A Toolkit for Managing Hope

In a Harvard Business Review article entitled, Managing the Hopes of Seriously Ill Patients, Brad Stuart describes a toolkit for managing hope.
(Comments and elaborations interwoven with directly quoted material.)

• “Relieving pain and other symptoms. Unrelieved pain triggers hopelessness, whereas controlling pain allows intrinsic hope to emerge. Hospice and palliative care providers are trained to do this.”

• Asking empathic questions. Hurried clinicians often want to deliver bad news quickly so they can go on to the next case. But when the news is that illness is incurable, certain questions can assist patients on the journey from focused to intrinsic hope — questions like “What do you hope to gain from treatment,” and “What do you hope we can help you with?”  It is a mismatch of magnitude to in any way take the delivery of this kind of news as routine or a task to be checked off. This is a life changing moment and that cannot be forgotten.

• Helping the body be the teacher. Downturns and new symptoms are distressing, but they often contain useful information that clinicians can use to help patients through denial and make constructive plans. Clinicians may view them as opportunities to help patients understand and accept the reality of illness progression.” Perhaps more importantly, if a patient can accept the idea of the body as a teacher, it is far better than considering the body a tyrant or a thief.

• Leaning on the door. If the message the clinician is trying to deliver triggers denial, trying to break the door down can be counterproductive.” “…continuing the conversation at the patient’s own pace, perhaps over several encounters, builds trust. “ It is important to note that patients and the people who love them have denial because they need it and give it up when it is no longer needed. We can never judge that for someone else.

• Learning to see in the dark. There are some clarifications being made in clinical and other circles about the differences between empathy and compassion, and people may define this differently. Stuart says “Empathy means feeling what the patient feels — and staying emotionally centered. Compassion means standing unflinchingly with patients, letting them know that the clinician can tolerate the very situation they find intolerable — so perhaps, over time, they can too. This kind of silent courage is contagious.” Another way to define empathy as mature empathy is to see and witness the experience of the patient without feeling what they feel or distancing for protection. Compassion is, in part, about witnessing suffering and staying present and unflinching.

• Seeing through to the other side of despair.” Depression is a clinical syndrome that should be detected and treated, but despair is different. When people realize they are going to die, despair may be an inevitable response; clinicians can expect it, accept it and work with it. “


- Pat Justis, Washington State Department of Health