BACKGROUND: Hope plays a pivotal role in enhancing the quality of life and coping strategies of individuals living with advanced diseases. The nature of the relationship between hope and prognostic awareness is unclear. AIM: To explore the experiences and meanings of hope and their association with prognostic awareness among people with advanced incurable diseases. DESIGN: Qualitative phenomenological study using reflexive thematic analysis of semi-structured interviews. SETTING/PARTICIPANTS: Interviews with 24 participants aged 30-99 years with advanced incurable disease were conducted in hospices and hospitals in the Czech Republic. RESULTS: We generated four distinct approaches to hope and prognostic awareness: Technical, Spiritual, Minimalist and Pragmatic. Each approach exhibited unique cognitive, emotional and behavioural dimensions of hope and prognostic awareness. The Technical and Minimalist approaches showed fluctuating hope influenced by medical updates, while the Spiritual and Pragmatic approaches demonstrated stable hope resilient to prognostic information. CONCLUSIONS: Recognizing these diverse hope approaches can guide tailored interventions in palliative care. Healthcare providers should adapt their communication strategies based on people's predominant hope orientations to support effective coping and enhance end-of-life care outcomes. This study sheds light on how different individuals navigate hope amidst terminal illnesses, providing insights into the nuanced psychological and emotional dynamics that influence their coping mechanisms.

• Keywords
• Hope, palliative care, prognosis, psychological adaptation, quality of life,
• MeSH
• Adaptation, Psychological * MeSH
• Adult MeSH
• Quality of Life psychology   MeSH
• Qualitative Research MeSH
• Middle Aged MeSH
• Humans MeSH
• Hope * MeSH
• Palliative Care * psychology   MeSH
• Terminal Care * psychology   MeSH
• Prognosis MeSH
• Interviews as Topic MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Terminally Ill * psychology   MeSH
• Awareness * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

BACKGROUND: The fear of taking away hope hinders clinicians' willingness to share serious news with patients with advanced disease. Unrealistic illness expectations, on the other hand, can complicate decision making and end-of-life care outcomes. Exploration of the association between hope and illness expectations can support clinicians in better communication with their patients. AIM: The aim of this study was to explore whether realistic illness expectations are associated with reduced hope in people with advanced cancer. DESIGN: This is a cross-sectional secondary analysis of baseline data from a primary palliative care cluster-randomized trial CONNECT (data collected from July 2016 to October 2020). Hope was measured by Herth Hope Index. Illness expectations were measured by assessing patients' understanding of their treatment goals, life expectancy, and terminal illness acknowledgement. Multivariable regression was performed, adjusting for demographical and clinical confounders. SETTING/PARTICIPANTS: Adult patients with advanced solid cancers recruited across 17 oncology clinics. RESULTS: Data from 672 patients were included in the study, with mean age of 69.3 years (±10.2), 53.6% were female. Proportion of patients indicating realistic expectations varied based on which question was asked from 10% to 46%. Median level of hope was 39 (IQR = 36-43). Multivariate non-inferiority regression did not find any significant differences in hope between patients with more and less realistic illness expectations. CONCLUSIONS: Our results suggest that hope can be sustained while holding both realistic and unrealistic illness expectations. Communication about serious news should focus on clarifying the expectations as well as supporting people's hopes.

• Keywords
• Psycho-oncology, awareness, cancer, communication, critical illness, hope, palliative care, terminally ill,
• MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Motivation MeSH
• Hope MeSH
• Neoplasms * therapy   MeSH
• Palliative Care methods   MeSH
• Terminal Care * MeSH
• Cross-Sectional Studies MeSH
• Randomized Controlled Trials as Topic MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

PURPOSE: Despite the current guidelines supporting open communication about serious news, the evidence about the impact of prognostic awareness on the quality of life in cancer patients is not clear. The aim of this study was to assess the association between quality of life and prognostic awareness in patients with advanced cancer. METHODS: This was a cross-sectional study which involved patients (n = 129) with incurable advanced cancer (estimated by oncologist using 12-month surprise question). Data were collected at oncology departments at 3 hospitals using structured interview in which patients were asked about their quality of life (using Integrated Palliative Outcome Scale-IPOS and a single-item global measure), prognostic awareness, information needs and demographics. RESULTS: Only 16% of the sample was completely aware of prognosis and 57% was partially aware. Accurate prognostic awareness was significantly associated (p = 0.02) with lower level of quality of life between (when measured by both the IPOS and the single-item scale) patients with accurate prognostic awareness (M = 37.1; 10.4) and partially aware (M = 31.9; 9.1) and unaware patients (M = 30; 7.4). Detailed analysis showed that significant difference between groups was found only for physical symptoms subscales (p = 0.002), not for emotional and communication subscales. CONCLUSION: Prognostic awareness was found to be negatively associated with physical domain of quality of life, but not with emotional and communication domains. More research is needed on personality factors that might influence the development of prognostic awareness and quality of life.

• Keywords
• Advanced cancer, Palliative care, Prognostic, Prognostic awareness, Quality of life, Understanding,
• MeSH
• Quality of Life * psychology   MeSH
• Humans MeSH
• Neoplasms * psychology   MeSH
• Palliative Care MeSH
• Prognosis MeSH
• Cross-Sectional Studies MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH