People manage hope and disappointment during life’s ups and downs in very personal ways. Doctors and patients usually place their hopes on a positive medical outcome. This is understandable: a patient wants his cancer to be cured, and a physician wants the patient to be cured. However, in conditions like cancer, when we place our hopes primarily on an outcome, our wish may not come true, causing dips of despair, panic, and anger. This can generate and exacerbate hopelessness, the danger from continuing to invest in a specific outcome or vision of a future that has become impossible. How to effectively manage expectations and hope as a patient, family member or doctor is part of what separates a good medical experience from a hated one.

Researchers have noted that hope and hopelessness are related to the quality of life for patients with terminal cancer. Hope has also been correlated with emotional and spiritual well-being. On the other hand, hopelessness is associated with poorer quality of life and the wish to die.

This is extremely important because it’s not like you either have hope, or you don’t. And it’s not like either you are hopeless, or you’re not. Physicians need to help frame hope beyond simply the hope to be cured or the hope to live as long as possible, because this devalues and undercuts the opportunities for a fuller life that comes from hoping for–and achieving–all kinds of things.

Even when cure or disease control is possible, some patients experience side effects that can last years, or for the rest of their lives. What can you hope for then? Patients and families can benefit from understanding that there are many and varied things one can hope for, even when other things, due to illness or treatment, are no longer possible. When my dad knew he was going to die, he still found joy in hoping for a nice sunrise or a joyful song on the radio. Because of the way medical care is provided currently, there are great challenges to attaining such hope, but there are also paths in contemporary medical care to a compassionate and loving generation of hope. Future posts will explore this.