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Where there is hope, there is life?

Does hope help?

Bandolier is sometimes seen as dreadfully stuck in its ways of quantification and arithmetic, but we do recognise good studies and research projects in which the only numbers are page numbers. A paper on the meta-analysis of hope seems to us to be an example of high quality research in a very difficult field [1].

The paper is a review of 46 articles published between 1975 and 1993 on the effects of hope on outcome. The literature review lists many fascinating titles, for example:

"The process of maintaining hope in adults undergoing bone marrow transplantation for leukaemia";

"Development of an instrument to measure hope";

"Fostering hope in terminally ill people".

Hope and false hope

The giving or sustaining of hope, or its destruction, are the types of subtle intervention which take place in almost every clinical interaction but which are very rarely discussed or studied. A whole variety of different types of interventions may have been wrongly packaged together under the label of the "placebo" or "non-specific" effects of clinical practice, and the clinician's attitude towards hope is one of these.

Ontology and epistemology

Ontology is the study of being or existing, a metaphysical study. Epistemology is a bit more hard-nosed, being concerned with the study of how we know things, and of course, much of philosophy from Plato to A. J. Ayer is concerned with how we know. Research is itself part of the process of epistemology.

What the authors have done is to look at the papers, try to identify what sort of concepts are implicit in the simple four letter word "hope". It would be very nice to have found 15 good quality randomised trials in which some patients had been given hope and others had not, although the complexities of designing such a single blind trial make it extremely daunting.

The authors concentrated on "describing the essence of hope" as it was used in these 46 papers, most of which were descriptive studies. Their conclusion, not surprisingly, was that the term was too vague and diffuse for meta-analysis of any of the results of the studies to be possible, but it is a very good example of an attempt to tackle a complex, diffuse and difficult topic.

Without a clear definition of the intervention, evaluation of its effect by quantifiable means is impossible.

Effectiveness of giving patients hope

Unfortunately the paper comes to no conclusions, and does no analysis of any of the outcomes, not even a simple vote counting of whether the studies showed a link between outcome and hope. But the authors have identified the studies, and this would be a good place to start for anyone interested in studies on the effects of hope on patient outcome.


  1. J Kylmä, K Vehviläinen-Julkunen, K. Hope in nursing research: a meta-analysis of the ontololgical and epistemological foundations of research on hope. Journal of Advanced Nursing 1997 25: 364-71

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