Nurturing Realistic Hope in Patients

with a Poor Prognosis

Wes Sedlacek, MDiv, BCC

Learning Goals:

1) To better understand the concept of hope

2) To become familiar with common factors that sustain or threaten a

patient’s sense of hope

3) To identify several behaviors medical caregivers can embrace or

avoid, to best nurture hope

Herth, K: Fostering hope in terminally-ill people. Journal of Advanced Nursing 15:1250-1259,

1990

Miller, JF: Hope-inspiring strategies of the critically ill. Applied Nursing Research Vol 2, No

1:23-29, 1989

Hagerty RG, Butow PN, et al: Communicating with realism and hope: Incurable cancer

patients’ views on the disclosure of prognosis. Journal of Clinical Oncology Vol 23, No 6:1278-

1288, 2005

Factors that Influence Hope - Relationships - Spiritual beliefs - Philosophy of life - Determination - Humor / lightheartedness - Attainable goals - Sense of control

Factors that Threaten Hope - Recognizing physical cues and evidence of setbacks - Disconnected from relationships - Negative hospital experiences - Negative attitudes of healthcare workers - Negative self-talk by patient - Uncontrolled pain and discomfort

Clayton JM, Hancock K, et al: Sustaining hope when communicating with terminally ill patients

and their families: A systematic review. Psycho-Oncology 17:641-659, 2008

Hagerty RG, Butow PN, et al: Communicating with realism and hope: Incurable cancer

patients’ views on the disclosure of prognosis. Journal of Clinical Oncology Vol 23, No 6:1278-

1288, 2005

Hope-Giving Behaviors - Being realistic - Giving time to ask questions - Acknowledging the patient as an individual - Giving information personally - Checking patient’s understanding - Explaining symptoms well - Assuring pain control - Communicating well

Hope-Hindering Behaviors - Appearing nervous or uncomfortable - Giving information in an impersonal manner - Using euphemisms - Talking about treatment but avoiding talk about the disease - Giving survival statistics - Hiding or distorting the truth