in the face of serious illness has long been a goal of patients, families, and clinicians. However, relatively little is known about the factors that sustain hope.1,2
Even so, hope is a key clinical and perhaps therapeutic variable, affecting cancer patients' adjustment and coping skills, overall well-being, immune function, and quality of life.3–10
Conversely, lack of hope and hopelessness is associated with physical illness, depression, and wish to hasten death.11,12
Therefore, developing greater understanding of the demographic and clinical factors that might be associated with or influence a patient's degree of hope could lead to strategies to identify patients at higher risk for hopelessness or factors that could be targeted by interventions to improve hope and coping with cancer.
Defining and operationalizing hope is a complex endeavor as the term has many different interpretations, meanings, and usages. Qualitative investigations of hope within nursing literature have helped describe and define the concept in terms of its sources, attributes, and goals. According to the conceptual model developed by Dufault and Martocchio, hope is a “multidimensional
dynamic life force characterized by a confident
expectation of achieving a future good which, to the hoping person, is realistically possible and personally significant.
” Furthermore, hope is described as a “complex of many thoughts, feelings, and actions that change with time.” Based on extensive research, Dufault and Martocchio conceptualized hope as composed of two spheres, “generalized hope” and “particularized hope,” each consisting of six shared dimensions: cognitive, temporal, affective, behavioral, affiliative, and contextual.13
As described in reviews by Butt14
and by Chi,15
a number of studies have investigated the role of hope in different populations of cancer patients using qualitative and/or quantitative methods. Various instruments have been used to measure hope, most common of which is the Hearth Hope Scale and its more concise counterpart, the Herth Hope Index (HHI). Of the studies that have quantitatively assessed the relationship between hope and cancer pain, findings have varied.16–21
Some research has evidenced direct negative correlations between pain severity and hope.16,18,22
Other studies, however, show no significant direct correlations between hope scores and pain intensity or duration.17,20
For example, a cross-sectional study of hospitalized cancer patients in Norway found HHI scores correlated negatively with several of the interference items on the Brief Pain Inventory (BPI), but not with pain severity per se.20
A study investigating the association between pain and hope levels in hospitalized Taiwanese cancer patients concluded that HHI scores did not differ between patients with and without cancer pain. However, among those patients with pain, hope levels correlated with patients' beliefs about their pain symptoms rather than the pain itself (i.e., pain duration, intensity, and relief), suggesting that cognitive and emotional processing may mediate the relationship between pain and hope.17
To our knowledge, none of the studies focused on hope and pain levels to date have included metrics of both psychological and spiritual well-being. According to Chochinov and others, spirituality can play a significant role in maintaining hope, and it has been recognized by the Institute of Medicine as an important aspect of supportive care at end of life.22–25
Research has also provided empirical support for the hypothesis that spiritual well-being might help to bolster psychological functioning and adjustment to illness.15,26–28
Because the prior literature has delivered inconsistent results and primarily focused on inpatients, the goal of this study was to examine the relationship between pain and hope among oncologic outpatients, while also controlling for psycho-spiritual factors and other potentially significant clinical and demographic variables. It was also important to evaluate the relationship between hope and pain among patients in the US, because prior published studies were set in Europe and Asia.