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Amanda is a 36 year old female who has been diagnosed with cancer. She is married, has 2 young
children, and works as an Insurance Agent. Amanda’s recent diagnosis of cancer has wreaked
havoc on her professional life, her life as a mother, and her life as a wife.
As you know, cancer can be fatal, but the death is not sudden. Even so, the diagnosis of cancer
does entail a certain type of loss. Amanda is seeking assistance and needs your help.
As a health and wellness specialist in the oncology department of a large hospital, you have been
asked to help Amanda understand her illness. Consider the following articles as part of your
Griffith, J. L. (2014). Hope in cancer treatment. Psychiatric Annals, 44(7), 323-325.
Link to Article
Eustache, C., Jibb, E., & Grossman, M. (2014). Exploring hope and healing in patients living with
advanced non-small cell lung cancer. Oncology Nursing Forum, 41(5), 497-508.
Link to Article
Apply the concepts explored in the articles above by writing a 2-3 page paper in APA format using
proper spelling and grammar. Your paper should address the following:
1. Discuss Kubler-Ross’ Theory of Death and Dying and apply it to what Amanda may be
experiencing psychologically.
2. Predict some of the barriers to psychological well-being that Amanda may experience due to her
3. Describe how you might be able to educate Amanda about her illness and the impact that it may
have on her and her family. Be sure to reference one or both articles above.
4. Explain how the concept of “hope” may help Amanda deal with her illness.
Please refer to Rasmussen’s APA Guide located on the Resourcestab for information
regarding APA format as well as APA referencing and citation procedures.
Hope in Cancer Treatment
Griffith, James LAuthor Information
Full text
Full text – PDF
References 11
. Psychiatric Annals; Thorofare Vol. 44, Iss. 7, (Jul 2014):
Research studies have repeatedly found hope to be a major determinant of effective coping with the
distress and uncertainty of a cancer diagnosis. Hope may also have direct salutatory physiological
effects that extend upon positive psychological effects. Psychotherapeutic strategies for building
hope are most fruitful with cancer patients when hope is regarded as a skilled practice rather than an
emotional reaction to one’s circumstances. Three general strategies for mobilizing hope include: (1)
individual problem-solving strategies, (2) relational coping strategies, and (3) strategies for
mobilizing a core identity. Assessing a patient’s coping style when facing past adversities can guide
the selection of a hope-building strategy for coping with cancer. Illustrative cases demonstrate how
different hope-building strategies can be implemented within the scope of brief psychotherapy.
[Psychiatr Ann. 2014; 44(7):323-325.] [PUBLICATION ABSTRACT]
Full Text
James L. Griffith, MD, is Leon M. Yochelson Professor and Chair, The George Washington
University Department of Psychiatry and Behavioral Sciences.
Disclosure: The author has no relevant financial relationships to disclose.
Psychiatric consultation was requested for both Mr. K. and Mr. T., two oncology patients on
neutropenic precautions. Each patient had advanced leukemia for which chemotherapy was failing.
The two requests for psychiatric consultation differed, however. For Mr. K., a recommendation was
sought for management of neuropathic pain following chemotherapy. For Mr. T., the request was for
suicide risk assessment.
When the psychiatric consultant entered his room, Mr. K. interrupted a phone conversation with a
friend to speak with the psychiatrist. Fresh flowers were at his bedside and balloons floated from a
bedpost. “These days are all extra for me,” Mr. K. commented. “My oncologist told me when this was
diagnosed to expect no more than 2 years to live.” Despite the burning pain in his feet and a dismal
medical prognosis, Mr. K. spoke spontaneously about the people in his life for whom he felt
gratitude. By medical criteria, Mr. K. was dying, yet his being was infused with hope.
Mr. T., by contrast, was on suicide precautions after locking himself in a hotel room and taking large
doses of cocaine and heroin. His survival had been accidental. Hotel housekeepers entered his
room thinking that it needed cleaning. They found him comatose. Mr. T. spoke bitterly about the
neglect, unreliability, and betrayals of family, friends, and lovers. He said he hated that he had ever
been born. Mr. T. was also dying but consumed by bitterness, resentment, and despair.
Does Hope Matter?
Mr. K.’s inspired living, despite his terminal illness, makes the point that hope is more than the
probable estimate for a desired outcome. His hope was grounded in the stance he had adopted
toward living. When hopeful, he could continue to problem solve, to care for himself and others, and
to voice his values and commitments. He presented himself as the person he most wanted to be.
