•Hope is a ubiquitous concept in everyday life but has particular relevance in crisis and change-seeking times.•A new theory of hope is presented that integrates uncertainty and control and involves ...appraisal of situations.•Appraisal involves the presence of uncertainty and the discernment of the utility of primary and secondary control.•This integrative theory of hope may have clinical utility particularly for serious illness and palliative care.
Hope has been a topic of interest across many centuries and among diverse cultures, gaining particular relevance in crisis and change-seeking times. Research has shown that hope plays an important role in both the context of everyday life as well as in the context of illness. This paper presents an integrative theory of hope, which incorporates uncertainty and control as key drivers of the hope process and also includes appraisal and meaning.
This new hope theory states that hope emerges when a specific situation is appraised as uncertain and involves the discernment of the utility of primary and secondary control. For example, in the context of high uncertainty and low control, importance is given to the meaning-making and transcendence in maintaining hope. In the context of low uncertainty and high control, importance is given to the agency and self-efficacy components of hope.
Although this integrative theory is based on current theory and evidence, it awaits empirical evidence for the integration of hope, uncertainty, and control in a process-oriented model of hope. The integrative theory may have clinical utility, particularly for serious illness and palliative care where uncertainty, hope and control transform with the trajectory of the illness.
Background:
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.
Stress related to the COVID-19 pandemic has implications for mental and physical well-being, but especially for persons with cancer. The stress mitigating role of tolerance of uncertainty (TU) was ...investigated in those with and without a cancer diagnosis. Design: 155 persons with and 150 without a cancer diagnosis completed measures of pandemic stress and TU (mediating variable). Main Outcome Measures: Measures of emotional and physical well-being (WB) were the outcome variables. Results: The mediated, indirect effect of TU in the pandemic stress-emotional WB relationship was significant for the cancer group and the non-cancer group. However, the indirect effects involving TU in the pandemic stress-physical WB relationship was not significant for the cancer group, whereas TU fully mediated the pandemic stress-physical WB relationship for the non-cancer group. Conclusions: Whereas TU was active as a mediator with emotional WB for both groups, it was ineffective as a mediator of the pandemic stress-physical WB relationship with the cancer group. Thus, the cancer group's physical WB was determined exclusively by pandemic stress. Stress reduction and enhancing TU may be critical for all people but for those with cancer decreasing pandemic stress would provide the most viable option for increasing physical well-being.
The purpose of this project was to develop a short-term, theory-based intervention for patients with self-reported limited self-efficacy to perform coping behaviors. Cancer patients with low coping ...self-efficacy were randomly assigned to a treatment (
N
= 66) or control condition (
N
= 68). The treatment, Mastery Enhancement Therapy, was based on self-regulation and self-efficacy theories. Measures of coping self-efficacy, functional status, depression, quality of life, and adjustment were administered at baseline, after session two, after the final (fourth) session, and at 3 months post-treatment. Control participants completed the measures at about the same time intervals. Treatment participants reported highly significant immediate post-treatment improvement in self-efficacy for coping compared to controls, although controls improved by 3 months post-treatment. However, treatment participants with lower levels of functional status benefited more than controls on depression and adjustment at follow-up. Mastery Enhancement Therapy is a time-limited treatment that increases coping efficacy and subsequently adjustment during active medical treatment, and appears to warrant a large-scale RCT with patients with below average coping self-efficacy and moderate to high symptoms.
Objective
Self‐efficacy expectations are associated with improvements in problematic outcomes widely considered clinically significant (ie, emotional distress, fatigue, and pain), related to positive ...health behaviors, and as a type of personal agency, inherently valuable. Self‐efficacy expectancies, estimates of confidence to execute behaviors, are important in that changes in self‐efficacy expectations are positively related to future behaviors that promote health and well‐being. The current meta‐analysis investigated the impact of psychological interventions on self‐efficacy expectations for a variety of health behaviors among cancer patients.
Methods
Ovid Medline, PsycINFO, CINAHL, EMBASE, Cochrane Library, and Web of Science were searched with specific search terms for identifying randomized controlled trials (RCTs) that focused on psychologically based interventions. Included studies had (a) an adult cancer sample, (b) a self‐efficacy expectation measure of specific behaviors, and (c) an RCT design. Standard screening and reliability procedures were used for selecting and coding studies. Coding included theoretically informed moderator variables.
Results
Across 79 RCTs, 223 effect sizes, and 8678 participants, the weighted average effect of self‐efficacy expectations was estimated as g = 0.274 (P < .001). Consistent with the self‐efficacy theory, the average effect for in‐person intervention delivery (g = 0.329) was significantly greater than for all other formats (g = 0.154, P = .023; eg, audiovisual, print, telephone, and Web/internet).
Conclusions
The results establish the impact of psychological interventions on self‐efficacy expectations as comparable in effect size with commonly reported outcomes (distress, fatigue, pain). Additionally, the result that in‐person interventions achieved the largest effect is supported by the social learning theory and could inform research related to the development and evaluation of interventions.
Objective
This study examined the relationship between a broad variety of stressors, resources, and outcomes to identify targets of intervention to enhance the quality of life of cancer patients and ...contribute to a comprehensive model of cancer care.
