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PubMed2002

Understanding hope and factors that enhance hope in women with breast cancer.

PURPOSE/OBJECTIVES: To examine the extent to which antecedent variables and appraisals differentiate levels of hope in women during treatment for breast cancer. DESIGN: Descriptive, correlational. SETTING: Two large midwestern urban areas. SAMPLE: 73 Caucasian women between the ages of 20-73 with first-time diagnosis of breast cancer; recruited through five physician offices; within three months after surgical intervention with planned chemotherapy, radiation therapy, or tamoxifen; and able to read English. METHODS: Identical surveys mailed to participants 3 and 12 months after surgery. Instruments included Lazarus' Appraisal Components and Themes Scales, Herth Hope Index, Rosenberg's Self-Esteem Scale, Personal Resource Questionnaire 85-Part 2, Helpfulness of Religious Beliefs Scale, and demographics questionnaire. MAIN RESEARCH VARIABLES: Appraisal, hope, self-esteem, social support, and helpfulness of religious beliefs. FINDINGS: Variables influencing appraisals during breast cancer treatment on both surveys were self-esteem and helpfulness of religious beliefs. Potential for coping appraisals and self-esteem contributed to variation in hope at both time points. Social support was a significant contributor to hope in the 12-month survey. Appraisal themes reflected challenge but not fear. CONCLUSIONS: Self-esteem and helpfulness of religious beliefs influence women's appraisals regarding the potential for coping; appraisals and antecedent variables relevant for differentiating hope are beliefs about the potential for coping, self-esteem, and social support. IMPLICATIONS FOR NURSING: Care of women with breast cancer during the first year of treatment should include assessment of beliefs regarding the potential for coping. Results suggest that support for interventions related to self-esteem, social support, and helpfulness of religious beliefs increase confidence in coping abilities and hope.

Adaptation, Psychological↗

PubMedDate not supplied

The concept of hope in nursing 2: hope and mental health nursing.

This article is the second in a series of six that explores the nature of hope, reviews the existing theoretical and empirical work in several discrete areas of nursing, and provides case studies to illustrate the role that hope plays in clinical situations. In this article we focus on hope within the formal area of psychiatric/mental health nursing. The article points out that there is a limited empirical literature covering several aspects and issues of hope, hopelessness and hope inspiration within the domain of psychiatry. However, despite these studies many questions still remain unanswered. The bulk of this empirical literature focuses on hopelessness, and in the main hopelessness associated with suicide/depression. As a result of these investigations, a range of interventions has been identified for inspiring hope in different client groups with mental health problems, and a summary of these is given. Importantly, however, the basic social process of hope inspiration for each of these client groups is fundamentally the same, in that the process remains subtle, unobtrusive and associated with the therapy/relationship. We conclude by indicating key areas/questions for future research, and raise key questions regarding future policy/education issues.

Adult↗

PubMed2000

A hope is not a promise: fostering hope within palliative care.

In palliative care, where patients have to live with a degree of uncertainty as to the possible course their illness may take and the length of life they may expect, hope is a major issue. It has been said that individuals who know they are going to die soon, can be literally dying for hope. Ahmedzai (1994) points out that a major challenge for palliative care is to find ways of inspiring patients towards new directions for hope. This reflective article will explore the nature of hope and discuss the potential problems surrounding false and unrealistic hope, and will focus on how nurses may foster and support hope throughout life-threatening illness and during the palliative phase of life.

Adaptation, Psychological↗

PubMed2004

Hope and despair: the awakening of hope following acute spinal cord injury-an interpretative study.

The aim of this paper was to explore the patients' experiences of hope during the first months following acute spinal cord injury. This qualitative study has a descriptive and explorative design. Data were collected by personal interviews (N = 10) at a rehabilitation centre in Norway. A phenomenological-hermeneutic approach inspired by Ricoeur was used to extract the meaning content of the patients' experiences. The findings revealed one main interpretation; the awakening of hope, expressed by two themes: hope and despair, and uncertainty. Awakening hopes, even sometimes silent hopes, constituted a contextual background in the immediate aftermath of spinal cord injury.

Acute Disease↗

PubMed1999

Hope in multiple chemical sensitivity: social support and attitude towards healthcare delivery as predictors of hope.

This paper examines hope, as measured by the Herth Hope Scale, and its predictors in a sample of 305 people self-identified with multiple chemical sensitivity. The sample had relatively low levels of hope with scores unrelated to gender, severity or length of illness, income loss as a result of illness, or reported iatrogenic harm. Hope scores were positively correlated with perceived social support, having found personal growth through illness, age, reported level of supportiveness from a partner, an improved course of illness and level of reported safety of the home environment in regard to chemical exposures. Negative correlations were found with attitude toward healthcare delivery, fatigue and reported abuse/ostracism from family members other than partner. Social support, Healthcare Orientation, growth through illness, fatigue and age predicted hope scores accounted for 55% of the variance. Implications and suggestions for future research are discussed.

Adaptation, Psychological↗

PubMed2005

Hope against the cold: individual differences in trait hope and acute pain tolerance on the cold pressor task.

Hope theory (see Snyder, 1994) is presented as a useful framework for understanding reactions to pain. In Study 1, persons scoring higher on the trait Hope Scale (Snyder, Harris et al., 1991) kept their hands in the freezing water (of a cold pressor task) for significantly longer. In Study 2, the higher-hope males, and not females, as measured by both trait and state hope (Snyder, Sympson et al., 1996), recognized the onset of the pain threshold significantly later. Moreover, in Study 2, results showed that individual differences measures of optimism, self-efficacy, depression, and positive and negative affects did not relate to the pain onset and tolerance variables. The implications of hope as related to the pain process and related research are discussed.

Acute Disease↗

PubMed2000

Where there is hope, there is life: toward a biology of hope.

Argues the thesis that where there is hope there is life. Grounds this thesis philosophically and theologically, then reviews it from the medical and nursing literature, and illustrates it in a vignette of hospital ministry. Argues that hope can enhance the quality and even the quantity of life. Proposes that hope helps people to deal with their feelings and to cope with their illness. Hope affects immunity and survival. Challenges chaplains, pastoral counselors, and parish clergy to become more effective "agents of hope."

Attitude to Health↗

PubMedDate not supplied

How hopeful is too hopeful? Responding to unreasonably optimistic parents.

Some parents are unreasonably hopeful, insisting on aggressive therapy for their children even when such treatment would cause additional suffering with little or no chance of success. The various sources of and influences upon such hopes are examined, and suggestions are offered about how to help these parents see the situation more realistically. This discussion covers such issues as religious beliefs, confusions about causation and responsibility, concern about how others see us, and the simple tragedy of children who die. The failure to address these hopes undermines parental decision making, leads to unnecessary tragedies, and can result in costly litigation. Communication is an essential part of dealing with unreasonable hopes, but there is also a place for medical futility judgments and limitation contracts. The goal is not to deprive parents of their hope, but to transform it into something that is both valuable and anchored in reality.

Adaptation, Psychological↗

PubMed1982

Hope Index Scale: an instrument for the objective assessment of hope.

Although many clinical observations suggest that Hope influences the onset, duration, prognosis, and recovery from mental and physical illnesses, a lack of direct scientific proof persists because no method exists for the objective assessment of hope. We have now constructed the Hope Index Scale, a testing instrument for the measurement of this rather elusive human attribute. Upon testing control and experimental subjects, it was found that score distribution on the Hope Index Scale correlates negatively with Beck's Hopelessness Scale (Pearson r = -.88, P <.001) and is independent of age, race, or sex. It is concluded that this tool can help identify individuals with varying degrees of psychosocial problems and that scores of 150 or below are indicative of pathologic hope deficit often associated with suicide.

Adult↗

PubMed1996

The HOPE (Heart Outcomes Prevention Evaluation) Study: the design of a large, simple randomized trial of an angiotensin-converting enzyme inhibitor (ramipril) and vitamin E in patients at high risk of cardiovascular events. The HOPE study investigators.

OBJECTIVE: To describe the design of the HOPE (Heart Outcomes Prevention Evaluation) study. DESIGN: Description of the key design features of HOPE, a large, simple randomized trial of two widely applicable treatments--ramipril, an angiotensin-converting enzyme inhibitor; and vitamin E, a naturally occurring antioxidant vitamin--in the prevention of myocardial infarction, stroke or cardiovascular death. SETTING: Two-hundred and sixty-seven hospitals, physician offices and clinics in Canada, the United States, Mexico, Europe and South America. PATIENTS: Over 9000 women and men aged 55 years and above at high risk for cardiovascular events such as myocardial infarction and stroke were recruited over 18 months. INTERVENTIONS: A 2X2 factorial design with ramipril and vitamin E with follow-up for up to four years. CONCLUSIONS: HOPE will be one of the largest trials of two new interventions to prevent myocardial infarction, stroke or cardiovascular death in high risk patients. The results of HOPE will have direct public health impact and are likely to be readily incorporated into clinical practice. Key design features of HOPE are inclusion of individuals at high risk of cardiovascular disease, inclusion of a substantial proportion of patients with diabetes (36%) and women (27%), and detailed substudies to provide data on mechanisms of benefit.