Hope helped preserve his identity.
Empirical studies have repeatedly found hope to be a major determinant of effective coping with the
distress and uncertainty of a cancer diagnosis.1 There is intriguing evidence that hope also may
have direct salutatory physiological effects that extend upon positive psychological effects.2
What Is Hope?
Hope requires a definition that can take into account patients such as Mr. K. who live with hope
despite a dismal prognosis or enormous daily suffering. Hope must be more than an expectation of
success or optimism.
Weingarten3,4 has emphasized hope as a practice. That is, hope at its core is “something you do,”
rather than “something you feel.” A practice is a program of action undertaken not for utilitarian
reasons, but rather to shape one’s being as a person and how one chooses to live in relation to
others.5 Practices are often connected to social, religious, or ideological traditions whose values
extend beyond individual motivations.6 Hope as a practice means locating one’s deep desire or
commitment and taking a step toward it. As such, hope can be embodied in the practices of
relationships, traditions, or institutions, not just limited to the life of an individual person.3,4,6
How Can a Patient’s Hope Be Assessed?
A patient’s capacities for hope often can be assessed by examining how the patient has responded
to past or current adversities: How did this affect you ? How did you respond to it ?7 Pathways for
mobilizing hope usually can be grouped into one of three categories: (1) individual problem-solving
strategies, (2) relational coping, and (3) mobilizing a core identity.
Hope as problem-solving strategies has been most extensively studied by Snyder and
colleagues,8,9 who have defined hope as the product of “pathways thinking” and “agency thinking.”
Pathways thinking begins by envisioning a desired future state, then imagining paths from one’s
current situation to that future state and the steps along those paths. Agency-thinking is the self-talk
that helps sustain a sense of personal agency (ie, that one can act effectively). Pathways-thinking
combined with agency-thinking turns “lemons into lemonade,” obstacles into stepping-stones, and
traumas into challenges.
For many individuals, however, the intuitive first step when facing adversity is not to start with
individual problem-solving, but to ask: To whom can I turn?3,10 Human beings are evolutionarily
equipped for utilizing an array of different kinds of relationships that can sustain hope: confiding
relationships, attachment relationships, embracing one’s group role, the neighborly relationships of a
social network, and generativity toward others in need.2,11
Finally, activating a core identity can mobilize enormous energy for assertively facing, engaging, and
struggling with adversity, rather than passively avoiding, withdrawing, or submitting. For one
individual, clarity about “this is the person I’m determined to be” matters most; for someone else it is
one’s role as a couple partner, family member, or team member; and for another it is an impersonal
identity as a member of a religious, national, ethnic, gendered, or political group.
How Can a Clinician Help Mobilize Hope?
Appraising how a patient has coped effectively with past adversities, whether by individual problemsolving, relational coping, or activating a core identity, can help a clinician attune quickly to the
patient’s best coping style. For example, Ms. D. was a 24-year-old engineering student who was
struggling through a bone marrow transplant for myeloblastic leukemia. As a skilled problem-solver,
she felt overwhelmed by feeling so ugly in her edematous body and lonely from separation from
loved ones. Overwhelmed by problems she could not solve, she stated, “I just want to give up!” After
listening for a few moments, the consultant psychiatrist said, “Let’s make two lists–the first list of
what is most important to address, then next most, then next most after that; then a second list of
what is hardest to address, then next most, then next most after that.” Together they generated a list
of contributors to her demoralization–physical pain, her appearance, insomnia, worries about her
school loans, loneliness, fear of dying. Ms. D. and the psychiatrist then chose two items of some
importance, but not the hardest challenges, to address first–insomnia and loneliness. As they
created an action plan together, Ms. D. commented how much better her spirit felt.
By contrast, Mr. R. primarily coped relationally. Mr. R. was evaluated after a suicide attempt by
overdose. His overdose had occurred the day he was diagnosed with prostate cancer, while still
grieving the death of his partner 6 weeks earlier. When deciding to end his life, Mr. R. said, “I just felt
confused and didn’t know where to turn.” He explained that his partner had always been the
organizer and problem-solver in their relationship. In addition to intense grief, he felt overwhelmed by
the prospects of cancer treatment.
