Purpose/Objectives: To explore the experience and meaning of hope in relation to the healing process of patients living with stage IIIb or IV non-small cell lung cancer.
Research Approach: Interpretative qualitative study design.
Setting: Peter Brojde Lung Cancer Centre in the Jewish General Hospital in Montreal, Quebec, Canada.
Participants: 12 English- and French-speaking patients, aged 36-78 years.
Methodologic Approach: One 60-90-minute semistructured interview per participant was conducted. An inductive approach to data analysis was taken, involving immersion in the data, coding, classifying, and creating linkages.
Findings: Four main themes emerged: (a) the morass of shattered hope, (b) tentative steps toward a new hope paradigm, (c) reframing hope within the context of a life-threatening illness, and (d) strengthening the link between hope and wellness.
Conclusions: Patients described a process where hope was diminished or lost entirely, regained, and reshaped as they learned to live and grow following their diagnosis.
Interpretation: This study adds to the literature by describing the dynamic nature of hope as well as factors facilitating or hindering the hope process. It demonstrates how finding meaning, a structural component of healing, can be used to envision a new hopeful future. This study suggests hope and healing cannot exist in isolation, and highlights the importance of understanding the fluctuating nature of hope in patients with advanced lung cancer to foster it, therefore promoting healing.
Akin, S., Can, G., Aydiner, A., Ozdilli, K., & Durna, Z. (2010). Quality of life, symptom experience and distress of lung cancer patients undergoing chemotherapy. <i>European Journal of Oncology Nursing, 14</i>, 400-409.
Amichai, T., Grossman, M., & Richard, M. (2012). Lung cancer patients' beliefs about complementary and alternative medicine in the promotion of their wellness. <i>European Journal of Oncology Nursing, 16</i>, 520-527. doi:10.1016/j.ejon.2012.01.004
Benzein, E., Norberg, A., & Saveman, B. I. (2001). The meaning of the lived experience of hope in patients with cancer in palliative home care. <i>Palliative Medicine, 15</i>, 117-126.
Buckley, J., & Herth, K. (2004). Fostering hope in terminally ill patients. <i>Nursing Standard, 19</i>(10), 33.
Buehler, J. A. (1975). What contributes to hope in the cancer patient? <i>American Journal of Nursing, 75</i>, 1353-1356.
Burnard, P. (1991). A method of analysing interview transcripts in qualitative research. <i>Nurse Education Today, 11</i>, 461-466.
Canadian Cancer Society. (2012). <i>Canadian cancer statistics 2012.</i> Toronto, Ontario, Canada: Author.
Cassel, E. J. (1982). The nature of suffering and the goals of medicine. <i>New England Journal of Medicine, 306</i>, 639-645.
Chen, M. L. (2003). Pain and hope in patients with cancer: A role for cognition. <i>Cancer Nursing, 26</i>, 61-67.
Chi, G. C. (2007). The role of hope in patients with cancer. <i>Oncology Nursing Forum, 34</i>, 415-424.
Chio, C. C., Shih, F. J., Chiou, J. F., Lin, H. W., Hsiao, F. H., & Chen, Y. T. (2008). The lived experiences of spiritual suffering and the healing process among Taiwanese patients with terminal cancer. <i>Journal of Clinical Nursing, 17</i>, 735-743.
Clayton, J. M., Butow, P. N., Arnold, R. M., & Tattersall, M. H. (2005). Fostering coping and nurturing hope when discussing the future with terminally ill cancer patients and their caregivers. <i>Cancer, 103</i>, 1965-1975.
Cooley, M. E., Short, T. H., & Moriarty, H. J. (2003). Symptom prevalence, distress, and change over time in adults receiving treatment for lung cancer. <i>Psycho-Oncology, 12</i>, 694-708.
Dobkin, P. L. (2009). Fostering healing through mindfulness in the context of medical practice. <i>Current Oncology, 16</i>(2), 4-6.
Downer, S. M., Cody, M. M., McCluskey, P., Wilson, P. D., Arnott, S. J., Lister, T. A., & Slevin, M. L. (1994). Pursuit and practice of complementary therapies by cancer patients receiving conventional treatment. <i>BMJ, 309</i>, 86-89.
Dufault, K., & Martocchio, B. C. (1985). Symposium on compassionate care and the dying experience. Hope: Its spheres and dimensions. <i>Nursing Clinics of North America, 20</i>, 379-391.
Egnew, T. R. (2005). The meaning of healing: Transcending suffering. <i>Annals of Family Medicine, 3</i>, 255-262.
Egnew, T. R. (2009). Suffering, meaning, and healing: Challenges of contemporary medicine. <i>Annals of Family Medicine, 7</i>, 170-175.
Erickson, H. (2006). <i>Modeling and role-modeling: A view from the client's world.</i> Cedar Park, TX: Unicorns Unlimited.
