title: Ultimate journey of the terminally ill: Ways and pathways of hope.
abstract: OBJECTIVE
  To better understand the role of hope among terminally ill cancer patients.
  
  
  METHODS
  Qualitative analysis.
  
  
  METHODS
  A tertiary specialized cancer centre in Canada.
  
  
  METHODS
  Cancer patients in palliative care with an estimated remaining life expectancy of 12 months or less (N = 12) and their loved ones (N = 12) and treating physicians (N = 12).
  
  
  METHODS
  Each patient underwent up to 3 interviews and identified a loved one who participated in 1 interview. Treating physicians were also interviewed. All interviews were fully transcribed and analyzed by at least 2 investigators. Interviews were collected until saturation occurred.
  
  
  RESULTS
  Seven attributes describe the experiences of palliative cancer patients and their caregivers: hope as an irrational phenomenon that is a deeply rooted, affect-based response to adversity; initial hope for miraculous healing; hope as a phenomenon that changes over time, evolving in different ways depending on circumstances; hope for prolonged life when there is no further hope for cure; hope for a good quality of life when the possibility of prolonging life becomes limited; a lack of hope for some when treatments are no longer effective in curbing illness progression; and for others hope as enjoying the present moment and preparing for the end of life.
  
  
  CONCLUSIONS
  Approaches aimed at sustaining hope need to reflect that patients' reactions might fluctuate between despair and a form of acceptance that leads to a certain serenity. Clinicians need to maintain some degree of hope while remaining as realistic as possible. The findings also raise questions about how hope influences patients' perceptions and acceptance of their treatments.
authors: Palliative care physician, a researcher, and Professor in the Research Centre and Palliative Care Service at the University of Montreal Hospital Centre and in the Faculty of Medicine at the University of Montreal in Quebec. serge.daneault.chum@ssss.gouv.qc.ca.
authors: Serge
authors: S
authors: Daneault
authors: Professor in the Department of Psychology at the University of Quebec at Montreal.
authors: Véronique
authors: V
authors: Lussier
authors: Professor in the School of Social Work at the University of Quebec at Montreal.
authors: Suzanne
authors: S
authors: Mongeau
authors: Clinical Investigator and Associate Clinical Professor in the Research Centre and for the Hematology and Oncology Service at the University of Montreal Hospital Centre and in the Faculty of Medicine at the University of Montreal.
authors: Louise
authors: L
authors: Yelle
authors: Palliative care physician and Director of the Programme de compétences avancées en soins palliatifs for the Palliative Care Service at the University of Montreal Hospital Centre and in the Faculty of Medicine at the University of Montreal.
authors: Andréanne
authors: A
authors: Côté
authors: Professor in the School of Public Health at the University of Montreal.
authors: Claude
authors: C
authors: Sicotte
authors: Professor in the Faculty of Education at the University of Sherbrooke in Quebec.
authors: Pierre
authors: P
authors: Paillé
authors: Palliative care physician at the Maisonneuve-Rosemont Hospital in Montreal and Assistant Professor at the University of Montreal.
authors: Dominique
authors: D
authors: Dion
authors: Nurse at the Maisonneuve-Rosemont Hospital.
authors: Manon
authors: M
authors: Coulombe
mesh_terms: D000328:Adult; D000368:Aged; D001293:Attitude to Death; D017028:Caregivers / Q000523:psychology*; D005260:Female; D065026:Hope; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010166:Palliative Care; D010821:Physicians, Family; D036301:Qualitative Research; D011788:Quality of Life; D011792:Quebec; D019452:Terminally Ill / Q000523:psychology*; D062606:Tertiary Care Centers