Assessment of Hope among adult palliative patients with cancer: An Evidence-Based Analysis

Khaldoon Aied Alnawafleh^* and Walid Theib Mohammad

^*Correspondence: Khaldoon Aied Alnawafleh, Princess Aisha Bint Al Hussein College for Nursing and Health Sciences, Al-Hussein Bin Talal University, Maan, Jordan, Email:

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Introduction

In serious illness, hope is a common feature, and it's linked to improved psycho-spiritual well-being and quality of life [1]. In oncology and palliative care, the balance between hope and hopelessness may influence how patients perceive their quality of life and death [2]. As a result, a cancer diagnosis is frequently viewed as a death sentence, and those who are diagnosed with cancer frequently feel physical and psychological pain. Furthermore, both patients and their careers’ quality of life (QOL) can be greatly impacted by cancer [3]. More specifically, the prevalence of depression among Jordanian patients with cancer in 2020 was 34% [4].

Because of horror about a vague outlook, Patients with cancer frequently seek additional forms of support in order to cope with the burden of their illnesses [5]. Therefore, hope has been acknowledged as a vital resource in the lives of cancer patients, assisting them in coping during times of suffering and uncertainty [6]. Hope is regarded as an effective coping strategy for cancer patients, providing adaptive power to help them get through the difficult condition and achieve desired goals [7].

Despite the fact that pessimism is frequently misunderstood as the polar opposite of optimism, it is unclear if hope and hopelessness are opposed constructs on the same spectrum or if each represents a separate construct [8].

Significance of study

Cancer stays to the present day a challenge for health care providers. As a result of early detection and medical treatment, the lives of cancer patients have been extended [9]. As cancer patients' life expectancies have increased, the existence of psychosocial disorders and concerns has become a long-term worry. As a result, the focus of psychology study has shifted away from death and dying and toward healthy adaptation and increasing quality of life [10]. Additionally, Puchalski, et al. [11] recommended that whatever can be done to inspire effective coping will improve the patient's quality of life.

In order to test and use new approaches to modify and enhance hope level, it is vital to standardize the assessment method in clinical sitting to capture the real statues of hope in many health related issue [12].

Nursing staff and health care providers must be aware of the many factors that influence patients' hope when they are diagnosed with cancer. Oncology nurse specialists' mission is to work as active members of a multidisciplinary team to help patients and their families cope with cancer [13]. This is necessary of nurses in order for them to be conversant with variables that may help to encourage and foster hope among cancer patients. Thus, identification of best tool to measure hope would help nurses to perform necessary assessments in order to identify patients at risk of hopelessness, premature death, or suicidal ideation [14]. Professionals should be able to devise suitable interventions to nurture hope in cancer patients if they can identify patients who are at risk for an increase in their sense of hopelessness. Furthermore, identifying individuals who are at risk of hopelessness can aid clinicians in anticipating difficulties and maximizing scarce resources [15].

It order to understand the phenomena of hope and choose the best tool to measure it, we must understand the elements and the factors that contribute to this phenomena.

The PICO summary and questions

P: The population of this review is adult palliative patients with cancer.

I: The intervention is assessment tool to measure hope level.

C: The comparison is between groups whom using Hope Herth Index (HHI) versus using other assessment tools.

O: The desired outcome is to identifying accurate and precise measurement of hope among adult palliative patients with cancer.

PICO questions

What is the most effective measure of hope among adult cancer palliative patients?

Methods

Literature search for this evidence based review was carried out in CINAHL, Science direct, MEDLINE, PubMed, EMBASE and Google search. Keywords used were: cancer, oncology, malignancy; terms related to hope measurement: hope, hope assessment; terms related to survivors: living with cancer, curable. Inclusion criteria were:

The subjects of the study are adult palliative cancer patient.

The subjects of the study are adult palliative cancer patient.

Full text article.

Published article.

Include a measure of hope.

The article is in English. No restrictions for study design were applied.

All related articles were reviewed, selected articles were analyzed, and the following data were summarized for included studies: author and year, objectives, main outcome variables, design, setting, sample number, exercise, data collection instruments, and main results.

Instrument assessment

The level of evidence was assessed using a criteria summarized in Appendix A (Hocking and Cousins, 2003). The level of evidence for included studies was summarized in the next section, however the level of evidence for the majority of included studies was moderate to high.

Results

Literature search

About 100 articles were results from the literature search, after title and abstract reviewing only 30 articles were selected for internal analyzes while the others were excluded because: It is not use the selected too to measure hope, not full text, or for pediatrics population, all duplicated articles which were included in systematic reviews or meta analyses were excluded to prevent redundancy, the final articles used in this review were ten articles: Three study with strong level of evidence (level I): Meta-analysis [16,17], two studies with moderate level of evidence (level II): Experimental trial [18,19], Five studies were with mild level (level III) which were a descriptive cross-sectional survey [20-23] included studies are summarized in Appendix B.

Assessment of hope

High-hope people use information about the cause of their illness to do more of what helps and less of what doesn't [24]; as a result of this study, nine randomized controlled trials were included, and the methodological quality of each randomized controlled trial (RCT) was evaluated; current evidence suggests that nursing intervention has a positive effect on hope in cancer patients. To corroborate these findings, more large-scale and high-quality randomized controlled trials are needed. Similarly [16] conducted a study to see if these hope-boosting tactics were linked to (a) Enhanced hopefulness, (b) Improved life satisfaction, and (c) Reduced psychological distress among participants, the outcome of these investigations These results of a meta-analysis of 27 research including 2,154 participants revealed substantial but minor impact sizes for hopefulness and life satisfaction, as well as no overall link between hope enhancement measures and reduced psychological distress. Because there is very limited evidence that hope enhancement tactics can boost hopefulness or life satisfaction, and no consistent evidence that hope enhancement strategies can decrease psychological distress, the current study is limited. Finally, a meta-analysis research [17] was conducted to better understand how hope and associated constructs are applied and quantified in healthcare, particularly in cancer patients. Two types of targeted literature reviews were carried out: (1) Hoperelated psychological assessments, and (2) Psychological function measures in cancer-related care, such as wellbeing and other positive psychological constructs Cancer treatment and symptom remission are influenced by positive psychological notions. The measurement of these domains is a crucial part of treatment selection and outcome evaluation. However, the availability of psychometrically sound instruments established for this context of use is required for trustworthy and effective assessment of hope and related dimensions. Chan, et al. [19] employed the short hope intervention (BHI) to assess rehabilitation cancer patients' hope levels and psychological and physical health results (RCP). The BHI was made up of four one-on-one sessions: two (1-hour) face-to-face sessions and two (30-minute) telephone follow-up sessions. With tiny impact sizes, the increases in current hope and depression ratings were inconsequential. The BHI appeared to have the potential to provide both physical and psychological advantages in RCP patients. On the other hand, the shortterm efficacy of a hope-based intervention program in enhancing hope levels and decreasing psychopathology among HCRC genetic testing participants was explored. Psychological questionnaires were given to participants immediately before and after the first and last sessions of the program to assess their levels of hope, anxiety, and depression. Our findings suggest that a hope-based intervention program could help HCRC genetic testing recipients feel more hopeful.

Hope aids oncology patients in adjusting to their sickness, regardless of their stage of cancer [22]. The goal of this study was to see how common hope is in a group of end-of-life patients, as well as look into the possible links between hope and a variety of clinical and psychosocial factors. Because hope is both a need and a tool for patients dealing with illness, it's critical to implement stage-specific and realistic hope-facilitating interventions, as well as to assist patients in their search for meaning, which improves spiritual well-being. Similarly, in a study conducted by [23] to investigate the relationships between personal resilience, hope, and other potential predictors of hope in advanced cancer patients, the findings were as follows: Given that resilience is a fluid, variable road that can lead to hope, resilience-enhancing medicines should be valued in palliative care settings and implemented as soon as possible with cancer patients. Such therapies will likely assist patients with advanced stages of non-malignant illnesses as well. Wnuk, et al. [25] explored the role of purpose of life, hope, and happiness on the happiness and life satisfaction of cancer patients during and after treatment. Cancer components were found to be adversely related to the loss of friends and six happiness and life satisfaction variables, showing that cancer treatment had a negative impact on patients' Patients in and out of treatment received psychological care at the cancer center. Despite the widespread use of the term "hope," the experience of hope in patients with chronic or even life-threatening illnesses is usually disregarded due to a lack of well-designed and validated evaluation measures.