The psychiatric consultant inquired about his relational world: Who knows what you are going
through? Who can you talk with when you are feeling low? Who can be available to help you get to
medical appointments? Who might help with food or house cleaning if you were to be ill from
treatments? Tell me about your work life– what makes you good at what you do ? These questions
revealed a rich network of friends and work colleagues who could be called upon for practical
assistance with cancer treatment. To check his assessment that Mr. R. primarily coped relationally,
the psychiatric consultant asked at the end of interview: “When you talk with someone as we have
been talking, does it make the emotional burden that you feel heavier or lighter?” “I feel better
talking,” Mr. R. responded. The consultant then recommended a psychotherapist, with whom Mr. R.
agreed to meet.
Activating a core identity often mobilizes hope when all else fails. Mr. F. had been a dynamic chief
executive officer of a corporation that produced educational software, which he now hoped to offer to
the low-income Asian nation of his ancestry through his philanthropy. Now afflicted with weakness,
pain, and fatigue from advanced Hodgkin’s disease, Mr. F. felt overwhelmed and discouraged. He
felt uncertain that he still had the capabilities for enacting his vision. The psychiatric consultant
asked Mr. F. for whom it would most matter that he succeed. He asked what it would have meant to
Mr. F.’s deceased father, who had supported his son’s emigration to the United States, for Mr. F. to
have returned with such a gift to his native country. The consultant asked what it would mean to the
school children of this country who would now have new possibilities for gaining an education.
Finally, he asked Mr. F. about the knowledge and skills that had propelled his success as an
entrepreneur and businessman, and how those capabilities now spoke to his confidence. “I need to
complete this,” Mr. F. stated simply. Later that month Mr. F. traveled to his native country to preside
over a strategic planning meeting to address political, language translation, and logistical obstacles
so that his new educational initiatives could move forward.
For cancer patients, sustaining hope is vital. Clinically, hope can be best regarded not as a reactive
feeling, but as a set of practices that can help a person to keep moving steadily toward desires and
commitments, despite the adversities of cancer and its treatment. By examining how a patient has
responded to past adversities, a clinician can discern whether a cancer patient’s best hope-building
competencies lie in problem-solving as an individual, in relational coping that relies on help from
others, or in accessing emotional energy from a core identity. Some patients, of course, can move
smoothly across all three hope-building domains, drawing appropriately from each when facing
different challenges. After this assessment, the clinician can ally with the patient in planning how to
utilize these pathways to build hope.
1. Duggleby W, & Ghosh S, & Cooper D, & Dwernychuk L. Hope in newly diagnosed cancer
patients. J Pain Symptom Manage. 2013 ; 46 : 661 – 670. 10.1016/j.jpainsymman.2012.12.004
2. Harris JC, & DeAngelis CD. The power of hope. JAMA. 2008 ; 300 (24): 2919 – 2920.
3. Weingarten K. Hope in a time of global despair. In: Flaskas C, & McCarthy I, & Sheehan J, eds.
Hope and Despair in Narrative and Family Therapy. New York, NY : Routledge ; 2007 : 13 – 23.
4. Weingarten K. Reasonable hope: construct, clinical applications, and supports. Fam Proc. 2010 ;
49 : 5 – 25. 10.1111/j.1545-5300.2010.01305.x
5. Griffith JL, & Griffith ME. Engaging the Sacred in Psychotherapy: How to Talk with People about
their Spiritual Lives. New York, NY : Guilford Press ; 2003.
6. Griffith JL, & Dsouza A. Demoralization and hope in clinical psychiatry and psychotherapy. In:
Alarcón RD, & Frank JB, eds. The Psychotherapy of Hope: The Legacy of Persuasion and Healing.
Baltimore, MD : Johns Hopkins University Press ; 2012 : 158 – 177.
7. Wade A. Small acts of living: everyday resistance to violence and other forms of oppression.
Contemp Fam Ther. 1997 ; 19 (1): 23 – 39. 10.1023/A:1026154215299
8. Snyder CR, & McDermott D, & Cook J, & Rapoff M. Hope for the Journey: Helping Children
through Good Times and Bad. Boulder, CO : Westview/Harper Collins ; 1997.
9. Snyder CR, ed. Handbook of Hope: Theory, Measures, and Applications. New York, NY :
Academic Press ; 2000.
