the challenges family members face when deciding to transfer a relative home to die from an intensive care unit. For example time pressures can limit the choices of family members so that to provide them with timely, ongoing, realistic updates for a greater involvement of family members in generating end of life care plans could be beneficial.1.
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6
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Zhang X, Ju B, Tu J, Wang B, Liu X, Wang Z, Cheng Y, Zhang C, He Y. The possibility of impossibility: The hope for a cure among terminally ill cancer patients in China. Eur J Cancer Care (Engl) 2022; 31:e13724. [PMID: 36193852 DOI: 10.1111/ecc.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 08/31/2022] [Accepted: 09/14/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Although the medical potential of the hope for a cure has been fiercely debated within academia, few researchers have approached this topic from the perspective of terminally ill cancer patients themselves. As such, this article aims to help bridge the gap by exploring how terminally ill cancer patients in China construct the hope for a cure. METHODS Seventeen terminally ill cancer patients were recruited from the department of oncology at a tertiary hospital, where data were collected through individual interviews and participatory observation from April to December 2020 and analysed via thematic analysis. RESULTS The respondents experienced a dynamic swing between construction and denial of the hope for a cure. Furthermore, the patients negotiated between three forms of hope, including the hope for a cure, the hope for prolonged life expectancy and the hope of living in the moment. Meanwhile, family-oriented hope was centred on intergenerational relationships, which further shaped the construction of the hope for a cure. CONCLUSION Medical staff needs to be sensitive to terminally ill cancer patients' dynamic swing, negotiation and motivation during the process of constructing the hope for a cure.
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Affiliation(s)
- Xin Zhang
- Digestive Diseases Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Bei Ju
- Macau University of Science and Technology, Macau, China
| | - Jiong Tu
- Department of Sociology, School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, China
| | - Bo Wang
- Department of Oncology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xuan Liu
- Department of Oncology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zhechen Wang
- Department of Psychology, School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Yu Cheng
- Department of Medical Humanities, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.,Department of Anthropology, School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, China
| | - Changhua Zhang
- Digestive Diseases Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yulong He
- Digestive Diseases Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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Qama E, Diviani N, Grignoli N, Rubinelli S. Health professionals' view on the role of hope and communication challenges with patients in palliative care: A systematic narrative review. PATIENT EDUCATION AND COUNSELING 2022; 105:1470-1487. [PMID: 34593262 DOI: 10.1016/j.pec.2021.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To identify health professionals' (HPs) perspectives on the role of hope and the main challenges faced when communicating with patients in palliative care (PC). METHODS Search on PubMed, Scopus, SocIndex, Cochrane, and Web of Science using: palliat*, palliative care, palliative medicine, hospice care, terminal care, long term care, supportive care, end of life (EOL) care and hope*, followed by a thematic narrative analysis. RESULTS Thirty-five studies were included. HPs' views were grouped in: Bringing out hope and Taking down hope. HPs believe that hope is elicited through a personal patient-provider bond and exhibited through medical treatment delivery. HPs face difficulties when delivering prognosis, referring to hospice, and providing palliation. CONCLUSION Hope is conveyed through verbal and non-verbal communication. HPs struggle to account for hope's shifting character, challenging the engagement in EOL discussions. PRACTICAL IMPLICATIONS Findings show a patient-provider clash of perspectives, suggesting a gap in acknowledging the shifting nature of hope. An important question emerges: Are the existing theories of hope that are solely explained from a patient experience relevant for HPs' own interpretation? Investigating the HPs' attitudes gathered in collective experiences in PC, might contribute to answering the question in the context of building more constructive communication approaches.
