title: Level and direction of hope in cancer patients: an exploratory longitudinal study.
abstract: OBJECTIVE
  Hope is an important factor to consider when caring for cancer patients as a key component of coping with adversity. The aim of our study was to address the following questions: Is there a difference in level of hope between those patients being curatively and those palliatively treated, and how does this change over time? What are patients' most important hopes? Better understanding of patients' hopes may promote more effective patient-centered care.
  
  
  METHODS
  Outpatients referred to medical oncology or pain and symptom clinics at the London Regional Cancer Program were surveyed before consultation. The Herth Hope Index (HHI) questionnaire was administered to assess level of hope, and the patients were asked to indicate their highest priority hopes. Qualitative thematic analysis was performed on the responses, and comparison was made between patients treated with curative vs those treated with palliative intent. This survey was repeated 4 months after initial assessment.
  
  
  RESULTS
  Fifty patients were surveyed (29 curative-intent; 21 palliative). Highest priority initial hopes were categorized as follows: cure, other positive health outcomes, emotional well-being, life achievements/return to normalcy, interpersonal goals, other. There was no association noted between treatment intent and choice of highest-priority hope. Follow-up assessments after 4 months revealed no significant differences in the distribution pattern of hopes. There was a statistically significant increase in the HHI over time in curatively treated patients, but none in the combined analysis.
  
  
  CONCLUSIONS
  Our study indicates that patients receiving palliative therapy have a HHI score not significantly different from patients being treated for cure. The hope deemed most important is also similar between groups. Over time, overall hope was maintained or increased even in the presence of a trend towards fewer patients hoping for a cure. These results remind oncologists to explore the experience of hope with all patients to ensure that the subjective needs and goals of the patients are met by the proposed therapies.
authors: London Health Sciences Centre, 790 Commissioners Road East, London, ON, N6A 4L6, Canada. michael.sanatani@lhsc.on.ca
authors: Michael
authors: M
authors: Sanatani
authors: Gil
authors: G
authors: Schreier
authors: Larry
authors: L
authors: Stitt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009013:Morale; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D010166:Palliative Care / Q000523:psychology*; D010549:Personal Satisfaction; D011379:Prognosis; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life; D012069:Religion and Psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome