Abstract
This systematic review aimed to understanding existing knowledge of hope in disclosing bad news in advanced cancer care. What conceptual and empirical research has been conducted? Does preserving hope matter to doctors and patients? Are there optimal forms of communication?
Method: The systematic review used Cochrane, Pubmed, Scopus, SocIndex and Web of Science in August, 2015. A second reviewer independently screened 20% of the sample. Disagreement over inclusion was solved through discussion. Studies were divided into three groups. 1) Hope and factors relevant to the process of preserving hope. 2) Problems encountered by doctors and patients in the communication of bad news in relation to hope. 3) Problems during breaking bad news.
Results: Exploring patient’s goals and perceptions of disease is necessary for doctors to shape their communication. Opportunity to decide how much information they want enables them to practice autonomy while relieving the doctor’s sense of responsibly for making decisions. How patient can be expected to practice autonomy and have realistic expectations and hope if not fully aware of the nature of the disease. The discontinuation of anti-cancer treatment or referral to palliative care can cause confusion for advanced cancer care patients, as it has been traditionally associated with death, and thus with a complete loss of hope.
Conclusion: Numerous tools that doctors should use in order to foster hope: 1) Softening, sweetening information and giving hopeful information, 2) Showing care was important especially when no further treatment was available. 3) Acknowledge fear enables patients to feel more able to talk about their concerns. 4) Being open to alternative treatments was valued as it demonstrated that their care provider did not give up on them. 5) Tools for demonstration such as diagrams, pictures, and credible websites was identified as helpful in order to understand information regarding the disease. Supportive relationships such as family were another key factor that played a vital role in preserving hope. Lack of time is frequently mentioned as an obstacle to effective doctor patient communications. Reducing the workload was suggested by doctors as a way of spending more time with and giving more support to patients.
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