The concept of hope is an important theme in chronic illness and palliative care and has been associated with increased psycho-spiritual well-being and quality of life. Psycho-spiritual interventions have been described in this population, but no systematic review of hope-enhancing interventions or hopelessness-reducing interventions has been conducted for persons with palliative care diseases.
Aim:
To describe and assess the effectiveness of interventions in palliative care that measure hope and/or hopelessness as an outcome.
Design:
This systematic review and meta-analysis was pre-registered (Prospero ID: CRD42019119956).
Data sources:
Electronic databases, journals, and references were searched. We used the Cochrane criteria to assess the risk of bias within studies.
Results:
Thirty-five studies (24 randomized controlled trials, 5 quasi-experimental, 6 pre-post studies) involving a total of 3296 palliative care patients were included. Compared with usual/standard cancer care alone, interventions significantly increased hope levels at a medium effect size (g = 0.61, 95% confidence interval (CI) = 0.28–0.93) but did not significantly reduce hopelessness (g = −0.08, 95% CI = −0.18 to 0.02). It was found that interventions significantly increase spirituality (g = 0.70, 95% CI = 0.02–1.37) and decrease depression (g = −0.29, 95% CI = −0.51 to −0.07), but had no significant effect over anxiety, quality of life, and symptom burden. Overall, quality of evidence across the included studies was rated as low.
Conclusions:
Evidence suggests that interventions can be effective in increasing hope in palliative care patients.
CarlsonLEZelinskiELToivonenKI, et al. Prevalence of psychosocial distress in cancer patients across 55 North American cancer centers. J Psychosoc Oncol2019; 37(1): 5–21.
2.
YiJCSyrjalaKL.Anxiety and depression in cancer survivors. Med Clin North Am2017; 101(6): 1099–1113.
3.
WiltinkJBeutelMETillY, et al. Prevalence of distress, comorbid conditions and well being in the general population. J Affect Disord2011; 130(3): 429–437.
4.
JonesJMHugginsMARydallAC, et al. Symptomatic distress, hopelessness, and the desire for hastened death in hospitalized cancer patients. J Psychosom Res2003; 55(5): 411–418.
5.
BrueraEHuiD. Conceptual models for integrating palliative care at cancer centers. J Palliat Med2012; 15(11): 1261–1269.
6.
SnyderCR.Hope theory: rainbows in the mind. Psychol Inq2002; 13(4): 249–275.
7.
HerthKA.The relationship between level of hope and level of coping response and other variables in patients with cancer. Oncol Nurs Forum1989; 16(1): 67–72.
8.
GumASnyderCR.Coping with terminal illness: the role of hopeful thinking. J Palliat Med2002; 5(6): 883–894.
9.
DaneaultSLussierVMongeauS, et al. Ultimate journey of the terminally ill: ways and pathways of hope. Can Fam Physician2016; 62(8): 648–656.
10.
LelorainSAnneBDolbeaultS, et al. Needs, priorities, and concerns of terminally ill cancer patients: a literature review. Psycho Oncol2011; 20: 181.
11.
DavisonSNJhangriGS.Existential and supportive care needs among patients with chronic kidney disease. J Pain Symptom Manage2010; 40(6): 838–843.
12.
HitzFRibiKLiQ, et al. Predictors of satisfaction with treatment decision, decision-making preferences, and main treatment goals in patients with advanced cancer. Support Care Cancer2013; 21(11): 3085–3093.
13.
HerthK.Fostering hope in terminally-ill people. J Adv Nurs1990; 15(11): 1250–1259.
14.
DaviesEHigginsonIJ.Communication, information and support for adults with malignant cerebral glioma: a systematic literature review. Support Care Cancer2003; 11(1): 21–29.
15.
HerthK.Enhancing hope in people with a first recurrence of cancer. J Adv Nurs2000; 32(6): 1431–1441.
16.
HerthKACutcliffeJR.The concept of hope in nursing 3: hope and palliative care nursing. Br J Nurs2002; 11(14): 977–983.
17.
AlloyLBAbramsonLYWhitehouseWG, et al. Depressogenic cognitive styles: predictive validity, information processing and personality characteristics, and developmental origins. Behav Res Ther1999; 37(6): 503–531.
18.
AlloyLBSeligmanME. On the cognitive component of learned helplessness and depression. Psychol Learn Motiv 1979; 13: 219–276.
19.
HallSGoddardCOpioD, et al. Feasibility, acceptability and potential effectiveness of dignity therapy for older people in care homes: a phase II randomized controlled trial of a brief palliative care psychotherapy. Palliat Med2012; 26(5): 703–712.
20.
BreitbartWPoppitoSRosenfeldB, et al. Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. J Clin Oncol2012; 30(12): 1304-1309.
21.