Angiotensin-Converting Enzyme Inhibitors↗

PubMedDate not supplied

Reduction of cardiovascular events and microvascular complications in diabetes with ACE inhibitor treatment: HOPE and MICRO-HOPE.

The Heart Outcomes Prevention Evaluation (HOPE) study, an international randomized trial, was designed to evaluate the effects of the angiotensin-converting enzyme (ACE) inhibitor ramipril and vitamin E in patients at high risk for cardiovascular events. The study did not detect any cardiovascular benefit or harm using vitamin E. Results for the vitamin E arm are not discussed here. Of 9541 patients, 3577 with diabetes received either ramipril (10 mg) or placebo. Among these patients, ramipril use was associated with a significant 25% reduction in risk for the composite endpoint of myocardial infarction (MI), stroke, or cardiovascular death after a median follow-up period of 4.5 years. This benefit was independent of any blood pressure-lowering effect. The Microalbuminuria, Cardiovascular, and Renal Outcomes in HOPE (MICRO-HOPE) substudy in this patient population showed that ramipril treatment was associated with a decreased risk of development of overt nephropathy. Use of a composite measure of microvascular complications also suggested a protective effect of ramipril treatment. An interesting finding in the HOPE study is that ramipril treatment was associated with a significant 34% reduction in new diagnoses of diabetes. The possibility that ACE inhibitor treatment with ramipril may prevent new diabetes in non-diabetic patients at high risk of the disease is to be examined prospectively in the Diabetes Reduction Assessment with ramipril and rosiglitazone (DREAM) trial.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed2005

Hope, false hope, and self-fulfilling prophecy.

Hope, false hope, and self-fulfilling prophecy are important aspects in the practice of medicine for all practitioners but are especially important in the field of neurosurgery, which deals with devastating, terrifying, and often fatal illnesses. The American Board of Medical Specialties and the Accreditation Council of Graduate Medical Education have jointly defined 6 "general competencies" that define a competent physician and should be part of the curriculum of all residency programs. One of these 6 is interpersonal and communication skills. A true test of this competence is the ability to harness the powerfully beneficial forces of hope and motivation and to avoid the destructiveness of false hope and self-fulfilling prophecy.

Brain Diseases↗

PubMed2001

HOPE for patients with Type 2 diabetes: an application of the findings of the MICRO-HOPE substudy in a British hospital diabetes clinic.

AIMS: The MICRO-HOPE substudy demonstrated that when ramipril treatment was added to people with Type 2 diabetes and additional cardiovascular risk factors cardiovascular events were reduced by 25% in 4.5 years. We wished to determine the proportion of people with Type 2 diabetes and additional cardiovascular risk factors registered with a hospital diabetes service. METHODS: Non-proteinuric people (n = 1370) with Type 2 diabetes identified on our diabetes register were subject to analysis. Anticipated reductions in cardiovascular events due to ramipril treatment were based on reductions observed in the MICRO-HOPE substudy. RESULTS: Non-proteinuric people (n = 1075 (78%)) with Type 2 diabetes had at least one additional cardiovascular risk factor. Twenty-nine percent were already taking an angiotensin-converting enzyme inhibitor. The remaining 764 patients were similar to ramipril-treated participants in the MICRO-HOPE substudy. Treatment with ramipril for 4.5 years would be anticipated to reduce cardiovascular deaths by 26, revascularization procedures by 19 and admissions for myocardial infarction and stroke by 18 and 26, respectively. CONCLUSIONS: Of non-proteinuric people with Type 2 diabetes, 78% have additional cardiovascular risk factors. Only a small proportion currently receive treatment with an angiotensin-converting enzyme inhibitor. The incidence of cardiovascular events could be reduced if more patients were treated with ramipril and other cardiovascular risk factors were addressed.

Aged↗

PubMed1997

Reliability and validity of the Norwegian version of the Nowotny Hope Scale. A nursing tool for measuring hope in cancer patients.

The purpose of the present study was to assess the reliability and validity of the Norwegian version of the Nowotny Hope Scale as applied to cancer patients. The questionnaire was first translated into Norwegian following internationally accepted guidelines. The scale was tested on a sample consisting of 131 newly diagnosed cancer patients. The findings supported the internal consistency of the instrument as a whole (alpha = 0.89) and of the six subscales: confidence (alpha = 0.85), relates to others (alpha = 0.75), future is possible (alpha = 0.80), spiritual beliefs (alpha = 0.94), active involvement (alpha = 0.53) and comes from within (alpha = 0.80). Stability over time was provided by a satisfactory 3-4-week test-retest correlation (r = 0.81). The validity was confirmed by the judgement of an expert and by a principal components analysis with orthogonal rotation. The result of the factor analysis was somewhat different from the original findings in an American sample. The results obtained in this study are promising and indicate that the Nowotny Hope Scale can be used to measure hope in newly diagnosed Norwegian cancer patients.

