Sunday, November 17, 2013
The Effect of Hope on Cancer Patient
Hope is a construct that involves targeting a future time or goal or an action that will be undertaken (Berg, Ritschel, Swan, An, & Ahluwalia, 2011). It involves goal-directed thought processes within which individuals assess possibilities and their personal abilities that can be used to facilitate accomplishing the goals (Snyder, 1996; 2002). It can also be defined as a construct that seems to have an important place in an individual's life when the present is difficult to tolerate or accept or when circumstances are suboptimal. Hopes change with knowledge, and although one goal may have to be altered to failure, these losses and alterations may be an inherent part of the goal-directed thought process (Snyder, 1996). For example, when patients are diagnosed with cancer, they may hope for a full recovery. Later, as the individual's condition deteriorates, they may hope for strength and peace as they approach death. Folkman (2010) believed coping fostered hope in the darkest of circumstances, and hope cultivated the lasting effects of coping.
Hope has a constructive place in health and longevity. Hope has been associated with better adaptation and adjustment in disease and injury (Barnum, Snyder, Rapoff, Mani, & Thompson, 1998; Jackson, Taylor, Palmatier, Elliott, & Elliott, 1998) and to increased pain tolerance (Berg, Snyder, & Hamilton, 2008). It is, as described by Elliott and Olver (2009) as essential to the well-being of patients. For this discussion, I have chosen the effects of hope in terminally ill cancer patients.
Helping Patients Generate and Sustain Hope
Hope is essential, and sustaining it provides psychological nourishment for the terminally ill (Elliott & Olver, 2009). However, Elliott and Olver (2009) found a paucity of research on how terminally ill patients relate, perceive, and interact with hope. Beinzein, Norberg, and Saverman (2001) found four distinct hopes in these individuals: for a cure, to live as normally as possible, to have someone with them until the end, and to come to terms with their finality. The first seems unrealistic and false, but fostering the latter three seems realistic. The patient could be encouraged to live as normally as possible in their home with the help of hospice care. If the patient has a companion, the value of that companionship could become a focus of hope, that they could enjoy each other until the end. He or she could be encouraged to actively work on coming to terms with the end of life. Hospice care could help facilitate that process. If the individual participates in a religion, a religious advisor could be helpful in sustaining hope for coming to terms with death.
Herth (1990) found as individuals approached death, having attainable goals, interpersonal connectedness, and spirituality were the most salient categories of hope. Herth suggested fostering hope through loving or caring relationships with the patient and his or her family and actively listening to the patient and expressing optimism and hopefulness when the patient expressed hope generated and sustained those hopes. Encouragement, humor, fostering lightheartedness, and facilitating an environment within which the individual can explore and reflect upon his or her spirituality are essential as well (Herth, 1990).
Hope in Relation to the Stress and Immune Response
Hope is like coping in that it is a transaction, of sorts, between the individual and their environment (Folkman, 2010). Often, the environment is an internal environment generated by self-reflection and thoughtfulness. Whereas coping is a method of managing demands, hope is a means of relieving the stress of a negative outcome. When patients are terminally ill, the future is uncertain, which leaves them feeling out of control, which can lead to a heightened stress response (Carver, 2011). Folkman suggested hope is a reappraisal process that reduces the threat of the disease. It is a component of the cognitive coping process that, along with other coping skills elicits a relaxation response that calms the stress response, which in turn allows the immune system to return to a normal state.
Barnum, D. D., Snyder, C., Rapoff, M. A., Mani, M. M., & Thompson, R. (1998). Hope and Social Support in Psychological Adjustment of Children Who Have Survived Burn Injuries and Their Matched Controls. Children's Health Care, 27(1), 15-30. doi: 10.1207/s15326888chc2701_2
Benzein, E., Norberg, A., & Saveman, B. I. (2001). The meaning of the lived experience of hope in patients with cancer in palliative home care. Palliative Medicine, 15, 117–126
Berg, C. J., Snyder, C., & Hamilton, N. (2008). The Effectiveness of a Hope Intervention in Coping with Cold Pressor Pain. Journal of Health Psychology, 13(6), 804-809. doi: 10.1177/1359105308093864
Berg, C. J., Ritschel, L. A., Swan, D. W., An, L. C., & Ahluwalia, J. S. (2011). The role of hope in engaging in healthy behaviors among college students. American Journal of Health Behavior, 35(4), 402–415.
Carver, C. S. (2011). Effects of stress on immune function: Implications for immunoprotection and immunopathy. In R. J. Contrada, & A. Baum (Eds.), The handbook of stress science (pp. 221-229). New York: Springer Publishing Company.
Eliott, J., & Olver, I. (2009). Hope, life, and death: a qualitative analysis of dying cancer patients' talk about hope. Death Studies, 33(7), 609-638.
Folkman, S. (2010). Stress, coping, and hope. Psycho-Oncology, 19(9), 901–908.
Gallagher, M. W., & Lopez, S. J. (2009). Positive expectancies and mental health: Identifying the unique contributions of hope and optimism. The Journal of Positive Psychology, 4(6), 548–556.
Herth, K. (1990). Fostering hope in terminally-ill people. Journal Of Advanced Nursing, 15(11), 1250-1259. doi:10.1111/j.1365-2648.1990.tb01740.x
Jackson, W. T., Taylor, R. E., Palmatier, A. D., Elliott, T. R., & Elliott, J. L. (1998). Negotiating the reality of visual impairment: Hope, coping, and functional ability. (1998). Journal of Clinical Psychology in Medical Settings, 5(2), 173.
Snyder, C. R. (1996). To hope, to lose, and to hope again. Journal Of Personal & Interpersonal Loss, 1(1), 1. doi:10.1080/15325029608415455
Snyder, C. R. (2002). Hope Theory: Rainbows in the Mind. Psychological Inquiry, (4), 249. doi:10.2307/1448867