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Affiliation(s)
- Enxhi Qama
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
| | - Nicola Diviani
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
| | - Nicola Grignoli
- Consultation-Liaison Psychiatry Service, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, 6850 Mendrisio, Switzerland.
| | - Sara Rubinelli
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
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Finkelstein EA, Baid D, Cheung YB, Schweitzer ME, Malhotra C, Volpp K, Kanesvaran R, Lee LH, Dent RA, Ng Chau Hsien M, Bin Harunal Rashid MF, Somasundaram N. Hope, bias and survival expectations of advanced cancer patients: A cross-sectional study. Psychooncology 2021; 30:780-788. [PMID: 33739561 DOI: 10.1002/pon.5675] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/27/2021] [Accepted: 03/04/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Many patients with advanced illness are unrealistically optimistic about their prognosis. We test for the presence of several cognitive biases, including optimism bias, illusion of superiority, self-deception, misattribution, and optimistic update bias, that could explain unrealistically optimistic prognostic beliefs among advanced cancer patients and quantifies the extent to which hope exacerbates these biases. METHODS A cross-sectional survey was administered to 200 advanced cancer patients with physician-estimated prognoses of one year or less. Hope was measured using the Herth Hope Index (HHI). Hypotheses were tested using linear and logistic regressions and a structural-equation model. RESULTS Results are consistent with the presence of optimism bias, illusion of superiority, self-deception, and misattribution. All of these biases are amplified by higher levels of hope. Each 1-point higher HHI is associated with a 6% (OR: 1.06; 95% CI: 1.01-1.11) greater odds of believing their illness is curable, a 0.33-year (95% CI: 0.17-0.49) longer expected survival, a 6% (OR: 1.06; 95% CI: 1.02-1.11) higher probability of believing that survival outcomes are better than the average patient, a 5% higher odds of believing primary intent of treatment is curative (OR: 1.05; 95% CI: 1.00-1.10), and a 12% (OR: 1.12; 95% CI: 1.05-1.17) higher odds of believing they are well-informed. Mediation analyses revealed that hope significantly mediates the effect of mental-well-being and loneliness on expected survival. CONCLUSIONS Results suggest advanced cancer patients succumb to several cognitive biases which are exacerbated by greater levels of hope. As a result, they are susceptible to possible over-treatment and regret.
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Affiliation(s)
- Eric A Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Drishti Baid
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Yin Bun Cheung
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Maurice E Schweitzer
- Wharton School of Business, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Kevin Volpp
- Wharton School of Business, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Lai Heng Lee
- Department of Haematology, Singapore General Hospital, Singapore
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Economou D, Walshe C, Brearley SG. Exploring the experience of recurrence with advanced cancer for people who perceived themselves to be cancer free: a grounded theory study. Support Care Cancer 2021; 29:3885-3894. [PMID: 33386990 DOI: 10.1007/s00520-020-05956-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/15/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Advances in cancer treatment have led to longer cancer-free periods and overall survival. This study aimed to understand patients' experiences of transitioning out of a state of believing to be cancer free into incurable recurrence with advanced disease. METHODS Using constructivist grounded theory with in-depth interviews patients (n = 15) with solid tumors from a major US cancer center participated. Theoretical sampling enabled concepts to be developed until theme saturation. Constant comparative analysis used initial and focused coding to develop themes and concepts to describe this specific period from extended time cancer free and transition to advanced incurable disease. RESULTS Three interrelated concepts were identified: reluctant acceptance, seeking survival through continuous treatment, and hope in the face of an uncertain future. A conceptual model of the experience was developed encompassing anger and sadness, at initial recurrence, to reluctant acceptance, and, finally, a cycle of seeking continuous treatment to prolong life leading to a sense of hope in the face of an uncertain future. CONCLUSION The cycle between treatment and hope creates a state of personal equilibrium, which provides insights into the importance of treatment for this population. This study provides direction for future research to understand the expectations of people experiencing advanced cancer recurrence. IMPLICATIONS FOR CANCER SURVIVORS Many cancer survivors live with advanced cancer. Assessing their needs as they transition from survivor with no disease to survivor with advanced disease requires a new conceptualization of the experience which recognizes expectations and priorities for care of this patient group.
