For healthcare professionals specializing in oncology, a primary concern when discussing cancer diagnosis care plans, especially with advanced-stage patients, is the potential impact on patient hope. There’s often an unspoken anxiety that initiating conversations about end-of-life care or advance care planning (ACP) might diminish a patient’s hope and increase anxiety during an already challenging time. However, recent research sheds light on this crucial aspect of cancer care, suggesting that these anxieties might be unfounded.
A detailed study published in a respected medical journal investigated the correlation between engaging in ACP and patients’ levels of hope. The research, a secondary analysis of a larger randomized controlled trial focused on palliative care for advanced cancer patients, specifically looked at patients who had not previously engaged in ACP. The study defined ACP engagement through two key actions: having an end-of-life (EOL) conversation with their oncologist and completing a living will or advance directive (AD). Hope levels were measured using the Herth Hope Index (HHI), a validated tool where higher scores indicate greater hope.
The study involved 672 patients with advanced cancers, predominantly lung, gastrointestinal, and breast/gynecologic cancers. Initially, a significant portion of these patients had not participated in EOL conversations or completed ADs. Over a three-month period, researchers tracked changes in hope levels in relation to ACP engagement. Interestingly, initial analysis showed no significant difference in hope levels between patients who had EOL conversations and those who did not. Similarly, there was no significant difference in hope between those who completed ADs and those who did not in unadjusted comparisons.
However, the crucial insights emerged after adjusting for various factors known to influence both ACP engagement and hope, such as baseline hope levels, age, religious beliefs, education, marital status, socioeconomic status, time since diagnosis, symptom burden, and pre-existing anxiety or depression. Following these adjustments, the study revealed a noteworthy finding: patients who engaged in EOL conversations actually demonstrated a statistically significant increase in hope compared to those who did not. Similarly, patients who completed advance directives also showed a significant rise in hope levels after adjustment for confounding variables.
These results are compelling. They directly challenge the anxiety surrounding ACP discussions and their potential negative impact on patient hope. Instead of diminishing hope, engaging in advance care planning, whether through conversations with oncologists or by formalizing wishes in advance directives, appears to be associated with maintained or even increased hope in patients facing advanced cancer.
For clinicians hesitant to initiate ACP due to concerns about patient anxiety and loss of hope, this research offers reassurance. Having end-of-life conversations and supporting patients in completing advance directives are not detrimental to their hope. In fact, these actions may contribute to a greater sense of hopefulness. This understanding is vital in providing comprehensive and emotionally intelligent cancer care, ensuring that patients’ psychological well-being is supported alongside their physical health throughout their cancer journey. By embracing advance care planning, healthcare providers can alleviate their own anxieties and provide more holistic and patient-centered care.
