Hope: Not as fragile as we think
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Transcript of 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 [email protected]: 619.471.9424
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