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Hope in the Context of Pain and Palliative Care

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Handbook of Pain and Palliative Care

Abstract

Hope is an important, even essential component of the resilience that translates into better coping and quality of life in the setting of a life-threatening illness, especially as death approaches, and the hope for positive outcomes turns to hope for being comfortable, well informed, accompanied by those who love us, and making meaning in devastating situations. There are little empirical data on the components and impact of hope in cancer care but a wealth of information about the psychology of hope and factors associated with hope and hopelessness. Hope can positively impact an individual’s behavior and choices, and interventions decrease levels of depression and hopelessness. However, the biology and mechanism of benefit are complex, and the relative contribution of the nonspecific physical, neuroendocrine, and inflammatory pathways is unknown. Hope can enhance quality of life in cancer patients, but any benefit in the length of survival is much more controversial, and new avenues of investigation show how social networks foster hope through support, information, and access to care. A common fear is that when the patient gives up, the disease takes over, and patients need structured informational and psychological support (An agreed (1) plan, (2) information and (3) support), with committed, optimistic, and personal attention. The ethics of hype and hope, and the need for honesty and realism apply as much to alternative as to conventional medicine. “Hope is the last thing to loose,” working toward a “good death” requires addressing the transcendent hopes of the moment and those embodied in spiritual beliefs and legacy. Hope can exist, even when the challenge is impossible, the odds long, and the time short. It is a huge privilege to nurture realistic hopefulness and to not abandon patients to fear and despair in their last days. The best care demands the science of medicine and the art of compassion. Then, we can all speak the language of hope, trust, and respect.

Hope is a good thing, maybe the best thing, and no good thing ever dies.

Andy Dufresne, The Shawshank Redemption (1994 film)

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Authors and Affiliations

  1. University of Alcalá de Henares, Madrid, Spain

    Maria Uribarren Movilla

  2. Raffles Cancer Centre, Singapore, Singapore

    Lynette Su-Mien Ngo MBBS, MRCP

  3. National Cancer Centre Singapore, Singapore, Singapore

    Gillianne Lai MD

  4. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Richard T. Penson MD, MRCP

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  1. Maria Uribarren Movilla
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  2. Lynette Su-Mien Ngo MBBS, MRCP
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  3. Gillianne Lai MD
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  4. Richard T. Penson MD, MRCP
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Correspondence to Richard T. Penson MD, MRCP .

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    Rhonda J. Moore

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Movilla, M.U., Ngo, L.SM., Lai, G., Penson, R.T. (2018). Hope in the Context of Pain and Palliative Care. In: Moore, R. (eds) Handbook of Pain and Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-95369-4_20

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