Experience of Hope in Terminal Cancer Patients: Applying Parse's Human Becoming Methodology

Jung Ee Kim; Hyang Sook So

doi:10.5388/aon.2019.19.2.55

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Kim and So: Experience of Hope in Terminal Cancer Patients: Applying Parse's Human Becoming Methodology

Original Article

Asian Oncol Nurs 2019;19(2):55-70.

Published online: 5 June 2019

DOI: https://doi.org/10.5388/aon.2019.19.2.55

Experience of Hope in Terminal Cancer Patients: Applying Parse's Human Becoming Methodology

Jung Ee Kim¹, Hyang Sook So²

¹Nursing Department, Chunnam Techno University, Gwangju, Korea

²College of Nursing, Chonnam National University, Gwangju, Korea

^∗ This manuscript is based on a part of the first author's doctoral dissertation from Chonnam National University.

Address reprint requests to: So, Hyang Sook College of Nursing, Chonnam National University 160 Baekseo-ro, Dong-gu, Gwangju 61464, Korea Tel: +82-62-530-4952 Fax: +82-62-220-4544 E-mail: hsso0075@jnu.ac.kr

Received 5 Feb 201910 May 2019 Accepted 12 May 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

초록

Purpose

The purpose of this study was to explore the experience of hope of terminal cancer patients in Korea.

Methods

Seven participants receiving hospice care were interviewed about hope experiences based on Parse's research methodology.

Results

Practical propositions derived from the structure of the hope experience were: Terminal cancer patients are beings newly recognizing the value of their lives by maintaining their hopes while they are experiencing powerlessness due to feelings of loss and distress. Ways of truly being with them are accepting their experience of distress, understanding the existence of paradoxical relationships, active symptom management, and finding hope in the current situation. Through these processes, the patients restructure their remaining lives for peaceful death by changing their perceptions about death. This structure can be interpreted as ‘the hope experience of terminal cancer patients is a process of changing the value of life, overcoming fear of death, enhancing meaning, and transcending.’

Conclusion

The concept of ‘true presence’ applied in this study was proved to be an effective nursing practice improving quality of life of the patients. Parse's Human Becoming Methodology may be applied to terminal cancer patients in the future.

Keywords: Hope, Terminally ill, Cancer, Qualitative research

REFERENCES

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Fig. 1.

Model of experienced hope in terminal cancer patients.

Table 1.

General Backgrounds of Participants

Participants	No. 1	No. 2	No. 3	No. 4	No. 5	No. 6	No. 7
Sex	Male	Female	Male	Female	Female	Female	Female
Age (years)	39	65	73	74	52	49	45
Religion	Catholic	Protestant	Catholic	Catholic	Protestant	Jehovah's witnesses	Catholic
Education	College dropouts	Middle school graduate	College dropouts	Middle school graduate	High school graduate	Middle school graduate	College
Marital status	Married	Married	Married	Married	Married	Separated	Married
Occupation	Technical worker	Technical worker	Public officer	Public officer	None	None	Research worker
Number of cohabitants	Five	Five	Two	Two	Four	Two	Four
Type of cancer	Pancreatic	Rectal	Colon	Stomach & prostatic	Stomach	Gall bladder	Breast
Type of treatment	Surgery Chemotherapy	Surgery	Surgery Chemotherapy	Surgery	Surgery Chemotherapy	Chemotherapy	Chemotherapy
Time since diagnosis	1 year	4 years 3 months	3 years 2 months	1 year 2 months	6 months	8 months	5 months
Recent length of stay in hospitals	2 weeks	5 months	1 week	2 months	1 month	1 week	1 week

No= number.

Table 2.

