Hope and positive thinking play an important role in the lives of people with cancer in all the different stages of the illness. In their daily language, people with cancer often use the words 'hope' or 'positive thinking'.
Nowadays, a growing number of people gets diagnosed with cancer, and lives with the disease. Amongst other reasons, this is because cancer is discovered sooner and can be treated more effectively. Two concepts that are generally used to describe the treatment goals, are curative and palliative treatments. Curative treatments are treatments aimed at curing the disease, whereas palliative or life-extending treatments are treatments aimed at prolonging life as long as possible, since the patient is not likely to survive, and at improving the patient’s comfort and quality of life. We have used this medical classification of curative and palliative treatments, because we are also concerned with a medical diagnosis and because the international literature uses this classification. Curative or palliative treatments are terms mainly used by health professionals; patients themselves discuss that a treatment is either aimed to cure, or that they can no longer be cured.
A cancer diagnosis has a major impact on a person's life and on the lives of those around them. The awareness of the finiteness of life and the uncertainty this brings can cause an existential crisis. Many cancer patients respond to this existential crisis by nurturing hope: hope they will suffer from a treatable variant; that the cancer has not spread; that they do not need to receive chemotherapy. And above all, hope for a complete recovery.
The hope is prominent and often does not run parallel with the medical facts and prognosis. Many health professionals feel uneasy when a patient expresses hope that goes (far) beyond the prognosis that has been communicated to them. Health professionals may think that people are insufficiently informed about their prognosis, or that they deny the situation. For this reason, and because people with cancer so often use the words 'hope' and 'positive thinking', these concepts deserve a thorough exploration.
The original plan of this thesis was to investigate hope in people with cancer in all the different stages of the disease process. During the data analysis of the cancer patients who were treated with curative intent, it was found that they often used the term ‘positive thinking’ for what in daily life, we simply refer to as ‘hope’. For this reason, this thesis focuses not just on hope, but also on positive thinking in people with cancer in all stages of the disease process.
Aim

This thesis aims to provide a better understanding of what hope and positive thinking means to people with cancer in the palliative or curative phase of their disease. It also aims to provide insight into the perspectives of health professionals in dealing with palliative patients who hope to live as long as possible, and to gain insight into the factors associated with hope in people during cancer treatment.
Methods
Two secondary analyses were conducted with a constructivist grounded theory approach. The data were obtained in a series of small studies in The Netherlands and Flanders. One study focused on interviews with people with cancer in the palliative phase of their disease (n = 76). The other study focused on interviews with cancer patients who are being treated with a curative intent (N = 74). De data were analysed according to the constant comparative method.
To explore how Dutch health professionals deal with palliative patients with cancer who hope for prolongation of life, focus group discussions (FGD) were conducted. To understand health professionals’ interpretation of and reaction to the hopefulness in palliative patients with cancer, an interpretive description approach was used. Three FGD’s were held, each consisting of five to ten health professionals working with palliative patients recruited in a general Dutch hospital and homecare organization.
A systematic review of empirical quantitative studies on hope in people with cancer during treatment was conducted. A total of 33 studies were included to explore factors associated with hope in cancer patients during treatment.
Results
First, we investigated what the meaning of hope is, from the perspective of the patients with cancer in the palliative phase of their disease. A striking outcome, is that the intensity of these patients’ hope seems to be determined mainly by the importance of the object that their hope is fixed on, for example being able to watch their children grow up. The object is often so important to patients that it seems they cannot live with the idea that it is unattainable. The intensity of the desire for a positive outcome is not related to the chance of their actually achieving this goal, yet the patient still clings to the idea that this goal is not completely unattainable.

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