The effectiveness of hope-fostering interventions in palliative care: A systematic review and meta-analysis.

Abstract

The concept of hope is an important theme in chronic illness and palliative care and has been associated with increased psycho-spiritual well-being and quality of life. Psycho-spiritual interventions have been described in this population, but no systematic review of hope-enhancing interventions or hopelessness-reducing interventions has been conducted for persons with palliative care diseases. To describe and assess the effectiveness of interventions in palliative care that measure hope and/or hopelessness as an outcome. This systematic review and meta-analysis was pre-registered (Prospero ID: CRD42019119956). Electronic databases, journals, and references were searched. We used the Cochrane criteria to assess the risk of bias within studies. Thirty-five studies (24 randomized controlled trials, 5 quasi-experimental, 6 pre-post studies) involving a total of 3296 palliative care patients were included. Compared with usual/standard cancer care alone, interventions significantly increased hope levels at a medium effect size (<i>g</i> = 0.61, 95% confidence interval (CI) = 0.28-0.93) but did not significantly reduce hopelessness (<i>g</i> = -0.08, 95% CI = -0.18 to 0.02). It was found that interventions significantly increase spirituality (<i>g</i> = 0.70, 95% CI = 0.02-1.37) and decrease depression (<i>g</i> = -0.29, 95% CI = -0.51 to -0.07), but had no significant effect over anxiety, quality of life, and symptom burden. Overall, quality of evidence across the included studies was rated as low. Evidence suggests that interventions can be effective in increasing hope in palliative care patients.