10. Pullybank Coffey E. Blowing on Embers. Tamarac, FL : Lumina Press ; 2007.
11. Weihs KL, & Enright TM, & Simmens SJ. Close relationships and emotional processing predict
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Word count: 1931
Copyright 2014, SLACK Incorporated
© Oncology Nursing Society. Unauthorized reproduction, in part
or in whole, is strictly prohibited. For permission to photocopy,
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Exploring Hope and Healing in Patients
Living With Advanced Non-Small Cell Lung Cancer
Chloe Eustache, RN, MSc(A)N, BA, BS, Emily Jibb, MSC(A), RN, BScH,
and Mary Grossman, BScN, MScN, PhD
ung cancer is the second most commonly diagnosed cancer in Canada (Canadian Cancer
Society [CCS], 2012). An estimated 85%–90%
of lung cancers are classified as non-small
cell lung cancer (NSCLC), with almost half of
patients with NSCLC presenting with advanced disease
at the time of diagnosis (CCS, 2012). Advanced disease
refers to NSCLC that has spread locally (stage IIIB) or
distally (stage IV) to the lymph nodes or other tissues
and organs (CCS, 2012). The five-year survival rates are
poor at 13% and 19% for men and women, respectively
(CCS, 2012).
Unsurprisingly, 43%–50% of patients with lung
cancer experience psychological distress, surpassing
the rates associated with all other diagnoses (Cooley,
Short, & Moriarty, 2003; Tishelman et al., 2005; Zabora,
BrintzenhofeSzoc, Curbow, Hooker, & Piantadosi,
2001). That distress has been linked to a number of
cancer- and treatment-related factors that have been
found to negatively affect the patients’ social, physical, and spiritual well-being and quality of life (Akin,
Can, Aydiner, Ozdilli, & Durna, 2010; Fan, Filipczak, &
Chow, 2007; Thompson, Solà, & Subirana, 2005). Such
distress also has been associated with poor adherence
to treatment and low satisfaction with care, contributing further to poor health and survival outcomes
(Graves et al., 2007; Kaasa, Mastekaasa, & Lund, 1989;
Kukull, McCorkle, & Driever, 1986).
Although the terms are sometimes used interchangeably and their definitions overlap, distress is not a
synonym of suffering but rather one of its components.
Psychological distress is a predictor of suffering in
patients with cancer (Wilson et al., 2007). Suffering has
also been reported at all phases of the cancer trajectory
and significantly affects patients’ ability to cope with
advanced disease (Chio et al., 2006; Ferrell & Coyle,
2008). One of the first to explore the affective experience
of suffering, Cassel (1982) deplored the separation of
mind and body, which he felt contributed to suffering
being given scant attention as it was unjustly relegated
to the realm of the mind, thereby giving it less credibility within medicine. Cassel (1982) posited that suffering
is experienced by the whole person and occurs when
the “impending destruction of the person is perceived”
and lasts until the threat has passed or until the person
can restore a new sense of integrity (p. 640). This suffering occurs in any of the multiple facets of the person
(e.g., physical, emotional, social, spiritual) (Cassel,
Oncology Nursing Forum • Vol. 41, No. 5, September 2014
Purpose/Objectives: To explore the experience and meaning of hope in relation to the healing process of patients
living with stage IIIb or IV non-small cell lung cancer.
Research Approach: Interpretative qualitative study design.
Setting: Peter Brojde Lung Cancer Centre in the Jewish
General Hospital in Montreal, Quebec, Canada.
Participants: 12 English- and French-speaking patients,
aged 36–78 years.
Methodologic Approach: One 60–90-minute semistructured interview per participant was conducted. An inductive approach to data analysis was taken, involving immersion in the data, coding, classifying, and creating linkages.
Findings: Four main themes emerged: (a) the morass of
shattered hope, (b) tentative steps toward a new hope
paradigm, (c) reframing hope within the context of a lifethreatening illness, and (d) strengthening the link between
hope and wellness.
Conclusions: Patients described a process where hope was
diminished or lost entirely, regained, and reshaped as they
learned to live and grow following their diagnosis.
Interpretation: This study adds to the literature by describing the dynamic nature of hope as well as factors facilitating
or hindering the hope process. It demonstrates how finding
meaning, a structural component of healing, can be used
to envision a new hopeful future. This study suggests hope
and healing cannot exist in isolation, and highlights the
importance of understanding the fluctuating nature of hope
in patients with advanced lung cancer to foster it, therefore
promoting healing.
Key Words: hope; healing; meaning
ONF, 41(5), 497–508. doi: 10.1188/14.ONF.497-508
1982). Cassel’s (1982) concept that suffering is linked
to a crisis of meaning has been echoed throughout the
literature (Dobkin, 2009; Egnew, 2005, 2009). The crisis
of meaning is linked to the loss of one’s pr …
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