Instruments of hope

Different instruments were used to assess hope level, after profound search, four tools was found to be used in psychological and medical field which is; The Miller Hope Scale (MHS), The Herth Hope Scale (HHS), EuroQol-5D and Trait hope.

Trait Hope Scale [26] it divided into eight items, four of which assess agency (e.g., "I work hard to achieve my goals") and pathways thinking (e.g., "There are many ways to solve any problem"). On a four-point scale, items are rated (from 1, definitely false to 4, definitely true). The overall hope score was used in this research. For the overall scale, Snyder, et al. [26] reported coefficient alphas ranging from.

The Miller Hope Scale (MHS) was created using important elements of hope identified in a literature review and an exploratory investigation of hope in people who had survived a serious illness. The MHS ratings range from 40 to 200, with higher levels suggesting greater hope. This healthy sample's mean hope score was 164.46 (SD = 16.31). The alpha coefficient for internal consistency ranged from 83 to 92. The MHS was compared to the Psychological Well-Being Scale to determine criterionrelated construct validity [27].

The Herth Hope Index (HHI) is a multi-dimensional 12-item index that measures a worldwide, non-time oriented sense of hope. It has three dimensions: time and the future, positive readiness and expectation, and interconnectivity. The Herth Hope Scale has been condensed into the Herth Hope Index. Internal consistency analyses found a test-retest reliability of.94, showing consistency across time, alpha values ranging from. For each of the three components, and an alpha range of. for the overall HHI, which varied by education, age, weariness, and sickness phase [28,29].

EuroQol-5D EQ-5D is a standardized health status measurement created by the EuroQol Group to provide a simple, generic measure of health for clinical and economic evaluation [30,31]. Mobility, self-care, typical activities, pain/discomfort, and anxiety/depression are the five dimensions of the EQ-5D-3L description system. Each dimension has three levels: no issues, minor issues, and major issues. The respondent is asked to tick (or cross) the box next to the most appropriate statement in each of the five parameters to reflect his or her health status. Despite the small number of items, the instrument had a high level of internal consistency.

Discussion

It is critical to understand what hope is in order to choose the appropriate technique for measuring hope among palliative adult cancer patients. The Herth Hope Index (HHI), Herth Hope Scale (HHS), Miller Hope Scale (MHS), as well as a generic health-related quality of life tool (EQ-5D) and the Adult Trait Hope Scale, are all used to assess hope. As a result, five research [20-23,25] have employed the Herth Hope Scale (HHS) to assess hope in various clinical settings. A Dufault, et al. [32] model will be used to guide and organize the literature review and the overall research plans. This model is argued to be particularly relevant to this subject. Hope is described as "a multidimensional dynamic life force characterized by a confident yet uncertain expectation of accomplishing a future benefit that is practically achievable and personally relevant to the hoping individual," according to this concept [32]. Aspects of hope, according to this paradigm, are affective, cognitive, behavioral, affiliative, temporal, and contextual. "Sensations and emotions that are part of the hoping process" are the focus of the emotional dimension. It entails a mix of confidence, ambiguity, and personal stakes in the outcome. "The processes by which persons wish, imagine, wonder, perceive, think, remember, learn, generalize, interpret, and judge in regard to hope" is the focus of the cognitive dimension. The behavioral dimension is concerned with "the hoping person's action orientation in connection to hope".

Praying or following religious practices are examples of actions that are either aimed to directly achieve a hope or are motivated by, but do not directly effect, the desired outcome. The affiliative dimension is concerned with "the hoping person's sense of relatedness or the involving person's experience of relatedness or engagement beyond self in relation to hope". This dimension is important in people's relationships with God, and it can be portrayed as a reliance on or openness to aid from others. The temporal dimension is concerned with the experience of time (past, present, and future) by the hoping individual in relation to hope and hoping. Hope is focused toward a better future, but it is also influenced by the past and present".

The contextual component is concerned with "those circumstances in one's life that surround, influence, and are a part of one's hope. The surroundings, in a way, serve as the circumstances that elicit hope, the opportunity for the hoping process to be triggered, or a situation in which hope is put to the test".