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Affiliation(s)
| | - Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Sarah G Brearley
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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10
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Chan K, Wong F, Tam SL, Kwok CP, Fung YP, Wong PN. The effects of a brief hope intervention on decision-making in chronic kidney disease patients: A study protocol for a randomized controlled trial. J Adv Nurs 2020; 76:3631-3640. [PMID: 33038022 DOI: 10.1111/jan.14520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/15/2020] [Accepted: 07/15/2020] [Indexed: 11/26/2022]
Abstract
AIMS This study describes the study protocol of a manualized brief hope intervention that is based on the theoretical proposition - hope theory. BACKGROUND Patients with stage 5 chronic kidney disease often had decisional regret when facing the tension of treatment alternatives between dialysis initiation and palliative care. Hope has been found to account for therapeutic changes in clients with depressive symptoms, heightens positive expectations, and striving to accomplish chosen goals. Nevertheless, little is known about the effect of hope on decisional conflict and its influences to the quality of life in these chronic kidney disease patients. DESIGN This study is a single-blinded, randomized controlled trial. METHODS Participants will be recruited from a regional hospital (approved in April 2018). They will be randomly assigned in equal numbers to either the brief hope intervention or the control arm on completion of the baseline assessment on the possible need of dialysis initiation. Participants in the intervention group will receive the pre-dialysis education and a 4-week Brief Hope Intervention [consisting of four sessions at weekly intervals (two face-to-face sessions and two telephone follow-up sessions in between)], while those allocated to the control arm will receive the renal education and social chats. Outcome measures will be carried out prior to the intervention (baseline), immediately, and 1 month after the intervention. These consist of the hope level, decisional conflict, and quality of life. Healthcare resources use data will be reported. IMPACT The study results have the potential to add scientific evidence to the research-tested programme when developing renal services integral to multimodal care management to optimize decision-making and attain better health outcomes.
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Affiliation(s)
- Kitty Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Frances Wong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Suet Lai Tam
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, China
| | - Ching Ping Kwok
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, China
| | - Yuen Ping Fung
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, China
| | - Ping Nam Wong
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, China
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11
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Li T, Pei X, Chen X, Zhang S. Identifying End-of-Life Preferences Among Chinese Patients With Cancer Using the Heart to Heart Card Game. Am J Hosp Palliat Care 2020; 38:62-67. [DOI: 10.1177/1049909120917361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Understanding the preferences for end-of-life (EOL) care is imperative in providing quality care to patients with life-threatening illness. However, it is difficult for patients, families, and health-care providers to initiate EOL conversations in China. An easy-to-use tool that could help health-care providers initiate EOL discussions is the Heart to Heart Card Game (HHCG), originally designed for Chinese Americans. Objective: To evaluate the EOL preferences among Chinese patients with cancer using the HHCG. Methods: We conducted a descriptive study to assess EOL preferences using HHCG among patients at the oncology chemoradiotherapy department of a Chinese tertiary hospital. Results: We recruited 58 patients in total of which 40 (69%) patients completed HHCG. The most frequently selected card was “I want my family to get along,” followed by “I don’t want to be a burden to my family,” and “I want to maintain my dignity.” Among the 3 cards selected, social needs were rated as the most important (36.7%), followed by spiritual needs (35.8%), physical needs (20.0%), and financial needs (7.5%). The evaluation of the HHCG revealed that more than 70% of the participants highly valued HHCG. Conclusion: The HHCG can be used as a communication tool to encourage EOL discussions between cancer patients and health-care providers in China. Moreover, Chinese patients with cancer attach significant importance to their family and maintaining dignity at the EOL.
