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Hope:Not as fragile as we think
KYLE P. EDMONDS, MD ASSISTANT CLINICAL PROFESSOR DORIS A . HOWELL PALLIATIVE CARE SERVICEUCSD HEALTH SCIENCES
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Summary
Hope is much more than medical hope for cure, it is a feature of being human that serves as a powerful
coping mechanism.
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Illness JourneyCRISIS
CRISIS
CRISIS
Peace of Mind
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The Provider’s World
Provider
ExperiencesPopulation
Data
Patient Data
Ambivale-nce
BeliefsChosen Role
Professional Norms
Education
Assump-tions
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The Patient’s World
Patient
Data
Cues
Framing
Ambival-ence
HistoryBeliefs
Coping Style
Trust in Provider
Chosen Role
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Acknowledging the Overlap
Elements to Negotiate
Provider Perspective
Patient Perspective
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Elements to Negotiate
Control
Meaning
Hope
Optimism
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The Power of Optimism
Thoughts influence outcomes◦ Optimism◦ Avoidance◦ Prognostication◦ Miracles
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“Hope”: The Word
•A “short-hand” term
•Objective v. Subjective
•Noun v. Verb
•Cultural Pressures
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“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.
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“Hope” in Medicine
Eliott & Olver, 2002.
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“Hope” in Medicine
•“Realistic”• Balanced / adjusted to
“truth”•Measuring words• Fragile
Olsman et al., 2014.
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“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.
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Patient’s “Hope”
Jacobson et al., 2013.
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Patients’ “Hope”
“…some patients may hold that ‘there is no hope’ yet conclude that ‘one can always hope.’”
Eliott & Olver, 2002.
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“Hope”: Resilient
•Beyond medical definition
•Words have power
•Window to patient goals
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Acknowledging the Overlap
Elements to Negotiate
Provider Perspective
Patient Perspective
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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!”
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•Affective
•Cognitive
•Spiritual
•Family
Meaning Making: “Do Everything”
Quill et al., 2009.
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In Words
•“Hoping for the best and planning for the worst”
•Align with patient
•Explore & reframe “everything”
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Communication In Action: Participation
Brown et al., 2004.
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Communication In Action: Anxiety
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Communication in Action: Outcomes
Influences to Coping◦ Challenge is Understood◦ Resources to Cope◦ Demands are Worthy of
Investment
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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.
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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 [email protected]: 619.471.9424
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