title: The relationships among hope, pain, psychological distress, and spiritual well-being in oncology outpatients.
abstract: OBJECTIVE
  Limited research in Taiwan and Europe suggest that hope is inversely correlated with certain dimensions of the pain experience. However, the relationship between hope and pain among oncology outpatients in the United States has not been evaluated. The aims of this study were to investigate the relationship between hope and cancer pain, after accounting for key psychological, demographic, and clinical characteristics.
  
  
  METHODS
  We enrolled a convenience sample of 78 patients who were receiving concurrent oncologic and symptom-focused care in a comprehensive cancer center. Patient demographic and clinical information was obtained from patient report and medical record review. Patients completed the Herth Hope Index, the Brief Pain Inventory, the Hospital Anxiety and Depression Scale, and the Steinhauser Spiritual Concern Probe.
  
  
  RESULTS
  Levels of hope were not associated with age, gender, or the presence of metastatic disease. Herth Hope Index scores were negatively correlated with average pain intensity (p=0.02), worst pain intensity (p<0.01), pain interference with function (p<0.05), anxiety (p<0.01), and depression (p<0.01), and were positively correlated with spiritual well-being scores (p<0.01). However, after controlling for depression and spiritual well-being with regression analysis, the relationship between pain intensity and hope was no longer significant.
  
  
  CONCLUSIONS
  While an association exists between the patients' experience of pain and levels of hope in this study, adjustment for depression and spiritual well being eliminates the relationship initially observed. Although the causal relationships have yet to be determined, in our study hope had a stronger connection to psycho-spiritual factors, than to pain experiences or severity.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA. blake.rawdin@ucsf.edu
authors.forename: Blake
authors.initials: B
authors.lastname: Rawdin
authors.forename: Carrie
authors.initials: C
authors.lastname: Evans
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rabow
mesh_terms: D001290:Attitude; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D010045:Outpatients / Q000523:psychology*; D010147:Pain Measurement; D010148:Intractable Pain; D010166:Palliative Care; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D029181:Spirituality; D013315:Stress, Psychological