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Affiliation(s)
- Tong Li
- School of Health Sciences, Wuhan University, Wuhan, Hubei province, China
| | - Xianbo Pei
- School of Health Sciences, Wuhan University, Wuhan, Hubei province, China
| | - Xiaoli Chen
- School of Health Sciences, Wuhan University, Wuhan, Hubei province, China
| | - Shuqin Zhang
- Department of Chemotherapy and Radiation Therapy, Zhongnan Hospital, Wuhan University, Wuhan, Hubei province, China
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12
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Chan K, Wong FKY, Lee PH. A Brief Hope Intervention to Increase Hope Level and Improve Well-Being in Rehabilitating Cancer Patients: A Feasibility Test. SAGE Open Nurs 2019; 5:2377960819844381. [PMID: 33415238 PMCID: PMC7774404 DOI: 10.1177/2377960819844381] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/23/2019] [Indexed: 12/22/2022] Open
Abstract
This article reports on the feasibility and effect of the brief hope intervention (BHI) in terms of increasing the hope level and psychological and physical health outcomes of rehabilitating cancer patients (RCP). Chinese RCP living in the community were invited to join the study. The BHI consisted of four one-on-one sessions: two (1-hour) face-to-face sessions and two (30-minute) telephone follow-up sessions in between. There were three core features in the hope therapy: (a) goal thoughts: finding workable goals, (b) pathway thoughts: finding ways to reach the targets, and (c) agency thoughts: positive self-talk to optimize their motivation to accomplish the set goals. A one-group pre- and postintervention design was used. Outcome measures included the Memorial Symptom Assessment Scale, the Center for Epidemiological Studies Depression Scale (CES-D), and the State Hope Scale. Recruitment, attrition, and qualitative feedback were collected to understand their comments on BHI. A total of 40 participants were recruited (female 92.3%). The mean age was 57.2 years (SD = 6.7). The participants had significant improvement in all aspects of the Memorial Symptom Assessment Scale, with moderate-to-large effect sizes (d = 0.49-0.74). The changes in present hope and depression scores were insignificant, with small effect sizes (d = 0.17-0.34). The BHI seemed to be promising in producing both physical and psychological benefits in RCP.
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Affiliation(s)
- Kitty Chan
- School of Nursing, The Hong Kong Polytechnic University, People's Republic of China
| | - Frances K Y Wong
- School of Nursing, The Hong Kong Polytechnic University, People's Republic of China
| | - Paul H Lee
- School of Nursing, The Hong Kong Polytechnic University, People's Republic of China
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He Y, Jian H, Yan M, Zhu J, Li G, Lou VWQ, Chen J. Coping, mood and health-related quality of life: a cross-sectional study in Chinese patients with advanced lung cancer. BMJ Open 2019; 9:e023672. [PMID: 31061015 PMCID: PMC6501988 DOI: 10.1136/bmjopen-2018-023672] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The ways patients cope with advanced cancer can influence their health-related quality of life (HRQoL). This study aims to examine the mediating role of positive and negative mood in the relationship between coping and HRQoL in patients with advanced lung cancer. METHODS A consecutive sample of 261 patients (mean age: 59.99±9.53) diagnosed with stage III or IV lung cancer was recruited from the inpatient unit in a hospital that specialises in chest-related disease in Shanghai, China. Participants completed measurements including Medical Coping Modes Questionnaire, Positive and Negative Affect Schedule, and 5-level EuroQol 5-dimension instrument. RESULTS Although the total effects of confrontation on HRQoL were not significant, competing indirect effects via mood were identified: (1) positive indirect effects through positive mood were found for confrontation on mobility, usual activities, pain/discomfort and overall utility index (indirect effect=0.01, 95% CI 0.003 to 0.03); (2) negative indirect effects through negative mood were found for confrontation on mobility, pain/discomfort, anxiety/depression and overall utility index (indirect effect=-0.01, 95% CI -0.03 to -0.001). Resigned acceptance was negatively associated with HRQoL, and indirect effects via mood were identified: (1) negative indirect effects through positive mood were found for resigned acceptance on mobility, self-care, usual activities, pain/discomfort and overall utility index (indirect effect=-0.01, 95% CI -0.03 to -0.003); (2) negative indirect effects through negative mood were found for resigned acceptance on domains of HRQoL and overall utility index (indirect effect=-0.04, 95% CI -0.06 to -0.02). CONCLUSIONS Confronting advanced lung cancer can fuel ambivalent emotional experiences. Nevertheless, accepting the illness in a resigned way can be maladaptive for health outcomes. The findings suggest interventions that facilitate adaptive coping, reduce negative mood and enhance positive mood, as this could help to improve or maintain HRQoL in patients with advanced lung cancer.