VélezCPalacioCMorenoI, et al. Psychological and family-related facts of suffering in patients with chronic diseases. Tech Reg Anesthesia Pain Manage2013; 17(1): 7–10.
22.
BentleyBO’ConnorMBreenLJ, et al. Feasibility, acceptability and potential effectiveness of dignity therapy for family carers of people with motor neurone disease. BMC Palliat Care2014; 13(1): 1–9.
23.
ChochinovHMHackTHassardT, et al. Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol2005; 23(24): 5520–5525.
24.
DaneaultSDionDSicotteC, et al. Hope and noncurative chemotherapies: which affects the other?J Clin Oncol2010; 28(13): 2310–2313.
25.
MoherDLiberatiATetzlaffJ, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg2010; 8(5): 336–341.
26.
SterneJACSavovićJPageMJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ2019; 366: l4898.
27.
BeckerBJ.Synthesizing standardized mean-change measures. Br J Math Stat Psychol1988; 41: 257–278.
28.
KnappGHartungJ.Improved tests for a random effects meta-regression with a single covariate. Stat Med2003; 22(17): 2693–2710.
29.
BorensteinMHigginsJPHedgesLV, et al. Basics of meta-analysis: I. Res Synth Methods2017; 8(1): 5–18.
30.
ViechtbauerW.Conducting meta-analyses in R with the metafor package. J Stat Software2010; 36(3): 1–48.
BentleyBO’ConnorMKaneR, et al. Feasibility, acceptability, and potential effectiveness of dignity therapy for people with motor neurone disease. PloS One2014; 9(5): e96888.
33.
McLeanLMJonesJMRydallAC, et al. A couples intervention for patients facing advanced cancer and their spouse caregivers: outcomes of a pilot study. Psycho Oncol2008; 17(11): 1152–1156.
34.
NakanoKKitaharaYMitoM, et al. Development of the Japanese version of an information aid to provide accurate information on prognosis to patients with advanced non-small-cell lung cancer receiving chemotherapy: a pilot study. BMC Palliat Care2018; 17(1): 38.
35.
SjoquistKMFriedlanderMLO’ConnellRL, et al. Hope, quality of life, and benefit from treatment in women having chemotherapy for platinum-resistant/refractory recurrent ovarian cancer: the gynecologic cancer intergroup symptom benefit study. Oncologist2013; 18(11): 1221–1228.
36.
SmithTJDowLAViragoE, et al. Giving honest information to patients with advanced cancer maintains hope. Oncology2010; 24(6): 521–525.
37.
WakiuchiJMarchiJANorvilaLS, et al. Hope of cancer patients undergoing chemotherapy. Acta Paul Enferm2015; 28(3): 202–208.
38.
ChujoMMikamiITakashimaS, et al. A feasibility study of psychosocial group intervention for breast cancer patients with first recurrence. Support Care Cancer2005; 13(7): 503–514.
39.
FallahRGolzariMDastaniM, et al. The effectiveness of spirituality intervention by group method on the increase of hope, happiness and life satisfaction in women surviving from breast cancer. Psycho Oncol2011; 20: 258-259.
40.
GuyMPHigginsonIJAmesburyDW.The effect of palliative daycare on hope: a comparison of daycare patients with two control groups. J Palliat Care2011; 27(3): 216–223.
41.
SanataniMSchreierGStittL.Level and direction of hope in cancer patients: an exploratory longitudinal study. Support Care Cancer2008; 16(5): 493–499.
42.
ZhangXXiaoHChenY.Evaluation of a WeChat-based life review programme for cancer patients: a quasi-experimental study. J Adv Nurs2019; 75(7): 1563–1574.
43.
AndoMMoritaTAkechiT, et al. Efficacy of short-term life-review interviews on the spiritual well-being of terminally ill cancer patients. J Pain Symptom Manage2010; 39(6): 993–1002.
44.
AngellKLKreshkaMAMcCoyR, et al. Psychosocial intervention for rural women with breast cancer: the Sierra-Stanford Partnership. J Gen Intern Med2003; 18(7): 499–507.
45.
BreitbartWRosenfeldBPessinH, et al. Meaning-centered group psychotherapy: an effective intervention for improving psychological well-being in patients with advanced cancer. J Clin Oncol2015; 33(7): 749–754.
46.
ChochinovHKristjansonLBreitbartW, et al. Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncol2011; 12(8): 753–762.
47.
ChoiNGMartiCNConwellY.Effect of problem-solving therapy on depressed low-income homebound older adults’ death/suicidal ideation and hopelessness. Suicide Life Threat Behav2016; 46(3): 323–336.
48.
DolbeaultSCayrouSBrédartA, et al. The effectiveness of a psycho-educational group after early-stage breast cancer treatment: results of a randomized French study. Psychooncology2009; 18(6): 647–656.
49.
