A Qualitative Study of Hope and the Environment of Persons Living With Cancer

Abstract

The purpose of this naturalistic study was to explore and describe the impact of factors from the internal and external, human and non-human environments on the hoping process utilized by persons living with cancer. Given the nature of difficulties encountered by persons living with cancer, a sense of hopefulness is deemed to be especially important in managing life with this diagnosis. Using semi-structured interviewing and a purposive sample of fifteen persons living with cancer, positive and negative factors from the total environment were explored. Special attention was given to the impact of health care providers and health care environments on participants' hoping processes. Current perceived level of hopefulness on a one to ten scale was elicited from each informant revealing a high level of hopefulness for the group (mean = 9.37). Participants were asked to rank their positive hope influencing factors by importance for the internal (self) and external (human and non-human) environmental domains and overall. Data were audio taped and transcribed. Analysis and interpretation of data revealed four broad theme categories for hope influencing factors from the internal environment—personal characteristics, uplifting thoughts, sustaining beliefs, and self care. Human relational groupings, other than health care providers, revealed six broad themes including encouragement, companionship, love, gifts, communications, and role modeling. For health care providers, broad themes were competence, caring and compassion, and recognition and respect. For the external non-human environment, six broad theme categories emerged from the data, including pleasant environmental stimuli, symbols, comfort, safety, power, and surrogates. Three to six sub-themes were developed under each broad category. Two theoretical models were developed to explain the hoping process. One was developed prior to gathering data and involved an integration of attachment/loss, need satisfaction/deficit, and developmental growth. This theory was supported by the data. Another theoretical perspective emerged from the data suggested by the difficulty expressed by participants in ranking their sources of hope. The importance of various factors and perceived level of hope were reported to vary with time and circumstances. The second theory explained hoping as a dynamic cyclical process of emergence and growth across time. The results of this study have implications for nursing education, practice, and research. Most important is the potential for increased knowledge of the hoping process to assist nurses in enhancing the well-being and holistic health of persons living with cancer.