Twenty two Synthetic Propositions and Five Core Concepts

Synthetic propositions	Core concepts
1 In the beginning, the patients want to deny the terminal cancer diagnosis, and become angry. Over time, they recognize the symptoms, accept the reality, and prepare for their own death and to say good-bye to family. 2 The patients worry about family members suffering because of them and even contemplate suicide. Over time, they accept the reality of imminent death, while recognizing the value of remaining life. 3 Even though the patients wish for painless death due to fear of pain, they still value their current lives.	Core concept 1. In the early stage of being diagnosed with terminal cancer, the patients express disbelief and anger, but over time, they recognize the subjective symptoms, whereupon they begin to re-think the meaning of their remaining lives and change their attitudes, while accepting the circum-stances and deeply recognizing the value of surviving each day. (Participant #1, 2, 5, and 7)
4 The patients take on a positive attitude toward death with peace of mind as they do all that they had desperately hoped to do with their families. 5 The patients shift their thinking to positive thoughts as they face the end of their life, while they feel both sorry and thankful to their spouses, who have been their life partners. 6 The patients feel happy about being alive and are thankful for all the love and interest they received after being diagnosed with the disease, rather than thinking about the pain and suffering.	Core concept 2. There is a mixed feeling of being thankful for the interest and love family members have shown for them and the feeling of pain from having to prepare to say good-bye to them (Participant #1, 2, 3, 4, and 7)
7 When patients are faced with having to make final arrangements in life, there is a mixed feeling of holding onto the positive feeling about the past and regret about life being cut short.
8 The patients accept that their own death is natural as they see the death of others around them. But sadness remains inside.
9 As they directly face death, reaffirmation of love between family members is mixed with the pain of having to say good-bye.
10 The patients gain peace of mind and physical stability by taking analgesics to control excruciating pain due to terminal cancer, while they hold out hope for treatment through the development of novel drugs. 11 Although the patients recognize the reality of terminal cancer, they cannot let go of the glimmer of hope for recovery.	Core concept 3-1. Physical pain in the uncertain remaining life is controlled with analgesics, and hope remains for extending life through the development of novel drugs, but they accept that there is presently no definitive cure. (Participant #1, 3, 4, 6, and 7)
12 The patients recognize that there is no cure for their disease and prepare for death with a disinterest-ed attitude.13 The patients hope for comfortable death as they experience polar opposites of life and death from exacerbation and alleviation of terminal cancer symptoms.	Core concept 3-2. They hold out hope for the alleviation of symptoms, but they feel despair with sudden exacerbation of symptoms. They contemplate death as an escape from suffering. (Participant #1, 3, 4, 6, and 7)
14 As the prospects of recovering from the disease become bleaker and symptoms become worse, they recognize the imminence of death. They abandon their feeling of resentment and accept it as fate.15 The patients sense the reality that little time remains in their lives due to decline in their physical strength, and exhibit anxiety, but they hold a strong desire for life and hope to be cured, as uncertain as it may be. 16 Facing death, the patients take on a tolerant attitude as their view on life changes.	Core concept 4. The patients overcome extreme p sychological anxiety in facing death and conflict from strong attachment to remaining alive through the faith of relying on an absolute being and strengthening relations with meaningful people. (Participant #1, 2, 3, 4, 5, 6, and 7)
17 While feeling the imminence of death, they sense the reality of surviving each day and hope to survive day by day despite the uncertainties of tomorrow.
18 The patients hold out hope and try to make a deal with the transcendent being to allow them to live long enough until their children have grown and have achieved major accomplishments.
19 The patients are thankful for being alive and for their lives to this point, while hoping for painless final days. 20 The patients desperately hope to live as long as possible to fulfill specific life goals 21 The patients find psychological stability as they sublimate their worries about leaving family behind through religious faith, while hoping that their children live a better life than them.	Core concept 5. As they change their view of death from end of life to just a process within life, the patients hope to take care of what remains in their lives and face a comfortable death. (Participant #1, 2, 3, 6, and 7)
22 As they face imminent death, the patients show changes in the view of life as they turn the past into sweet memories and try to think positively and accept the present.

Table 3.

Core Concepts and Heuristic Analysis of Hope Experience

Items	Core concept 1	Core concept 2	Core concept 3	Core concept 4	Core concept 5
Structural integrity · Ne val	ewly recognizing the lue of their lives	· Closer & seperation relationship with significant others	· Confronting limitations and capacities of medi-cations · Intersection of hope & despair	· Solving internal conflicts by believing in God	· Aware switch for death · Reconstruction of the rest of their life
Conceptual analysis	Meaning	Rhythmicity	Rhythmicity	Cotranscendence	Cotranscendence
	Valuing	Connecting-Separating	Enabling-Limiting	Powering	Transforming

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