title: Resilience and hope during advanced disease: a pilot study with metastatic colorectal cancer patients.
abstract: BACKGROUND
  The balance between hope-hopelessness plays an important role in the way terminally ill patients report quality of life, and personal resilience may be related to hope at the end of life. The objective of this study was to explore associations between personal resilience, hope, and other possible predictors of hope in advanced cancer patients.
  
  
  METHODS
  A cross-sectional pilot study was carried out with metastatic colorectal cancer patients in a tertiary hospital. The patients answered the Connor-Davidson Resilience Scale, Herth Hope Index, Barthel Index, an instrument addressing family and social support, visual-numeric scales for pain and suffering, a two-item screening for depression, socio-demographic and socio-economic information about the family.
  
  
  RESULTS
  Forty-four patients were interviewed (mean age 56 years; range 29-86). A strong correlation was noted between resilience and hope (0.63; p < 0.05). No correlation was found between hope and independence for activities of daily living, support from family and community, and pain and suffering levels. Of the 44 patients, 20 presented with depressive symptoms. These depressive patients had lower resilience (p = 0.005) and hope (p = 0.003), and higher scores of suffering (p < 0.001). The association between resilience and hope kept stable after adjusting for age, gender, and presence of depression (p < 0.001).
  
  
  CONCLUSIONS
  Given that resilience is a dynamic, changeable path that can improve hope, resilience-fostering interventions should be most valued in palliative care settings and should be commenced as soon as possible with cancer patients. Patients with advanced stages of non-malignant conditions would also probably benefit from such interventions.
authors.affiliation: Hospital das Clínicas of Universidade de São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 (INCOR), 2° andar, bloco I, Zipcode: 05403-900, São Paulo, Brazil. joaopaulocsolano@uol.com.br.
authors.forename: Joao Paulo Consentino
authors.initials: JP
authors.lastname: Solano
authors.affiliation: A.C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Amanda Gomes
authors.initials: AG
authors.lastname: da Silva
authors.affiliation: Centro Universitário São Camilo Medical School, São Paulo, Brazil.
authors.forename: Ivan Agurtov
authors.initials: IA
authors.lastname: Soares
authors.affiliation: Hospital das Clínicas of Universidade de São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 (INCOR), 2° andar, bloco I, Zipcode: 05403-900, São Paulo, Brazil.
authors.forename: Hazem Adel
authors.initials: HA
authors.lastname: Ashmawi
authors.affiliation: Department of Anesthesiology, Universidade de São Paulo Medical School, São Paulo, Brazil.
authors.forename: Joaquim Edson
authors.initials: JE
authors.lastname: Vieira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications / Q000473:pathology / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000523:psychology; D004739:England; D005190:Family / Q000523:psychology; D005260:Female; D065026:Hope; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010166:Palliative Care; D010865:Pilot Projects; D011788:Quality of Life; D055500:Resilience, Psychological; D012944:Social Support; D029181:Spirituality; D019452:Terminally Ill / Q000523:psychology*; D062606:Tertiary Care Centers
keywords: Cancer; Hope; Oncology; Palliative care; Psychological; Resilience; Terminal care