False Hope

In my December 25th Oncology Times column I discuss false hope. Here's a brief excerpt, with paragraphs rearranged for clarity:

Imagine I splay out a full deck of cards face down and promise to give you 50 bucks if you pick a queen. Oblige me and pull one card, knowing your chance of success is ~8%. If you experience a pleasurable feeling in association with your belief that turning over the card might make you richer, you have hope.

Now keep the setup the same, except I inform you that I've removed all four queens. Once again oblige me by pulling a card from the deck. If you're not convinced of my claim about the missing queens, you can feel hopeful of winning the cash. Your subjective experience of hope may feel exactly the same as before. But since your pleasurable feeling is linked to an erroneous belief, this time you are experiencing false hope....

To detect false hope, scrutinize the foundation of patients' beliefs regarding their chance for the desired outcome. Patients who anchor their belief in facts nurture healthy, life-enhancing hope. In contrast, those who base their belief on inaccurate information or wishful thinking foster false hope.

False hope can lead patients away from wise treatment decisions that reflect patients' values and priorities. Thus false hope can strip patients of dignity, meaningfulness, comfort and joy that are possible at the end of life.

Click here to read why patients may nourish false hope and how Healthy Survivors can address it.

Comments

[Bill Kleine]

Thank you for your clarity. It reminds me of the sadness I feel when I see people forgo treatments with the potential to help them because of the false fear. Sure, cancer treatments can be tough. There is no easy way to kill these cells. Just look at how awful our own immune system makes us feel, and all it has to do is kill things that obviously don't belong in our body. Chemotherapies have to somehow kill our own, but terribly confused cells without damaging too many of their close cousins. I make it a habit to tell folks, if you really can't stand this or that chemo, you can quit it--the doctor may very well have an alternative.

I once read an article in a medical journal that defined "false hope" quite differently. It chided doctors for offering patients treatments when their cancers were "too" advanced, which they claimed would lead to "needless suffering". Sort of like my original surgeon's advice that I go home and prepare a will. I have remained alive 20 years through such interventions.

[Wendy S. Harpham, MD]

Dear Bill,

The problem, of course, is knowing if there is any realistic chance of success when treating advanced cancer and if the price of trying is worth it to an individual. Your surgeon's remarks suggest (s)he felt you had no chance of recovery, while the oncologist who treated you disagreed, believing you did have a chance, however small.

One Healthy Survivor may decline toxic therapy for a 1% chance of recovery while another Healthy Survivor may be willing to suffer treatment and aftereffects for that same 1% chance. Both these patients are making wise decisions if these decisions are in keeping with their values and outlook.