Fan, G., Filipczak, L., & Chow, E. (2007). Symptom clusters in cancer patients: A review of the literature. <i>Current Oncology, 14</i>, 173-179.
Farran, C. J., Herth, K. A., & Popovich, J. M. (1995). <i>Hope and hopelessness: Critical clinical constructs.</i> Thousand Oaks, CA: Sage.
Feldman, D., & Snyder, C. (2005). Hope and the meaningful life: Theoretical and empirical associations between goal-directed thinking and life meaning. <i>Journal of Social and Clinical Psychology, 24</i>, 401-421.
Ferrell, B. R., & Coyle, N. (2008). The nature of suffering and the goals of nursing. <i>Oncology Nursing Forum, 35</i>, 241-247.
Graves, K. D., Arnold, S. M., Love, C. L., Kirsh, K. L., Moore, P. G., & Passik, S. D. (2007). Distress screening in a multidisciplinary lung cancer clinic: Prevalence and predictors of clinically significant distress. <i>Lung Cancer, 55</i>, 215-224.
Grossman, M., Agulnick, J., & Batista, G. (2012). The Peter Brojde Lung Cancer Centre: A model of integrative practice. <i>Current Oncology, 19</i>(3), e145-e159.
Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation. <i>Field Methods, 18</i>(1), 59-82.
Hagerty, R. G., Butow, P. N., Ellis, P. M., Lobb, E. A., Pendlebury, S. C., Leighl, N., … Tattersall, M. H. (2005). Communicating with realism and hope: Incurable cancer patients' views on the disclosure of prognosis. <i>Journal of Clinical Oncology, 23</i>, 1278-1288.
Heidegger, M. (1962). <i>Being and time.</i> New York, NY: Harper and Row.
Herth, K. (1990). Fostering hope in terminally-ill people. <i>Journal of Advanced Nursing, 15</i>, 1250-1259.
Herth, K. (1992). Abbreviated instrument to measure hope: Development and psychometric evaluation. <i>Journal of Advanced Nursing, 17</i>, 1251-1259.
Hinds, P. S. (1984). Inducing a definition of "hope" through the use of grounded theory methodology. <i>Journal of Advanced Nursing, 9</i>, 357-362.
Hinds, P. S., & Martin, J. (1988). Hopefulness and the self-sustaining process in adolescents with cancer. <i>Nursing Research, 37</i>, 336-340.
Johnson, S. (2007). Hope in terminal illness: An evolutionary concept analysis. <i>International Journal of Palliative Nursing, 13</i>, 451-459.
Kaasa, S., Mastekaasa, A., & Lund, E. (1989). Prognostic factors for patients with inoperable non-small cell lung cancer, limited disease: The importance of patients' subjective experience of disease and psychosocial well-being. <i>Radiotherapy and Oncology, 15</i>, 235-242.
Koithan, M., Verhoef, M., Bell, I. R., White, M., Mulkins, A., & Ritenbaugh, C. (2007). The process of whole person healing: "Unstuckness" and beyond. <i>Journal of Alternative and Complementary Medicine, 13</i>, 659-668.
Kukull, W. A., McCorkle, R., & Driever, M. (1986). Symptom distress: Psychosocial variables, and survival from lung cancer. <i>Journal of Psychosocial Oncology, 4</i>(1-2), 91-104.
Lee, V. (2008). The existential plight of cancer: Meaning making as a concrete approach to the intangible search for meaning. <i>Supportive Care in Cancer, 16</i>, 779-785.
Lin, C. C., Tsai, H. F., Chiou, J. F., Lai, Y. H., Kao, C. C., & Tsou, T. S. (2003). Changes in levels of hope after diagnostic disclosure among Taiwanese patients with cancer. <i>Cancer Nursing, 26</i>, 155-160.
Magaletta, P. R., & Oliver, J. M. (1999). The hope construct, will, and ways: Their relations with self-efficacy, optimism, and general well-being. <i>Journal of Clinical Psychology, 55</i>, 539-551.
Maxwell, J. A. (1992). Understanding and validity in qualitative research. <i>Harvard Educational Review, 62</i>, 279-300.
McClement, S. E., & Chochinov, H. M. (2008). Hope in advanced cancer patients. <i>European Journal of Cancer, 44</i>, 1169-1174. doi:10.1016/j.ejca.2008.02.031
McElligott, D. (2010). Healing: The journey from concept to nursing practice. <i>Journal of Holistic Nursing, 28</i>, 251-259.
McEvoy, L., & Duffy, A. (2008). Holistic practice—A concept analysis. <i>Nurse Education in Practice, 8</i>, 412-419.
McEwen, B. S. (2008). Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators. <i>European Journal of Pharmacology, 583</i>, 174-185.
McEwen, B. S., Eiland, L., Hunter, R. G., & Miller, M. M. (2012). Stress and anxiety: Structural plasticity and epigenetic regulation as a consequence of stress. <i>Neuropharmacology, 62</i>(1), 3-12.
