Hope in palliative care: an integrative review.
OBJECTIVE
The objective of this review is to describe the current status of research on hope in palliative care.


METHODS
Integrative review was conducted to determine current knowledge on the topic. CINAHL and PubMed MEDLINE databases were used to find the articles relevant to this review. The data consisted of 34 articles on hope and palliative care published in peer-reviewed journals. A qualitative approach utilizing content analysis was used in this review.


RESULTS
There are at least two overarching themes of patients' hope in the palliative context: "living with hope" and "hoping for something" which however are not separate contents. Several instruments for measuring hope in a palliative context have been produced. However, future research is needed to gather further validity evidence for these instruments. Factors related to patients, other people (e. g. significant others), illness, care and context contribute to or threaten patient hope. Hope of the significant other was defined as an inner force. However, the main concern for caregivers was "hanging on to hope" in spite of eroding effects on hope caused by different factors, for example in the health care system. Also significant others' hope in a palliative care context has been measured, but the results of the studies appear inconsistent. Nurses' reflection in action, affirmation of the patient's worth, working with the patient, considering the patient in a holistic sense were the main hope-engendering interventions generated from this review.


CONCLUSIONS
Hope is important in both living and dying. The majority of the hope research in a palliative context focuses on patient hope and factors influencing patient hope. Research on hope in significant others and nurses in palliative care is scant. More research is needed about the factors threatening patient hope, hope in significant others, and interventions to engender hope in palliative and their outcomes.
Department of Nursing Science, University of Kuopio, Kuopio, Finland. jari.kylma@uku.fi
Jari
J
Kylmä
Wendy
W
Duggleby
Dan
D
Cooper
Gustaf
G
Molander
D017051:Hospice Care; D006801:Humans; D009042:Motivation; D009723:Nurse-Patient Relations; D010166:Palliative Care / Q000523:psychology*; D012803:Sick Role; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology