Maintaining Hope

If hope were a medication, it would be used for many different conditions. Physicians and Nurses would prescribe it liberally as a companion along with therapy to treat cancer and other diseases with uncertain futures. Hope would also be used to treat anxiety, hopelessness, depression and fear that can accompany this uncertainty.

What is hope?

Hope has three components the person hoping, the object of hope (what is hoped for), and positive expectancy (the connecting process).

A person hoping: A person has individual needs for hope, depending on a prior history of hopes fulfilled, current emotional state, other resources, and need for control. Some people use hope as their primary coping mechanism, other people dare not use hope because the cost of disappointment is too high.

The object of Hope: What is hoped for also varies. Hope may be very different for someone who is diagnosed at early stage versus someone who is diagnosed at a later stage of disease. The goal for someone with more advanced disease may become a longer or better quality of life. It may be looking forward to a big event (a vacation, wedding, birth etc.) and living to be with loved ones for that event.

Positive Expectancy: This process is most important, because it depends on your ability to imagine a desired future and project yourself into it. It may also depend on your ability to focus on your goal and limit distractions. This positive expectancy provides the energy to do what is necessary to achieve your goals. Fear’s negative expectancy can paralyze you, preventing you from accomplishing these goals.

How do people describe hope?

Hope has been described as needed when there is uncertainty or doubt and effort is required to keep going. Hope can be used to overcome even the greatest fears, if used constructively.

Hope has also been used as a form of pathological denial or false hope.

• Hope is constructive when it provides the strength needed to get through difficult times. Hope focuses on a positive outcome, while acknowledging the uncertainty.
• Denial can also be constructive, when it allows you to cope with issues one at a time, to avoid becoming overwhelmed and paralyzed.
• True Hope is adaptive when it gives you energy for positive action or helps you cope with uncertainty, depression, or fear. For example, true hope can help you get out of your house and to the clinic for treatment, knowing the treatment may not cure, but can decrease bothersome symptoms and improve quality of life.
• False Hope interferes with communicating with your family and your medical team. It creates a reality that cannot be shared by others. It also creates problems for people around you. Others who do not share your reality may become uncomfortable if they have to make decisions for you or require your help with legal procedures.
• The Fighting Spirit: Some people might think a warrior who fights cancer must be like Rambo when facing his enemies or David when meeting Goliath. Many people cannot identify with these aggressive images, but still feel the same fight spirit within themselves. The essence of the fighting spirit is its heroism and courage to take one-step at a time.
• Faith focuses on the process and produces a feeling of certainty. However, as with hope, faith can be misused when it forms a defense against reality. If attention is only focused on spiritual concerns, there is a danger of ignoring the needs of the body.

How do people maintain hope?

• Fight harder, not just smarter. Do not blindly do everything possible. Develop a strategy that integrates your treatments.
• Be clear what you are fighting for. Are you sacrificing so much in the effort that you don’t have a life left over even if you are successful?
• Decide what you are fighting. Are you fighting the biological disease, or are you fighting the part of yourself not feeling fully alive?
• Use the resources available to you. Decide who and what the enemy is. The cancer is a part of you that has turned destructive. You may need allies to help you overcome that part.
• Focus on the ultimate goal. Determination is the willingness to do whatever is necessary. It may simply be a quiet resolve to go through even the most difficult tasks.
• Uses of prayer have been suggested as a powerful strategy for helping deal with uncertainty and maintain hope.
• Participate in a support group. Your local church or The American Cancer Society can help you.

What can family members and friends do to help me maintain hope?

• Ask family members and friends to encourage you to talk about what you are going through.
• Ask family members to help you focus on information that will help you maintain your hope and faith.
• Have family members and friends help talk you through relaxation exercises, controlled breathing exercises, or visualizing pleasant scenes in your head.
• Have family members encourage you to attend spiritual or religious services.

What should I report to my doctor or nurse?

• Not eating for more that 24 hours
• Not wanting to get out of bed or get dressed
• Loss of interest in things you used to enjoy
• Feelings that you want to hurt or kill yourself or doing things to hurt or try to kill yourself
• Feeling sad, blue or down in the dumps for more than 2 weeks
• Recurrent thoughts of death

Where can I get more information?

• Discuss with your healthcare providers.
• Contact your local mental health agency for support groups in your area.
• Contact the American Cancer Society at 1-800-ACS-2345 or through the Internet at: http://www.cancer.org.
• Contact the cancer website: http://www.cancersourcern.com (a website for doctors, nurses and patients).
• Contact your local church affiliation for support.
• Visit the Family Care Research Program at : http://www.cancercare.msu.edu/.

References:

1. Buchholz, WM & Buchholz, SW (2001) Live longer, live larger: a holistic approach for cancer patients and families. O’Reilly & Associates, Inc. Sebastopol, CA. 134-49.
2. Oncology Nursing Society’s website at: http://www. cancersourcern.com, click on the reference center,then disease content information.