title: Hope against hope: exploring the hopes and challenges of rural female caregivers of persons with advanced cancer.
abstract: BACKGROUND
  This paper focuses on the qualitative component of a study evaluating a hope intervention, entitled Living with Hope Program (LWHP), designed to foster hope in female caregivers of family members living with advanced cancer. The purpose of this research is to share, in the form of a story, the experiences of rural female caregivers caring for family members with advanced cancer, focusing on what fosters their hope. Hope is a psychosocial and spiritual resource that has been found to help family caregivers live through difficult transitions and challenges.
  
  
  METHODS
  Twenty-three participants from rural Western Canada completed daily journal entries documenting their hopes and challenges. Cortazzi's (2001) method of narrative analysis was used to analyze the data, which was then transcribed into a narrative entitled 'hope against hope.'
  
  
  RESULTS
  The journal entries highlighted: the caregivers' hopes and what fostered their hope; the various challenges of caregiving; self-care strategies, and; their emotional journey. Hope was integrated throughout their entire experience, and 'hope against hope' describes how hope persists even when there is no hope for a cure.
  
  
  CONCLUSIONS
  This research contributes to the assessment of caregiver interventions that impact hope and quality of life, while illustrating the value of a narrative approach to both research and practice. Journaling may be particularly valuable for rural caregivers who are isolated, and may lack direct professional and peer support. There is an opportunity for health professionals and other providers to foster a relationship of trust with family caregivers, in which their story can be told openly and where practitioners pay closer attention to the psychosocial needs of caregivers.
authors.affiliation: School of Geography and Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4 K1, Canada. awill@mcmaster.ca.
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
authors.forename: Wendy
authors.initials: W
authors.lastname: Duggleby
authors.forename: Jeanette
authors.initials: J
authors.lastname: Eby
authors.forename: Reverend Dan
authors.initials: RD
authors.lastname: Cooper
authors.forename: Lars K
authors.initials: LK
authors.lastname: Hallstrom
authors.forename: Lorraine
authors.initials: L
authors.lastname: Holtslander
authors.forename: Roanne
authors.initials: R
authors.lastname: Thomas