Adaptation, Psychological↗

PubMed1995

Hope and schizophrenia: clinicians identify hope-instilling strategies.

Nurses have many opportunities to assist individuals with schizophrenia because of the frequency and nature of their contacts. The nurses in this study believed that they can make a difference and can identify hope-instilling strategies. Strategies for rehabilitation include assisting persons with schizophrenia to set goals, seeing them as people, and joining with them on their journey of recovery. Recognizing that the establishment of the relationship is central in assisting the development of client hope, and (hopefully) eventual recovery, may help nurses to persevere despite what may be a challenging and lengthy process.

Adaptation, Psychological↗

PubMed2005

The HOPE TIPS: the HOPE study translated into practices.

The HOPE TIPS study assessed the practicality and tolerability of ramipril titration to a target dose of 10 mg (as achieved in definitive efficacy studies) in a clinical practice setting. 3881 patients at high cardiovascular risk (HOPE study criteria) were recruited in primary and specialist care settings in 9 countries by 439 investigators. Dose titration of ramipril from 2.5 mg to 10 mg daily took place over 9-12 weeks. The mean age of the patients was 64 years, 60% were male and 79% Asian. The target dosage of 10 mg daily was reached in 73% of patients with 96% of patients achieving 5 mg or 10 mg daily. During the study period uncontrolled hypertension (> 160/90) was recorded in 15% of patients, myocardial infarction or unstable angina 1.6%, heart failure 0.4%, new diabetes 0.6%. Only 9.8% of patients discontinued treatment with 5.9% attributed to treatment side-effects and 4% related to cough. The large majority of patients in a wide range of clinical practice settings with high cardiovascular risk can be treated with ramipril titrated to 10 mg daily with good tolerability.

Aged↗

PubMed2000

Best hope or last hope: access to phase III clinical trials of HER-2/neu for advanced stage breast cancer patients.

Breast cancer is a major public health problem, with a 12% incidence among women. The over-expression of the proto-oncogene HER-2/neu is associated with 30% of breast and ovarian cancers that are very aggressive and do not respond to standard therapeutic regimens. Entrance into clinical trials can represent the best hope and even the last hope for these patients. Entrance, however, is based on satisfying eligibility criteria. In examining advanced stage breast cancer patients' access to phase III clinical trials for HER-2/neu, two specific arguments regarding eligibility will be addressed. First, if research is to provide the utilitarian goal of the 'greatest good to the greatest number', delineation of the population receiving the 'good', rather than a homogeneous sub-set of this population, must be addressed, along with patients' values and goals, very relevant to determining a 'good life', how to achieve it, and whether a treatment is a part of that process. Second, the 'good' being generated should involve realistic, practical values of quality ways of living with advanced breast cancer and not just increased survival, or cure. Arguments for relaxing criteria are based on an accurate versus over-simplified interpretation of utilitarian principles and concepts of human flourishing. Only through addressing these issues can the true 'good' of clinical trials and research be given to the greatest number of people.

Antibodies, Monoclonal↗

PubMed2002

What should the role of ACE inhibitors be in the treatment of diabetes? Lessons from HOPE and MICRO-HOPE.

Experimental and clinical evidence suggest that angiotensin converting enzyme (ACE) inhibition may reduce cardiovascular (CV) risk by directly affecting endothelial dysfunction, atherosclerosis and thrombus formation. These direct effects are in addition to effects on vascular tone or pressure. The Health Outcomes and Prevention Evaluation (HOPE) study assessed the role of an ACE inhibitor ramipril in reducing CV events in 9297 patients > or = 55 years who were at high risk of CV events but did not have left ventricular dysfunction, heart failure, or high blood pressure at the time of study entry. In the overall HOPE population, the risk of the primary composite outcome (cardiovascular death, myocardial infarction, or stroke) was reduced by 22% (p < 0.001), and in patients with diabetes plus one other CV risk, it was reduced by 25% (p = 0.0004). Ramipril treatment achieved risk reduction in patients with mild renal insufficiency (serum creatinine > or = 1.4 mg/dl). Ramipril treatment did not increase adverse events in patients with renal insufficiency. The Study to Evaluate Carotid Ultrasound changes in patients treated with Ramipril and Vitamin E (SECURE) demonstrated that ramipril 10 mg significantly reduced the rate of carotid intimal medial thickening, suggesting a direct effect on atherosclerotic progression.

Angiotensin-Converting Enzyme Inhibitors↗