The trait hope scale is a brief scale that can save time and effort, but it can only be used for acute health problems and short-term illnesses. The reported coefficient alpha's range from 74 to 84, which is adequate but not sufficient for height. Furthermore, it excludes the emotive dimension, limiting its applicability to adult patients receiving palliative care.

Miller Hope is a short and thorough tool that covers all of the variations of hope in a simple and easy to use format. Its internal consistency alpha coefficient ranged from.83 to.92, which is considered quite high. It should be used in conjunction with other scales in order to cover the multidimensional status of hope, which makes it ineffective when used alone.

EuroQol-5D EQ-5D criteria measure hope only in the clinical area, which limits their use as a comprehensive and long-term tool in palliative care for cancer patients. Science it hasn't been used in many studies for cancer patients or other palliative conditions, so its reliability and validity haven't been captured, but it could be used in conjunction with other scales to cover this area specifically.

Finally, the Herth Hope Index (HHI) is a multidimensional index that measures a worldwide, non-time oriented sense of hope. It encompasses all hope losses. It can be used on the chronic diseases and it have height realbility and validity rate r- 0. 94 is the highest among the given assessment tools ,it been used constantly in cancer patient to capture hope level in many cultures, it easy to be followed however it is hard to be used in pediatric populations as this index measure diminutions that developing in the child personality and not mature yet to be measured.

Conclusions

Findings indicate that Herth Hope Index (HHI) is a trustworthy measure of hope in individuals with cancer in a palliative context. There is a need for more research into the (HHI) factor structure in adolescents and young adults.. Also further qualitative studies require capturing the factors that influence hope among cancer patient as unique population with consideration for the cultural and medical background.

Recommendations

For practice nurses

Encourage nurses in the clinical setting to use (HHI) as effective tool to measure hope among palliative patients with cancer to better understand and management this phenomena

For educators

Educators, and students need to know the most effective way to measure and capture hope among cancer survivors, more attention on these concepts can help to improve the nursing care process.

For researcher

More Randomized Control Trial (RCT) about the to evaluate and update the hope assessment tools among cancer patients of different types are needed.

References

1. Salamanca-Balen N, Merluzzi TV, Chen M. The effectiveness of hope-fostering interventions in palliative care: A systematic review and meta-analysis. Palliat Med 2021; 35:710-728.

Indexed at, Google Scholar, Cross Ref

2. Sachs E, Kolva E, Pessin H, et al. On sinking and swimming: The dialectic of hope, hopelessness, and acceptance in terminal cancer. Am J Hospice Palliat Med 2013; 30:121-127.

 Google Scholar, Cross Ref

3. Kang E, Keam B, Lee NR, et al. Impact of family caregivers’ awareness of the prognosis on their quality of life/depression and those of patients with advanced cancer: A prospective cohort study. Support Care Cancer 2021; 29:397-407.

Indexed at, Google Scholar, Cross Ref

4. Malak MZ, Tawalbeh LI, Al-Amer RM. Depressive symptoms among older Jordanian patients with cancer undergoing treatment. Clin Gerontol 2021; 44:133-142.

Indexed at, Google Scholar, Cross Ref

5. Lavallée JF, Grogan S, Austin CA. Cancer patients’ family members’ experiences of the information and support provided by healthcare professionals. Health Educ J 2019; 78:416-427.

Indexed at, Google Scholar, Cross Ref

6. Oishi A, Murtagh FE. The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: A systematic review of views from patients, carers and health-care professionals. Palliat Med 2014; 28:1081-1098.

Indexed at, Google Scholar, Cross Ref

7. Gallagher MW, Lopez SJ. The Oxford handbook of hope. Oxford University Press 2018.

Google Scholar

8. Huen JM, Ip BY, Ho SM, et al. Hope and hopelessness: The role of hope in buffering the impact of hopelessness on suicidal ideation. PloS One 2015; 10:e0130073.

Indexed at, Google Scholar, Cross Ref

9. Moyer VA, US Preventive Services Task Force. Screening for lung cancer: US preventive services task force recommendation statement. Ann Intern Med 2014; 160:330-338.
10. Snowden JA, Greenfield DM, Bird JM, et al. Guidelines for screening and management of late and long-term consequences of myeloma and its treatment. Br J Haematol 2017; 176:888-907.

