02 November 2009

Happily hopeless: chronically ill

Holding on to hope may not make patients happier as they deal with chronic illness or diseases.


Holding on to hope may not make patients happier as they deal with chronic illness or diseases, according to a new study by University of Michigan Health System researchers.

"Hope is an important part of happiness," said Peter A Ubel, director of the University of Michican Centre for Behavioural and Decision Sciences in Medicine, and one of the authors of the happily hopeless study, "but there's a dark side of hope. Sometimes, if hope makes people put off getting on with their life, it can get in the way of happiness."

The results showed that people do not adapt well to situations if they are believed to be short-term. Ubel and his co-authors studied patients who had new colostomies: their colons were removed and they had to have bowel movements in a pouch that lies outside their body.

At the time they received their colostomy, some patients were told that the colostomy was reversible — that they would undergo a second operation to reconnect their bowels after several months. Others were told that the colostomy was permanent and that they would never have normal bowel function again. The second group reported being happier over the next six months than those with reversible colostomies.

Getting on with life
"We think they were happier because they got on with their lives. They realized the cards they were dealt, and recognised that they had no choice but to play with those cards," says Ubel.

"The other group was waiting for their colostomy to be reversed," he added. "They contrasted their current life with the life they hoped to lead, and didn't make the best of their current situation."

The research was published in Health Psychology.

Co-author George Loewenstein said these results also may explain why people who lose a spouse to death often recover better emotionally over time than those who get divorced. "If your husband or wife dies, you have closure. There aren't any lingering possibilities for reconciliation," Loewenstein said.

Ubel said health professionals find it easier to deliver optimistic news to patients even when they believe the prognosis is unfavourable, justifying it by assuming that holding on to hope was better for the patient.

Said Loewenstein: "It may be easier for a doctor to deliver a hopeful message to a patient, even when there isn't much objective reason for hope, but it may not be best for the patient."

"Hopeful messages may not be in the best interests of the patient and may interfere with the patient's emotional adaptation," Ubel says. "I don't think we should take hope away. But I think we have to be careful about building up people's hope so much that they put off living their lives." - (EurekAlert!, November 2009)

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