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Affiliation(s)
- Yaping He
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- Center for Health Technology Assessment, Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Jian
- Department of Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Meiqiong Yan
- Department of Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jingfen Zhu
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- Center for Health Technology Assessment, Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Guohong Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- Center for Health Technology Assessment, Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - Jieling Chen
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
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Hou X, Lu Y, Yang H, Guo R, Wang Y, Wen L, Zhang Y, Sun H. Preferences for a good death: a cross-sectional survey in advanced cancer patients. BMJ Support Palliat Care 2019; 12:e570-e577. [PMID: 30944121 DOI: 10.1136/bmjspcare-2018-001750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of this study was to describe preferences for a good death among Chinese patients with advanced cancer and then to explore factors contributing to their preferences including patient demographics and disease variables. METHODS A convenience sample of 275 patients with advanced cancer was recruited from a tertiary cancer hospital in Beijing, China, between February and December 2017. A Chinese version of the Good Death Inventory (GDI) was used to measure patients' preferences for dying and death. Besides, data were collected using a multi-itemed questionnaire focusing on demographic and disease characteristics of patients. RESULTS Of the 275 questionnaires returned, 248 responses were analysed (effective response rate 90.2%). According to the total scores for each of the 20 domains, the five most important domains of a good death were: good relationship with family (19.80±2.39), independence (19.66±2.56), maintaining hope and pleasure (19.56±2.55), good relationship with medical staff (18.92±3.73), not being a burden to others (18.89±3.30). Patients' characteristics including age, educational status, religious belief, medical payment types, family economic status, past experiences of the death of others, the period since cancer diagnosis, past experiences of hospitalisation and subjective physical condition influenced their preferences for a good death (all p<0.05). CONCLUSIONS We had an in-depth knowledge and understanding of their preferences for good death among Chinese patients with advanced cancer. Meanwhile, we found some patients' factors contributed to different preferences for a good death. These findings have the potential to guide hospice care services aimed at achieving a good death for patients with advanced cancer.
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Affiliation(s)
- Xiaoting Hou
- Department of Thoracic Oncology Ⅰ, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yuhan Lu
- Nursing Administrative Department, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Hong Yang
- Nursing Administrative Department, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Renxiu Guo
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yun Wang
- Department of Integrative Medicine and Geriatric Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Lihong Wen
- Interventional Therapy Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yaru Zhang
- Departement of Radiation Therapy, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Hongyu Sun
- Humanities Teaching and Research Section, School of Nursing, Peking University, Beijing, China
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Silva NM, Santos MAD, Oliveira RAAD, Storti LB, Souza IMO, Formighieri PF, Marques S. Idosos em Tratamento Quimioterápico: Relação entre Nível de Estresse, Sintomas Depressivos e Esperança. PSICOLOGIA: TEORIA E PESQUISA 2019. [DOI: 10.1590/0102.3772e35441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A prevalência do câncer entre idosos tem aumentado nas últimas décadas. O tratamento oncológico pode acarretar aumento dos níveis de estresse e depressão. Nesse cenário, a esperança tem sido definida como um dos recursos relevantes de enfrentamento. Este estudo teve por objetivo analisar a relação entre estresse, sintomas depressivos e esperança em idosos submetidos a tratamento quimioterápico. Trata-se de um estudo quantitativo, descritivo e transversal com amostra não-probabilística de 123 idosos vinculados a um hospital geral público terciário do interior do Estado de São Paulo. Os resultados mostram que os idosos apresentavam elevados níveis de estresse percebido e de esperança; 71,5% não manifestavam sintomas depressivos. Níveis de estresse e esperança foram correlacionados negativamente, assim como sintomas depressivos e níveis de esperança, sugerindo que a esperança pode ter efeitos benéficos sobre o estresse e depressão.
