The Relationship of Hope to Goals and Psychological Outcomes in Patients with Advanced Lung Cancer: A Test of Hope Theory

Background. Hope is an important positive psychological construct that may help to explain how individuals cope in the context of life-threatening illness. Snyder’s hope theory states that humans are goal-oriented, and that goals link hope to psychological outcomes. The purpose of the current study was to investigate the relationship of hope to emotional well-being, meaning and purpose in life, and positive and negative affect in a sample of patients with advanced stage lung cancer. The study also sought to identify how hope relates to patients’ goals and to explore whether goal characteristics and progress in achieving goals mediated the relationship between hope and emotional well-being. Methods. Patients receiving first-line treatment for advanced stage lung cancer were recruited from the Moffitt Cancer Center Thoracic Oncology Clinic to participate in a mixed methods study. Participants completed questionnaires including measures of hope (Adult Hope Scale), emotional well-being (FACT-L emotional well-being subscale), meaning and purpose in life (PROMIS meaning and purpose scale), and positive and negative affect (PANAS) at baseline (Time 1) and approximately one month later (Time 2). At Time 1 participants also underwent in a semi-structured interview to elicit patient goals and characteristics of their goals (e.g., perceived attainability, perceived control over reaching goals, anticipated progress in the short-term); at Time 2 participants also underwent a brief follow-up interview about perceived progress toward goals, actions in relation to goals, and barriers to progress. Results. Participants (N = 75, M age = 65.14 years, 59% female) endorsed high levels of hope thinking, with values comparable to other samples of patients with advanced cancer. As expected, hope was positively correlated with meaning and purpose in life and positive affect. Contrary to predictions, hope was not correlated with emotional well-being or negative affect. Consistent with hope theory, hope was positively correlated with goal characteristics (e.g., perceived attainability, perceived control over reaching goals), and these characteristics were associated with psychological outcome variables in the anticipated direction (e.g., emotional well-being, meaning and purpose in life, positive and negative affect). Two goal characteristics (perceived attainability, perceived control over reaching goals) mediated the relationship between hope at Time 1 and emotional well-being at Time 1; reverse mediation analyses did not yield evidence of mediation. Perceived progress toward goals over the follow-up period did not mediate the relationship between hope at Time 1 and emotional well-being at Time 2. Conclusions. Findings confirming predictions about the relationships among hope, goal characteristics, and psychological outcomes warrant replication and extension in larger samples of patients with advanced stage lung cancer using longer, longitudinal follow-up windows