March '98
Sally Turco R.N
Nurse Consultant Regional Palliative Care Program Capital Health Authority, Edmonton, Alberta, Canada.

Hope is vitally important to human existence. Without some dimension of hope, terminally ill patients may experience hopelessness, helplessness and despair. Hope energizes people to move forward and protects them from being engulfed by suffering and negativity. Hope is a coping strategy used by those facing a terminal or chronic illness. Hope enhances the quality of remaining life and should never be destroyed!

Hope can be promoted in terminally ill patients in several ways:

• Maintain meaningful and supportive relationships. The ability to listen to the individual's story is very important. The patient needs to have a sense of being needed and a sense of being part of something.
• As caregivers, sustain personal hope; use humor, be positive and hopeful in interactions with others - it's contagious. Personal hope can be sustained by our interactions with others; willingness to share part of yourself through touch, reassuring presence, and encouragement are some of the ways to make this happen.
• Affirm the worth of the individual; emphasize remaining abilities and things to look forward to. Maintaining human dignity and acceptance of the individual by your words and actions go a long way to promote feelings of worth and hope for the individual, honoring their individuality in spite of their increasing debility.
• Help recall positive memories, times of joy and fulfillment. This helps to affirm the worth of the individual and provides a reminder of the individual's place in the lives of others.
• Respect the extent of the individual's "need to know", being honest and clear in the delivery of information. Each individual has a right to information about the disease process and options for treatments as well as the right to accept or reject those options, in whole or in part. As well, the individual has the right to reject this knowledge, placing decision-making in the hands of caregivers. The rights of the individual must be respected within the context of their unique and personal life.
• Support meaningful spiritual practices. Spiritual faith and belief provides a sense of meaning for the individual's suffering and as such fosters hope. Help to find images, symbols, or rituals that foster hope for the individual.
• Conserve or enhance available energy, and control pain. The individual who is in pain can't focus on other aspects of life that may be important. Pain greatly impacts on the individual's quality of life. In addition, uncontrolled pain leads to increasing fatigue and lack of energy to invest in the hope process.
• Encourage time refocusing: focus on the present and what is immediately ahead rather than on an uncertain future. Individuals must be able to continue to establish and meet certain goals. Realistic and attainable aims, no matter how small, serve to give meaning to remaining life, there by fostering hope.
  

It is important to help people review the legacy they leave behind. This may include their children and grandchildren and the work they have done in their lives and any areas where they may have "made a difference". These beliefs should be explored and supported.

When asked about prognosis, it may be better to speak in terms of "days to weeks", "weeks to months", or "months to years", in order to reduce the idea of certainty about length of life.

References:

• Rando, T. (1984). Grief, Dying and Death. Research Press, Illinois, pp269-270.
• Herth, K. (1990). Fostering hope in the terminally ill. Journal of Advanced Nursing 15:1250-1259.
• Herth, K. (1993). Hope in the family caregiver of terminally ill people. Journal of Advanced Nursing, 18: 538-548.
• Jevne, R. (1993). Enhancing hope in the chronically ill. Humane Medicine, 9:2 120-130.