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Robieux L, Zenasni F, Flahault C, Tavani JL. L’espoir dans la maladie chronique : représentations sociales de l’espoir chez les patients et soignants. PSYCHOLOGIE FRANCAISE 2018. [DOI: 10.1016/j.psfr.2016.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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17
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Garcia E, Wijesekera K, Lester P. A Family-Centered Preventive Intervention Within Pediatric Oncology: Adapting the FOCUS Intervention for Latino Youth and Their Families. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2017. [DOI: 10.1080/10474412.2017.1323221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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18
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MacArtney JI, Broom A, Kirby E, Good P, Wootton J. The Liminal and the Parallax: Living and Dying at the End of Life. QUALITATIVE HEALTH RESEARCH 2017; 27:623-633. [PMID: 26658234 DOI: 10.1177/1049732315618938] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Transitions to palliative care can involve a shift in philosophy from life-prolonging to life-enhancing care. People living with a life-limiting illness will often receive palliative care through specialist outpatient clinics, while also being cared for by another medical specialty. Experiences of this point of care have been described as being liminal in character, that is, somewhere between living and dying. Drawing on experiences of illness and care taken from semistructured interviews with 30 palliative care outpatients in Australia, we found that this phase was frequently understood as concurrently living and dying. We suggest that this is a "parallax experience" involving narratives of a coherent linear self that is able to understand both realities, in a way that acknowledges the benefits of being multiple. These findings have significant implications for the ways in which palliative care is understood and how the self and subjectivity might be conceptualized at the end of life.
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Affiliation(s)
| | - Alex Broom
- 2 University of New South Wales, Australia
| | - Emma Kirby
- 2 University of New South Wales, Australia
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Brown P. From rationalities to lifeworlds: analysing the everyday handling of uncertainty and risk in terms of culture, society and identity. HEALTH RISK & SOCIETY 2016. [DOI: 10.1080/13698575.2016.1271866] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Patrick Brown
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
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20
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Geiser F, Zajackowski K, Conrad R, Imbierowicz K, Wegener I, Herth KA, Urbach AS. The German Version of the Herth Hope Index (HHI-D): Development and Psychometric Properties. Oncol Res Treat 2015; 38:356-60. [PMID: 26278579 DOI: 10.1159/000435900] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/19/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The importance of hope is evident in clinical oncological care. Hope is associated with psychological and also physical functioning. However, there is still a dearth of empirical research on hope as a multidimensional concept. The Herth Hope Index is a reliable and valid instrument for the measurement of hope and is available in many languages. Until now no authorized German translation has been published and validated. METHODS After translation, the questionnaire was completed by 192 patients with different tumor entities in radiation therapy. Reliability, concurrent validity, and factor structure of the questionnaire were determined. RESULTS Correlations were high with depression and anxiety as well as optimism and pessimism. As expected, correlations with coping styles were moderate. Internal consistency and test-retest reliability were satisfactory. We could not replicate the original 3-factor model. Application of the scree plot criterion in an exploratory factor analysis resulted in a single-factor structure. CONCLUSIONS The Herth Hope Index - German Version (HHI-D) is a short, reliable, and valid instrument for the assessment of hope in patient populations. We recommend using only the HHI-D total score until further research gives more insights into possible factorial solutions and subscales.
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Affiliation(s)
- Franziska Geiser
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Bonn, Germany
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