The Importance of Hope
by Lois M. Ramondetta, MD
Although there are many definitions of hope, my perception of hope involves a dynamic response to the rough waves on the sea of life. It is the expectation that good will come despite challenging circumstances. Although some have described hope as a passive process, it is most certainly an active internal process requiring motivational energy. That said, one’s ability to foster hope is, without question, deeply affected by the external state of affairs and by other individuals.
While for some people hope is intimately intertwined with one’s religious affiliation, for others the basis of hope is a strong personal spiritual philosophy. According to Dr. Kaye A. Herth, discovering hope in the midst of difficult situations requires four steps: appraisal of the situation, reflection, reframing to develop new goals, and viewing the situation in a relational context.
Hope is important for individuals with expectation of cure, as well as for those with limited time. Hope correlates with positive coping, resilience, better pain tolerance, better quality of life, and higher self-esteem. Hope requires reinforcement and is partially dependent on the presence of quality relationships and strong social networks. Importantly, hope can be influenced by the perception of control over illness and can mediate the relationship between one’s system of belief and fighting spirit. Alternatively, lack of hope has been correlated with increased distress, psychological pain, deterioration of physical status, fear, loss of control, and can even be an obstacle to effective interventions.
Caregivers, including physicians, nurses, and family and friends, can inspire, enable, enhance, and foster hope at every stage of illness.
So what do people with cancer hope for? Although cure seems the most obvious answer, most people express a desire for a meaningful life, inner peace, and sustained life quality. Of course, many hope that they will be an exception to the statistics and may hope that their diagnosis was a terrible mistake. But often, all that is realistically hoped for is the continuation of “normal” interpersonal activities – time with family, friends, and a chance to go to reunions, on vacations, and to attend religious services. People may simply hope that nausea will be controlled, the neuropathy will fade, and perhaps, the tumor marker level will decrease. Ultimately, I believe we all hope for peace of mind.
In an ongoing study at our center, we are evaluating changes in hope, center of control, and spirituality in people newly diagnosed with ovarian cancer over time. Results from the study reveal that hope is associated with feelings of well-being, decreased symptom burden, and less anxiety. Interestingly, religiosity did not correlate with anxiety, depression, or quality of life. Although directionality is unclear at this first time point, it is clear that increased hope and, to a lesser extent, spirituality are associated with better quality of life and decreased symptom burden.
So, how does one become more hopeful? The endeavor does not fall solely on the individual with cancer, nor does it fall only on the caregiver. It is a shared effort requiring not only personal investment, but also effort from all those interacting with the survivor. Acquiring hope requires gleaning information to perform a realistic assessment of the threat which then allows one to overcome fear and uncertainty. After the threat is defined, a person should consider alternatives and, if necessary, shift expectations. Lastly, they may need to “prepare for the worst and hope for the best.” In addition to a situational assessment, a personal resource assessment should be undertaken. Supportive relationships should be fostered, and detrimental relationships should be limited or terminated. As my friend Dr. Deborah Sills said, “Some people are better at cancer than others.” In our book, The Light Within, she discusses how it is necessary to have some BC (before cancer) friends and AC (after cancer) friends.
Hope correlates with positive coping, resilience, better pain tolerance, better quality of life, and higher self-esteem.
I believe communication between an individual and his or her physician is one of the most important factors in defining hope. It is so important that the physician be skilled at providing just the information the individual wants and not “full explicit disclosure” before the appropriate time. Maintaining this delicate balance is difficult. The goal is to foster realistic hopefulness by providing truthful information and emphasizing only effective therapeutic options. A physician can also share personal views regarding what might give a person’s life meaning. It is also important to note that for some individuals, hope in one’s caregiver or faith in one’s God is all the “information” and “control” one needs.
For me, hope is interwoven with what gives meaning to my life and my sense of spirituality. Few express this idea better than Viktor Frankl in his book Man’s Search for Meaning. He describes finding meaning through creating a work or doing a deed, experiencing something, such as truth, goodness, beauty, love, and most importantly, by the attitude we take toward unavoidable suffering. Cancer survivors and caregivers can help preserve and build hope through engaging in interventions including meaning-based group therapy, dignity therapy, and life review, and possibly, something as simple as a daily gratitude diary.
Promoting hope does not mean keeping patients up-beat or from ever experiencing sadness. Bad news should not be hidden. Instead, the goal is to inform and then help the person reflect and reframe goals in order to reach a new way of living where the individual can again hope for an improved future. Caregivers, including physicians, nurses, and family and friends, can inspire, enable, enhance, and foster hope at every stage of illness. The best way to start helping is to ask a person, “Do you have hope?” “What do you hope for?” and to genuinely listen to their response. Really all any of us can hope to know is this: “Everything will be ok in the end, and if it isn’t ok, then [we hope] it isn’t the end.”
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Dr. Lois Ramondetta is a professor of gynecologic oncology at The University of Texas MD Anderson Cancer Center in Houston, TX.
This article was originally published in Coping® with Cancer magazine, January/February 2012.