Study: Chronically ill may be happier by giving up hope
Study: Chronically ill may be happier by giving up hope
Research focused on colostomy patients
Much attention has been focused in the past on the role of hope in healing or in dealing with a terminal illness.
But a new study by researchers at the University of Michigan Health System found that hope is not always a positive, specifically when dealing with patients who are chronically ill.
Titled "Happily Hopeless: Adaptation to a Permanent, But Not to a Temporary, Disability," the study looked at patients who had new colostomies — i.e., their colons were removed, and they were required to have bowel movements in a pouch located outside the body.
At the time of their procedure, some patients were told that the colostomy was reversible and that they would undergo a separate operation to reconnect their bowels after several months. However, the second group was told that their colostomy was permanent and that they would never have normal bowel function again.
In the study results, those presumably without hope of returning to normal functioning reported being happier than those who had expectations of returning to normal functioning.
"They showed quite a bit of resilience, which is exactly what we expected, because people are often amazingly resilient," Peter A. Ubel, MD, tells Medical Ethics Advisor. "When they're given adversity, they find a way to cope with it.
"But the group with the temporary colostomy, who kept knowing that, 'Someday, I won't have to deal with this anymore, my bowels will be reconnected, and I won't have to wear this terrible pouch again,' — they did not bounce back."
Ubel says while a great deal of research has been conducted on topics such as optimism, in the current study, he and his colleagues were focused on the "characteristic of a situation," rather than "a characteristic of a person."
"The optimist is going to thrive more than the pessimist," he notes. "So, they're different people, given the same situation. And optimism is a good thing.
"We didn't have that in our study — [there were] different circumstances. In our group, they were told different things, and so what we're studying is what do these different circumstances mean for well-being? And specifically, is this the kind of hope that makes it easier for you to kind of put your life on hold?
"Does that kind of hope then, potentially, impede happiness," he says.
Implications for doctor-patient communications
Ubel notes that their study has implications for physician-patient communication, although it's still unproven how well any communication strategies might work.
"In this exact situation, for example, I think it means we need to really attend very carefully to those people we objectively say are better off — 'it's just temporary,'" Ubel says. "Maybe we don't worry about them as much, because we know they'll eventually get out of this situation. In fact, early on, we should worry about that group more."
"The other kind of implications are: We have to be aware that sometimes when we, as clinicians, try to give our patients hope, we have to be aware that [this] could get in their way of them accepting their current circumstances.
"And so, if we can find a way to balance hope and acceptance, maybe our patients will do better," Ubel says.
While the implications are less direct for the role of hope in end-of-life care, in his experience, Ubel says he sees many time where "people are so desperate to cling for any hope of a cure."
Despite evidence to the contrary, i.e., every possible treatment and still, perhaps, a tumor is getting larger, "I see patients who then look for that new experimental treatment. Salvage chemotherapy — they're desperate for this.
"I understand that need to keep trying something, but those people often then aren't . . . coming to grips with their likely fate, and I think that causes them to suffer," Ubel says.
Source
- Peter A. Ubel, MD, Director, University of Michigan Center for Behavioral and Decision Sciences in Medicine. University of Michigan, Ann Arbor. MI. E-mail: [email protected].
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