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“Our best hope is a cure.” Hope in the context of advance care planning

Published online by Cambridge University Press:  24 February 2012

Carole A. Robinson
Carole A. Robinson*
Affiliation:
School of Nursing, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
*
Address correspondence and reprint requests to: Carole A. Robinson, School of Nursing, Faculty of Health and Social Development, University of British Columbia Okanagan, 3333 University Way, Kelowna BC, V1V 1V7Canada. E-mail: [email protected]
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Abstract

Objective:

Advance care planning (ACP) has the potential to enhance end-of-life care, yet often fails to live up to that potential. This qualitative interpretive study was designed to explore the process and outcomes of ACP using the patient-centered Advance Care Planning Interview (PC-ACP) developed by the Respecting Choices® program in Wisconsin.

Method:

Patients diagnosed with advanced lung cancer and close family members were recruited. Nine family dyads participated in the PC-ACP interview, which was audio-recorded. Follow-up interviews took place 3 and 6 months after the PC-ACP interview and were also recorded. Thematic analysis was conducted on transcribed interviews using constant comparison.

Results:

Analysis showed that hope was a significant theme in the ACP process and this article reports on that theme. Hope for a cure was one of many hopes that supported quality of life for the participant dyads. Three themes were identified: hope is multifaceted, hope for a cure is well considered, and hope is resilient and persistent. The seeming paradox of hoping for a cure of an incurable cancer did not interfere with the process of ACP. The dyads engaged in explicit discussions of end-of-life scenarios and preferences for care. ACP did not interfere with hope and hope for a cure did not interfere with ACP.

Significance of results:

Concerns about false hope are called into question. The principle of honoring hope is not necessarily in conflict with the principle of truthful communication. This is clinically significant, as the findings suggest we need not disrupt hope that we think of as “unrealistic” as long as it supports the family to live well. Further, ACP can be successful even in the context of hoping for a cure.

Keywords

ACPHopeFalse hopeAdvanced cancerTerminal illness
Type
Original Articles
Information
Palliative & Supportive Care , Volume 10 , Issue 2 , June 2012 , pp. 75 - 82
Copyright
Copyright © Cambridge University Press 2012

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