Viktor Frankl survived the extermination camps of the Second World War. He wrote that “the last of human freedoms” was the ability to “choose one’s attitude in a given set of circumstances”. This encapsulated what one of our primary aims in Palliative Care must be….. to guide and nurture the movement of hope towards realistic goals, being always aware that a clinical approach will not do. Engendering hope is an issue of the heart.
Patients draw upon a variety of mechanisms to sustain hope when facing chronic disease, including
- hope for a cure,
- support from others,
- seeking information,
- spiritual beliefs,
- limiting the impact,
- adapting to changing capacities,
- living in the moment, and
- transcending the self.
The palliative care team can play an important role by promoting discussions regarding hopefulness and its many forms.
Interventions that engender hope
- Adequate control of symptoms
- Fostering and developing interpersonal connectedness and relationships
- Assistance in attaining practical goals
- Exploring spiritual beliefs
- Supporting and identifying personal attributes, such as determination, courage, and serenity
- Encouraging light heartedness when appropriate
- Affirming worth by treating the patient as a valued individual
- Encouraging normality
- Recalling uplifting memories with life review
Hope is the expectancy of good in the future. It plays a role in the successful coping with illness and in improving the quality of a person’s life. In the context of a terminal illness, hope can exist even when time is limited. Such hope is bolstered by appreciating our patients’ value, strengthening and reconciling their relationships with family and friends, helping them to explore spiritual matters, and controlling their symptoms. Although some may find it hard to comprehend, when everything seems to be lost, hope may actually be stronger than ever before.
