title: Faith and protection: the construction of hope by parents of children with leukemia and their oncologists.
abstract: BACKGROUND
  Oncologists are criticized for fostering unrealistic hope in patients and families, but criticisms reflect a perspective that is oversimplified and "expert" guidance that is ambiguous or impractical. Our aim was to understand how pediatric oncologists manage parents' hope in practice and to evaluate how they address parents' needs.
  
  
  METHODS
  Participants were 53 parents and 12 oncologists whom they consulted across six U.K. centers. We audio recorded consultations approximately 1-2, 6, and 12 months after diagnosis. Parents were interviewed after each consultation to elicit their perspectives on the consultation and clinical relationship. Transcripts of consultations and interviews were analyzed qualitatively.
  
  
  RESULTS
  Parents needed hope in order to function effectively in the face of despair, and all wanted the oncologists to help them be hopeful. Most parents focused hope on the short term. They therefore needed oncologists to be authoritative in taking responsibility for the child's long-term survival while cushioning parents from information about longer-term uncertainties and being positive in providing information about short-term progress. A few parents who could not fully trust their oncologist were unable to hope.
  
  
  CONCLUSIONS
  Oncologists' pivotal role in sustaining hope was one that parents gave them. Most parents' "faith" in the oncologist allowed them to set aside, rather than deny, their fears about survival while investing their hopes in short-term milestones. Oncologists' behavior generally matched parents' needs, contradicting common criticisms of oncologists. Nevertheless, oncologists need to identify and address the difficulty that some parents have in fully trusting the oncologist and, consequently, being hopeful.
authors.affiliation: Division of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK. psalmon@liv.ac.uk
authors.forename: Peter
authors.initials: P
authors.lastname: Salmon
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hill
authors.forename: Joanne
authors.initials: J
authors.lastname: Ward
authors.forename: Katja
authors.initials: K
authors.lastname: Gravenhorst
authors.forename: Tim
authors.initials: T
authors.lastname: Eden
authors.forename: Bridget
authors.initials: B
authors.lastname: Young
mesh_terms: D005190:Family; D006801:Humans; D010290:Parents / Q000523:psychology*; D010361:Patients; D010820:Physicians / Q000941:ethics* / Q000523:psychology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000523:psychology