• Can Fam Physician · Aug 2016

    Ultimate journey of the terminally ill: Ways and pathways of hope.

    • Serge Daneault, Véronique Lussier, Suzanne Mongeau, Louise Yelle, Andréanne Côté, Claude Sicotte, Pierre Paillé, Dominique Dion, and Manon Coulombe.
    • Palliative care physician, a researcher, and Professor in the Research Centre and Palliative Care Service at the University of Montreal Hospital Centre and in the Faculty of Medicine at the University of Montreal in Quebec. serge.daneault.chum@ssss.gouv.qc.ca.
    • Can Fam Physician. 2016 Aug 1; 62 (8): 648656648-56.

    ObjectiveTo better understand the role of hope among terminally ill cancer patients.DesignQualitative analysis.SettingA tertiary specialized cancer centre in Canada.ParticipantsCancer patients in palliative care with an estimated remaining life expectancy of 12 months or less (N = 12) and their loved ones (N = 12) and treating physicians (N = 12).MethodsEach patient underwent up to 3 interviews and identified a loved one who participated in 1 interview. Treating physicians were also interviewed. All interviews were fully transcribed and analyzed by at least 2 investigators. Interviews were collected until saturation occurred.Main FindingsSeven attributes describe the experiences of palliative cancer patients and their caregivers: hope as an irrational phenomenon that is a deeply rooted, affect-based response to adversity; initial hope for miraculous healing; hope as a phenomenon that changes over time, evolving in different ways depending on circumstances; hope for prolonged life when there is no further hope for cure; hope for a good quality of life when the possibility of prolonging life becomes limited; a lack of hope for some when treatments are no longer effective in curbing illness progression; and for others hope as enjoying the present moment and preparing for the end of life.ConclusionApproaches aimed at sustaining hope need to reflect that patients' reactions might fluctuate between despair and a form of acceptance that leads to a certain serenity. Clinicians need to maintain some degree of hope while remaining as realistic as possible. The findings also raise questions about how hope influences patients' perceptions and acceptance of their treatments.Copyright© the College of Family Physicians of Canada.

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