Miller, A. H., Ancoli-Israel, S., Bower, J. E., Capuron, L., & Irwin, M. R. (2008). Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. <i>Journal of Clinical Oncology, 26</i>, 971-982.
Moore, S. (2005). Hope makes a difference. <i>Journal of Psychiatric and Mental Health Nursing, 12</i>(1), 100-105.
Mount, B. M. (2003). Existential suffering and the determinants of healing. <i>European Journal of Palliative Care, 10</i>(2, Suppl.), 40-42.
Mount, B. M., Boston, P. H., & Cohen, S. R. (2007). Healing connections: On moving from suffering to a sense of well-being. <i>Journal of Pain and Symptom Management, 33</i>, 372-388.
Mulkins, A. L., & Verhoef, M. J. (2004). Supporting the transformative process: Experiences of cancer patients receiving integrative care. <i>Integrative Cancer Therapies, 3</i>, 230-237.
O'Connor, A. P., Wicker, C. A., & Germino, B. B. (1990). Understanding the cancer patient's search for meaning. <i>Cancer Nursing, 13</i>, 167-175.
Pert, C. B., Dreher, H. E., & Ruff, M. R. (1998). The psychosomatic network: Foundations of mind-body medicine. <i>Alternative Therapies in Health and Medicine, 4</i>(4), 30.
Polit, D., & Beck, C. T. (2008). <i>Collecting unstructured data.</i> In Nursing Research (8th ed., pp. 392-413). Philadelphia, PA: Wolters Kluwer.
Post-White, J., Ceronsky, C., Kreitzer, M. J., Nickelson, K., Drew, D., Mackey, K. W., … Gutnecht, S. (1996). Hope, spirituality, sense of coherence, and quality of life in patients with cancer. <i>Oncology Nursing Forum, 23</i>, 1571-1579.
Ramfelt, E., Severinsson, E., & Lützén, K. (2002). Attempting to find meaning in illness to achieve emotional coherence: The experiences of patients with colorectal cancer. <i>Cancer Nursing, 25</i>, 141-149. doi:10.1097/00002820-200204000-00011
Reb, A. M. (2007). Transforming the death sentence: Elements of hope in women with advanced ovarian cancer [Online exclusive]. <i>Oncology Nursing Forum, 34</i>, E70-E81.
Saleh, U. S., & Brockopp, D. Y. (2001). Hope among patients with cancer hospitalized for bone marrow transplantation: A phenomenologic study. <i>Cancer Nursing, 24</i>, 308-314.
Schrank, B., Stanghellini, G., & Slade, M. (2008). Hope in psychiatry: A review of the literature. <i>Acta Psychiatrica Scandinavica, 118</i>, 421-433.
Stoner, M. H., & Keampfer, S. H. (1985). Recalled life expectancy information, phase of illness and hope in cancer patients. <i>Research in Nursing and Health, 8</i>, 269-274.
Tan, M., & Karabulutlu, E. (2005). Social support and hopelessness in Turkish patients with cancer. <i>Cancer Nursing, 28</i>, 236.
Thayer, J. F., & Sternberg, E. (2006). Beyond heart rate variability: Vagal regulation of allostatic systems. <i>Annals of the New York Academy of Sciences, 1088</i>, 361-372.
Thompson, E., Solà, I., & Subirana, M. (2005). Non-invasive interventions for improving well-being and quality of life in patients with lung cancer—A systematic review of the evidence. <i>Lung Cancer, 50</i>, 163-176.
Thompson, S., & Janigian, A. (1988). Life schemes: A framework for understanding the search for meaning. <i>Journal of Social and Clinical Psychology, 7</i>, 260-280.
Thorne, S., Kirkham, S. R., & MacDonald-Emes, J. (1997). Interpretive description: A noncategorical qualitative alternative for developing nursing knowledge. <i>Research in Nursing and Health, 20</i>, 169-177.
Thorne, S. E., Hislop, T. G., Armstrong, E. A., & Oglov, V. (2008). Cancer care communication: The power to harm and the power to heal? <i>Patient Education and Counseling, 71</i>(1), 34-40.
Tishelman, C., Degner, L. F., Rudman, A., Bertilsson, K., Bond, R., Broberger, E., … Levealahti, H. (2005). Symptoms in patients with lung carcinoma: Distinguishing distress from intensity. <i>Cancer, 104</i>, 2013-2021.
Watson, M., Homewood, J., Haviland, J., & Bliss, J. M. (2005). Influence of psychological response on breast cancer survival: 10-year follow-up of a population-based cohort. <i>European Journal of Cancer, 41</i>, 1710-1714.
Wilson, K. G., Chochinov, H. M., McPherson, C. J., LeMay, K., Allard, P., Chary, S., … Fainsinger, R. L. (2007). Suffering with advanced cancer. <i>Journal of Clinical Oncology, 25</i>, 1691-1697
Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. <i>Psycho-Oncology, 10</i>, 19-28.