Indexed at, Google Scholar, Cross Ref

11. Puchalski CM, Vitillo R, Hull SK, et al. Improving the spiritual dimension of whole person care: reaching national and international consensus. J Palliat Med 2014; 17:642-656.

Indexed at, Google Scholar, Cross Ref

12. Holmes EA, Ghaderi A, Harmer CJ, et al. The lancet psychiatry commission on psychological treatments research in tomorrow's science. Lancet Psychiatr 2018; 5:237-286.

Indexed at, Google Scholar, Cross Ref

13. Speese Owens N. Psychological components of cancer nursis. Nursing care of the cancer patient. London the CV Mosby Company. 1981; 45-60.

Google Scholar

14. Tang PL, Wang HH, Chou FH. A systematic review and meta-analysis of demoralization and depression in patients with cancer. Psychosom 2015; 56:634-643.

Indexed at, Google Scholar, Cross Ref

15. Maslach C, Leiter MP. Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry 2016; 15:103-111.

Indexed at, Google Scholar, Cross Ref

16. Weis R, Speridakos EC. A meta-analysis of hope enhancement strategies in clinical and community settings. Psychol The Res  Prac 2011; 1:1-6.

Indexed at, Google Scholar, Cross Ref

17. Meyers OI, Higgins K, Foley K. Measurement of hope in patients with cancer. Value Health 2015; 18:A473.

Indexed at, Cross Ref

18. Ho SM, Ho JW, Pau BK, et al. Hope-based intervention for individuals susceptible to colorectal cancer: A pilot study. Fam Cancer 2012; 11:545-551.

Indexed at, Google Scholar, Cross Ref

19. Chan K, Wong FK, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: A feasibility test. SAGE Open Nurs 2019; 5:2377960819844381.

Indexed at, Google Scholar, Cross Ref

20. Abdi N, Asadi-Lari M. Standardization of three hope scales, as possible measures at the end of life, in Iranian population. Int J Cancer Manag 2011; 4.

Indexed at, Google Scholar

21. Ripamonti CI, Buonaccorso L, Maruelli A, et al. Hope Herth Index (HHI): A validation study in Italian patients with solid and hematological malignancies on active cancer treatment. Tumori J 2012; 98:385-392.

Indexed at, Google Scholar, Cross Ref

22. Bovero A, Opezzo M, Botto R, et al. Hope in end-of-life cancer patients: A cross-sectional analysis. Palliat Support Care 2021; 19:563-569.

Indexed at, Google Scholar, Cross Ref

23. Solano JP, da Silva AG, Soares IA, et al. Resilience and hope during advanced disease: A pilot study with metastatic colorectal cancer patients. BMC Palliat Care 2016; 15:1-8.

Indexed at, Google Scholar, Cross Ref

24. Li P, Guo YJ, Tang Q, et al. Effectiveness of nursing intervention for increasing hope in patients with cancer: A meta-analysis. Rev Lat Am Enfermagem 2018; 26.

Indexed at, Google Scholar, Cross Ref

25. Wnuk M, Marcinkowski JT, Fobair P. The relationship of purpose in life and hope in shaping happiness among patients with cancer in Poland. J Psychosoc Oncol 2012; 30:461-483.

Indexed at, Google Scholar, Cross Ref

26. Snyder CR, Forsyth DR. Handbook of social and clinical psychology: The health perspective. Pergamon Press 1991.

Indexed at, Google Scholar, Cross Ref

27. Miller JF, Powers MJ. Development of an instrument to measure hope. Nurs Res 1988; 37:6-10.

Indexed at, Google Scholar, Cross Ref

28. Herth KA. The relationship between level of hope and level of coping response and other variables in patients with cancer. Oncol Nurs Forum 1989; 16:67-72.

Indexed at, Google Scholar

29. Herth K. Fostering hope in terminally-ill people. J Adv Nurs 1990; 15:1250-1259.

Indexed at, Google Scholar, Cross Ref

30. Group TE. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 1990; 16:199-208.

Google Scholar

31. Farran CJ, Herth KA, Popovich JM. Hope and hopelessness: Critical clinical constructs. Sage Publications, Inc; 1995.

Indexed at, Google Scholar

32. Moseley JR. Symposium on compassionate care and the dying experience. Alterations in comfort. Nurs Clin North Am 1985; 20:427-438.

Indexed at, Google Scholar