hope: not as fragile as we think

Hope:Not as fragile as we think

KYLE P. EDMONDS, MD ASSISTANT CLINICAL PROFESSOR DORIS A . HOWELL PALLIATIVE CARE SERVICEUCSD HEALTH SCIENCES

Summary

Hope is much more than medical hope for cure, it is a feature of being human that serves as a powerful

coping mechanism.

Illness JourneyCRISIS

CRISIS

CRISIS

Peace of Mind

The Provider’s World

Provider

ExperiencesPopulation

Data

Patient Data

Ambivale-nce

BeliefsChosen Role

Professional Norms

Education

Assump-tions

The Patient’s World

Patient

Data

Cues

Framing

Ambival-ence

HistoryBeliefs

Coping Style

Trust in Provider

Chosen Role

Acknowledging the Overlap

Elements to Negotiate

Provider Perspective

Patient Perspective

Elements to Negotiate

Control

Meaning

Hope

Optimism

The Power of Optimism

Thoughts influence outcomes◦ Optimism◦ Avoidance◦ Prognostication◦ Miracles

“Hope”: The Word

•A “short-hand” term

•Objective v. Subjective

•Noun v. Verb

•Cultural Pressures

“Hope”: The Noun• Limited to medicine

• “No hope”

• Negative future

• Absolutes

• Person• Subject to• Biological

• Focus on Death

Adapted from Table 1: Eliott & Olver, 2006.

“Hope” in Medicine

Eliott & Olver, 2002.

“Hope” in Medicine

•“Realistic”• Balanced / adjusted to

“truth”•Measuring words• Fragile

Olsman et al., 2014.

“Hope”: The Verb• More than medicine

• “I hope”

• Positive future

• Possibilities

• Patient• The subject of• Relatedness

•Focus on Life

Adapted from Table 1: Eliott & Olver, 2006.

Patient’s “Hope”

Jacobson et al., 2013.

Patients’ “Hope”

“…some patients may hold that ‘there is no hope’ yet conclude that ‘one can always hope.’”

Eliott & Olver, 2002.

“Hope”: Resilient

•Beyond medical definition

•Words have power

•Window to patient goals

Acknowledging the Overlap

Elements to Negotiate

Provider Perspective

Patient Perspective

Small Groups: “Sarah”• 58yo mother of three with metastatic colorectal CA•Admitted with recurrent SBO (being medically

managed) and pain out of control• You broach the concept of hospice with her

•“Oh no, doctor I still have HOPE to get stronger and have more chemo…•“I want to do EVERYTHING possible!”

•Affective

•Cognitive

•Spiritual

•Family

Meaning Making: “Do Everything”

Quill et al., 2009.

In Words

•“Hoping for the best and planning for the worst”

•Align with patient

•Explore & reframe “everything”

Communication In Action: Participation

Brown et al., 2004.

Communication In Action: Anxiety

Communication in Action: Outcomes

Influences to Coping◦ Challenge is Understood◦ Resources to Cope◦ Demands are Worthy of

Investment

Communication In Action: Palliative Consultation

More accurate prognostic understanding1

◦ Addressed QOL2

◦ Focus on unique patient2 ◦ Contained more pessimistic

cues2

1. Temel et al., 2011.2. Gramling et al., 2012.

Summary

Hope is much more than medical hope for cure, it is a feature of being human that serves as a powerful

coping mechanism.

Kyle P. Edmonds, MD kpedmonds@ucsd.eduO: 619.471.9424

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