title: Improving communication on hope in palliative care. A qualitative study of palliative care professionals' metaphors of hope: grip, source, tune, and vision.
abstract: BACKGROUND
  Hope is important in palliative care. However, palliative care professionals' perspectives on hope are not well understood. Metaphors of hope are a way of better understanding these perspectives.
  
  
  OBJECTIVE
  To describe palliative care professionals' perspectives on hope by examining the hope metaphors they spontaneously used to describe their own hope and their perspectives on the hope of patients and their families.
  
  
  METHODS
  Semistructured interviews with palliative care professionals were recorded, transcribed, and analyzed using a narrative approach. Results were discussed until the researchers reached consensus and reinforced by other health-care professionals and by observing several palliative care settings.
  
  
  RESULTS
  The 64 participants (mean (SD) age, 48.42 (9.27) years and 72% female) were physicians (41%), nurses (34%), chaplains (20%), or other professionals (5%), working in Canada (19%) or The Netherlands (81%). Participants described the hope of patients, their families, or themselves as a 1) grip, which implied safety; 2) source, which implied strength; 3) tune, which implied harmony; and 4) vision, which implied a positive perspective. Compared with Dutch participants, Canadian participants generally put more emphasis on spirituality and letting go of their own hope as a grip (safety). Compared with other included professionals, physicians used hope as a grip (safety) most often, whereas chaplains used hope as a tune (harmony) most often.
  
  
  CONCLUSIONS
  Our findings help to increase the understanding of hope and contribute to improving communication skills in palliative care professionals.
authors.affiliation: Section of Medical Ethics, Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: h.j.olsman@amc.uva.nl.
authors.forename: Erik
authors.initials: E
authors.lastname: Olsman
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Wendy
authors.initials: W
authors.lastname: Duggleby
authors.affiliation: Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Nekolaichuk
authors.affiliation: Section of Medical Ethics, Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Willems
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Judith
authors.initials: J
authors.lastname: Gagnon
authors.affiliation: Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Renske
authors.initials: R
authors.lastname: Kruizinga
authors.affiliation: Department of Ethics of Care, University of Humanistic Studies, Utrecht, The Netherlands.
authors.forename: Carlo
authors.initials: C
authors.lastname: Leget
mesh_terms: D000328:Adult; D002170:Canada; D002977:Clergy / Q000523:psychology; D003142:Communication; D003431:Cross-Cultural Comparison; D005260:Female; D065026:Hope; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D019365:Metaphor; D008875:Middle Aged; D009426:Netherlands; D009726:Nurses / Q000523:psychology; D010166:Palliative Care / Q000379:methods*; D010820:Physicians / Q000523:psychology; D011369:Professional-Patient Relations; D036301:Qualitative Research; D029181:Spirituality
keywords: Palliative care; communication; ethics; metaphor; nurse-patient relations; physician-patient relations; qualitative research; spirituality; terminal care