Methods
Five hundred and sixty persons with a diagnosis of cancer completed measures of stressors (past negative life events, current problems, current symptoms, comorbidities), resources (coping self‐efficacy, social support, satisfaction with care) and outcomes (emotional and functional well‐being).
Results
Multivariate canonical correlations between pairs of canonical variates (stressors‐outcomes, Rc = 0.56; stressors‐resources, Rc = 0.42, resources‐outcomes Rc = 0.66) were significant (all ps < 0.0001), which confirmed the relationship between those components and supported proceeding to more granular levels of analysis. More refined analyses revealed that the most critical variables in relation to outcomes (i.e., emotional and functional well‐being), were current problems and symptoms among the stressors and coping self‐efficacy, social support and patient satisfaction among the resources.
Conclusions
This study provided an approach to the discernment of the most critical aspects of interventions that may improve supportive care and quality of life outcomes. Thus, efforts to address current problems (e.g., financial, home life, work), as well as effective management of symptoms (e.g., pain, fatigue, sleep), using the coordinated integration of medical care, support services and psycho‐social interventions would provide the greatest impact on quality‐of‐life outcomes. Interventions that focus on problem solving and reinforce patient agency and activation may be most effective in sustaining quality of life outcomes into survivorship.
Perceived discrimination (PD; e.g. racism, agism, sexism, etc.) negatively impacts quality of life (QOL) among cancer patients. Prior research has established that for African American Cancer ...Patients (AACPs) only disengagement/denial coping mediated the PD-QOL relationship. In contrast, for Caucasian American Cancer Patients (CACPs), both agentic and disengagement/denial coping were mediators of the PD-QOL relationship. However, according to social constraint theory there may be a difference between subtle and overt PD in terms of the utility of certain coping mechanisms in relation to QOL, especially for AACPs.
217 AACPs and 121 CACPs completed measures of PD, coping (agentic, disengagement/denial, adaptive disengagement) and QOL. PD items were classified as subtle or overt microaggressions. PD was mainly attributed to race/ethnicity by AACPs and to income, age, and physical appearance for CACPs.
: In both subtle and overt microaggression models with CACPs, agentic coping and disengagement/denial coping were significant mediators of PD-QOL. Like CACPs, for AACPs, agentic and disengagement/denial coping were significant in the context of subtle microaggressions. In contrast, for overt microaggression only disengagement/denial coping was a significant mediator of the PD-QOL relationship for AACPs. Adaptive disengagement was related to QOL only for AACPs.
: Whereas more research is needed, it appears that overt microaggressions for AACPs, that consist mainly of racial and ethnic maltreatment, constitute a class of social contexts that may raise above the threshold for serious threat and harm, and, as a result, disengagement/constraint may reduce negative consequences. This additional burden for AACPs contributes to disparities in QOL. Future research is needed on the utility of adaptive disengagement for AACPs in relation to PD.
Relinquishing control (RC) of outcomes to God is a long-standing form of religious coping with serious illness. Placing cancer outcomes “in God's hands” has been positively related to coping and ...quality of life (QOL). However, the mechanisms involved in this relationship have not been established. A serial mediation model i.e., RC (X)-Meaning/Peace (M1)-Coping Efficacy (M2)-Symptoms, Physical QOL, Functional QOL (Ys) tested the hypothesis that Meaning/Peace alone and in conjunction with coping would mediate the RC-QOL relationship.
548 persons with a cancer diagnosis completed the Religious Problem-Solving Scale (RPSS), FACIT-Sp Meaning and Peace Scales, Cancer Behavior Inventory (coping efficacy), and measures of Physical Quality of Life (PQOL), Functional Quality of Life (FQOL) and Symptoms.
As hypothesized, the single mediation effects of Meaning/Peace were significant Indirect Effects: PQOL: .23 (95% CI: 0.15, 0.34); FQOL: 0.46 (95% CI: 0.33, 0.61); Symptoms: −0.18 (95% CI: −0.27, −0.10). In addition, mediation was confirmed for the serial mediation model (i.e., Meaning/Peace - Coping Efficacy as serial mediators) with significant indirect effects Indirect Effects: PQOL: 0.37 (95% CI: 0.27, 0.48); FQOL: 0.57 (95% CI: 0.42, 0.72); Symptoms: −0.25 (95% CI: −0.35, −0.17).
In the mediation models tested, the RC-QOL and RC-Symptoms relationships were mediated by the confluence of a sense of peace perhaps due to patients' feelings that outcomes were “in God's hands” and a sense of coherence between their current situation and a spiritually-based meaning system. Meaning/Peace was also related to coping efficacy, suggesting that these mediating constructs could be used to inform evidence-based interventions, such as Meaning-Centered therapies, that are sensitive to the belief systems of cancer patients and enhance QOL.
•Religious approaches to cancer may involve relinquishing control of outcomes to God.•Relinquishing outcomes to God is related to peace and meaning in one's life.•Peace and meaning are positively related to coping self-efficacy behaviors.•Peace/meaning and coping efficacy are related to better quality of life outcomes.
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