The Importance of Hope as a Mediator of Psychological Distress and Life Satisfaction in a Community Sample of Cancer Patients

Tone Rustøen, PhD, RN; Bruce A. Cooper, PhD; Christine Miaskowski, PhD, RN, FAAN


Cancer Nurs. 2010;33(4):258-67. 

In This Article

Abstract and Introduction


Background: Although hope is an important resource for cancer patients, few studies include it as an independent or dependent variable in quality-of-life research.
Objective: The purposes of this study, in a community-based sample of cancer patients, were to evaluate the relationships between demographic and clinical characteristics, health status, hope, psychological distress, and life satisfaction and evaluate whether hope mediated the relationship between psychological distress and life satisfaction.
Methods: Participants (n = 194) completed a demographic and clinical questionnaire, a single item of self-assessed health, the Herth Hope Index, Impact of Event Scale, and a single-item rating of satisfaction with life. Structural regression models were examined to evaluate the interrelationships among these variables, with life satisfaction as the primary outcome.
Results: Participants were primarily women with breast cancer. In the final structural regression model that explained 60% of the variance in life satisfaction, poorer health status, lower hope, and higher psychological distress were significantly related to lower satisfaction with life. Hope was found to mediate the relationship between psychological distress and health status, such that the direct association between distress and health status was no longer significant with hope in the model. Finally, hope partially mediated the association between psychological distress and life satisfaction.
Conclusions: These data suggest that hope is an important resource for oncology patients that impacts their quality of life.
Implications for Practice: Hope may be an important coping mechanism that clinicians need to consider when they try to help patients reduce the psychological distress associated with cancer and its treatment.


The evaluation of quality of life (QOL) has become an important outcome variable in oncology research. In fact, the National Cancer Institute in the United States emphasized the need to evaluate a variety of patient-reported outcomes including QOL to better understand the impact of cancer and its treatment from patients' perspectives.[1]

Cancer patients experience a variety of physical and psychological effects from their disease and its treatment.[2] Physical impairments can have a sustained impact on patients' ability to function and decrease their QOL. In addition, psychological distress can result in chronic mood disturbances and decreases in QOL. These psychological responses can be influenced by patients' perceptions of stress and burden, as well as by the resources available to them to cope with their cancer.[2] Hope is considered to be a significant resource for newly diagnosed patients,[3,4] as well as for those with a recurrent disease[5] or those in the terminal stages of cancer.[5,6] However, the relationships between hope, psychological distress, and QOL have not been evaluated in detail in cancer patients.

In the conceptual model of QOL proposed by Wilson and Cleary[7] and revised by Ferrans and colleagues,[8] physiological and psychological factors, symptom status, functional health, and general health perceptions are proposed as key factors that impact an individual's overall QOL. This model was used to guide the conceptualization of the variables that are tested in this study. We hypothesized that various demographic and clinical factors would have an impact on patients' health status and that health status, hope, and psychological distress would affect a person's QOL (measured in this study as life satisfaction). The specific purpose of this study was to evaluate the relationships between demographic and clinical characteristics, self-assessed health, hope, psychological distress, and life satisfaction in a sample of cancer patients who initiated contact for a self-experienced need to the Norwegian Cancer Society (NCS). A summary of some of the literature that supports the modeling of these relationships is highlighted below.