Dissertation committee:
Βασίλειος Κουλουλίας , Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Νικόλαος Τεντολούρης , Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Ψάρρος, Αν. Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αλεξάνδρα Τσαρούχα, Καθηγήτρια, Τμήμα Ιατρικής, Δημοκρίτειο Πανεπιστήμιο Θράκης
Άννα Ζυγογιάννη, Αν. Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Σωκράτης Παπαγεωργίου, Αν. Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Γεωργακόπουλος, Επ. Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction: Sixty years after the distinguished psychiatrist Karl Menninger's
challenge to the scientific community to consider a very important but often neglected
component in clinical practice, that of Hope, its value needs further recognition by
health professionals. Hope has been positively associated with health and plays an
important role in managing illness and the losses that accompany it. For the oncology
patient, Hope is a prerequisite for effective adaptation to the disease as well as a strategy
for dealing with physical and mental upheavals. It has a protective role against the
physical, mental and social burden of the disease. Although the loss of Hope is
accompanied by reduced functioning and is related to depression and anxiety, as a
multidimensional concept it represents much more, and the question is to be able to
understand it in depth. Hope promotes coping with the disease, psychological
adjustment and quality of life. Due to the complexity of the effect of Hope on the cancer
patient and on the sufferer in general, its investigation has been and still is today a great
challenge for many researchers. Patients' Hope and Expectations are subjective
concepts that depend on several factors such as the person's personality, the truth of the
disease, the prognosis and course of the disease, knowledge of the concept and benefits
of Palliative Care. The investigation of patients' Hope and Expectations from Palliative
Care is of fundamental importance and can be an indicator of the quality of care and
motivate the care providers to fulfill these expectations as much as possible. The
functional value attributed to Hope and Expectations by many scholars makes its further
investigation imperative.
Purpose: This thesis, through a mixed approach, aims in principle to quantitatively
evaluate Hope and its relationship with anxiety and depression in cancer patients. Then,
through the qualitative study, the overall psychological state, Hope and Expectations of
patients from the Palliative Care Unit are explored in depth.
Methodology: Mixed approaches, combining quantitative and qualitative methods in
their design, make better use of the advantages of each method. The design option used
is the explanatory sequential design, which takes place in two distinct phases.
Quantitative data are collected and analyzed, followed by qualitative data collection
and analysis. For the quantitative research which concerns Hope in the oncology
patient, the Greek Herth Hope Index and the Hospital Anxiety and Depression Scale
were used.
For the qualitative research which concerns the Hope and Expectations of patients from
palliative care, Interpretive Phenomenological Analysis was applied. Information was
elicited from patients through a one-hour semi-structured interview.
Results: The sample consists of people with high levels of Hope and low levels of
Anxiety and Depression. There is a statistically significant high negative correlation
between Hope, HAD anxiety (r=-0.491) and HAD depression (r=-0.626). No
statistically significant differences were found between Hope level, age, education, and
socio-economic conditions. Patients with ECOG 0-1 and those who had received
radiotherapy had a higher overall hope score, in contrast to patients with ECOG 2-3 and
those who had not received radiotherapy. Multiple linear regression showed that
subjects who underwent radiotherapy have 2.49 points higher Hope score than those
who did not and a 1 point increase in depression results in a 0.65 point decrease in Hope
score. During the Interpretive Phenomenological Analysis of the qualitative data, 3
super thematic sections emerged which were: 1) Cancer Diagnosis and Kaleidoscope
of Emotions, 2) Hope and the oncology patient, 3) The Oncology Patient's Expectations
from Palliative Care
Conclusions: The conceptualization of cancer from the patient's perspective includes
symptom management, reconceptualization of illness, coping with changes in
functioning, and open communication between patient, family, doctors, and Palliative
Care team, indicating the need for a multidisciplinary approach and strengthening
positive driving forces.
Keywords:
Cancer, Hope, Expectation, Anxiety and depression, Palliative care