DugglebyWDDegnerLWilliamsA, et al. Living with hope: initial evaluation of a psychosocial hope intervention for older palliative home care patients. J Pain Symptom Manage2007; 33(3): 247–257.
50.
GreenMJSchubartJRWhiteheadMM, et al. Advance care planning does not adversely affect hope or anxiety among patients with advanced cancer. J Pain Symptom Manage2015; 49(6): 1088–1096.
51.
HallSGoddardCOpioD, et al. A novel approach to enhancing hope in patients with advanced cancer: a randomised phase II trial of dignity therapy. BMJ Support Palliat Care2011; 1(3): 315–321.
52.
HansenMJEnrightRDBaskinTW, et al. A palliative care intervention in forgiveness therapy for elderly terminally ill cancer patients. J Palliat Care2009; 25(1): 51–60.
53.
Hosseini RafsanjaniTArabMRavariA, et al. A study on the effects of spiritual group therapy on hope and the mental and spiritual health of patients with colorectal cancer. Prog Palliat Care2017; 25(4): 171–176.
54.
KissaneDWBlochSSmithGC, et al. Cognitive-existential group psychotherapy for women with primary breast cancer: a randomised controlled trial. Psychooncology2003; 12(6): 532–546.
55.
LaneLGVineyLL.The effects of personal construct group therapy on breast cancer survivors. J Consult Clin Psychol2005; 73(2): 284–292.
56.
McLeanLMWaltonTRodinG, et al. A couple-based intervention for patients and caregivers facing end-stage cancer: outcomes of a randomized controlled trial. Psycho Oncol2013; 22(1): 28–38.
57.
RustøenTWiklundIHanestadBR, et al. Nursing intervention to increase hope and quality of life in newly diagnosed cancer patients. Cancer Nurs1998; 21(4): 235–245.
58.
SalzerMSPalmerSCKaplanK, et al. A randomized, controlled study of Internet peer-to-peer interactions among women newly diagnosed with breast cancer. Psychooncology2010; 19(4): 441–446.
59.
WallLM.Changes in hope and power in lung cancer patients who exercise. Nurs Sci Q2000; 13(3): 234–242.
60.
PoorgholamiFMansooriPMontaseriZ, et al. Effect of self care education with and without telephone follow-up on the level of hope in renal dialysis patients: a single-blind randomized controlled clinical trial. Int J Community Based Nurs Midwifery2016; 4(3): 256–264.
61.
RakhshanMPGanjalivandSMZarshenasLP, et al. The effect of collaborative care model-based intervention on hope in caregivers and patients with multiple sclerosis: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery2018; 6(3): 218–226.
62.
MackenLBremnerSGageH, et al. Randomised clinical trial: palliative long-term abdominal drains vs large-volume paracentesis in refractory ascites due to cirrhosis. Aliment Pharmacol Ther2020; 52(1): 107–122.
63.
OshvandiKAminiSMoghimbeigiA, et al. The effect of a spiritual care on hope in patients undergoing hemodialysis: a randomized controlled trial. Curr Psychiatry Res Rev2020; 16(1): 68–75.
64.
PustejovskyJERodgersMA.Testing for funnel plot asymmetry of standardized mean differences. Res Synth Methods2019; 10(1): 57–71.
65.
DugglebyWJWrightKPopkinD, et al. Living with hope: initial evaluation of a psychosocial hope intervention. J Palliat Care2006; 22(3): 208.
66.
XiaoJChowKMLiuY, et al. Effects of dignity therapy on dignity, psychological well-being, and quality of life among palliative care cancer patients: a systematic review and meta-analysis. Psychooncology2019; 28(9): 1791–1802.
67.
BreitbartWPessinHRosenfeldB, et al. Individual meaning-centered psychotherapy for the treatment of psychological and existential distress: a randomized controlled trial in patients with advanced cancer. Cancer2018; 124(15): 3231–3239.
68.
TemelJSGreerJAMuzikanskyA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med2010; 363(8): 733–742.
69.
MerluzziTVPhilipEJ.“Letting go”: from ancient to modern perspectives on relinquishing personal control-a theoretical perspective on religion and coping with cancer. J Relig Health2017; 56(6): 2039–2052.
70.
JimHSPustejovskyJEParkCL, et al. Religion, spirituality, and physical health in cancer patients: a meta-analysis. Cancer2015; 121(21): 3760–3768.
71.
SalsmanJMPustejovskyJEJimHS, et al. A meta-analytic approach to examining the correlation between religion/spirituality and mental health in cancer. Cancer2015; 121(21): 3769–3778.
72.
ShermanACMerluzziTVPustejovskyJE, et al. A meta-analytic review of religious or spiritual involvement and social health among cancer patients. Cancer2015; 121(21): 3779–3788.
73.
WampoldBE.How important are the common factors in psychotherapy? An update. World Psychiatry2015; 14(3): 270–277.
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