A Context for Hope in Evidence-Based Care
Is "hope" the most taboo word in mainstream medicine?
Tuesday, May 26, 2015
by: Robert Kachko, ND, LAc

Section: Healthy Aging

About Dr. Robert Kachko

Robert Kachko, ND, LAc is a Naturopathic Doctor and Licensed Acupuncturist at InnerSource Health in New York City. He proudly serves on the Board of Directors of the American Association of Naturopathic Physicians (AANP) and takes an active role in the New York Association of Naturopathic Physicians (NYANP). He graduated Summa Cum Laude with a Doctoral Degree in Naturopathic Medicine and a Masters Degree in Acupuncture from the University of Bridgeport College of Naturopathic Medicine and Acupuncture Institute. He has completed an additional 2 year course of study in Classical Homeopathy at the New England School of Homeopathy. He completed his pre-medical studies with a Bachelor's Degree with honors at the University of Wisconsin, Madison.

Dr. Kachko believes in the importance of expanding access to Naturopathic Medicine and Acupuncture for all patients. At the College of Naturopathic Medicine, he was founding President of the expanded local chapter of the Naturopathic Medical Student Association (NMSA) and received the prestigious award for Outstanding Service to the Profession.

To learn more about Dr. Kachko, please visit him on Facebook and www.innersourcehealth.com/Robert-Kachko.
As I sit here and ponder the nature of the role that hope plays in daily medical practice, the ever-rational and categorically determined left hemisphere of my brain demands a clinically relevant literature review on the subject. Appropriately, as I realize that there’s at the moment very little to be found, the creative and intuitive right hemisphere plays the role of care-taker to its traditionally less remitting counterpart: reminding my collectively conscious mind that just because we don’t yet understand the mechanism by which some reality exists doesn’t exclude it from existence. Those who feel comfortable speaking (and writing) about the nature of hope in the patient encounter risk sounding non-scientific. The prevailing view, mostly by omission of critical thought, is that accepting what we cannot yet fully explain equates to blind faith. As a clinician who takes to heart the suffering of my patients no matter the brand of faith they subscribe to, I feel it important to explore the subject.
Hope, if we are lucky, is our most formidable ally in the struggle against fear. This is fortunate, as we tend to rely upon it in the most fearful moments of our lives. In Man’s Search for Meaning, Viktor Frankl details his experience in the Nazi concentration camps from two very different perspectives: as prisoner and as psychiatrist-researcher who’s just written an academic manuscript based on his own research. This unique position allowed him to observe, in keeping with his theory of psychotherapy (which he had coined Logotherapy – from the Greek logos or meaning), that those prisoners who were able to maintain some semblance of meaning in their lives were the most likely to survive. For Frankl, publishing his life’s work became the ultimate source of hope in the face of unimaginable circumstance.
Hope allows us the necessary leap of faith to push the boundaries of our current reality and to forge a new path. In this way, it’s a concept hard-wired into our evolutionary development and a requirement for the survival of our species.
It is no surprise, then, that maintaining hope in the context of chronic disease affords a very real survival advantage. Perhaps even better still is the relatively new understanding that we can induce a hopeful and optimistic reality by simply wishing it so: researchers have discovered that smiling, even if inauthentic, permeates our perspective and illuminates our experience. In one study, those who were asked to force a smile reported a more positive experience when presented with the same images and videos than those who were not.[i] 
Logotherapy is a unique approach to psychotherapy as it guides the clinician to walk hand in hand with their patient in rediscovering life’s meaning and the hopeful outlook which is born out of that meaning. A group of researchers tested this hypothesis in women with breast cancer, and discovered that meaning-based therapy reduced somatization, depression, anxiety, and hostility.[ii] In times of need, a person’s support system may become their guiding light to recovery. In one study, quality of life was significantly improved for cancer patients when either they or their family members engaged in “group meaning-centered hope therapy”.[iii] In one small but statistically significant study of 40 patients with cancer, group logotherapy improved overall life expectancy.[iv]
We live in an era where the phrase “patient centered care” has been nearly wrung dry in the service of healthcare related socio-political progress. In order to stay true to the rhetoric though, our job as clinicians is to foster an environment which supports rather than rejects the role of self-reflection in the patient experience. This is the new definition of being on the cutting edge, and as the body of available research grows I suspect that the concept will no longer be reduced to the blind faith of those with nothing left to lose.

[i] Soussignan, R. Duchenne smile, emotional experience, and autonomic reactivity: A test of the facial feedback hypothesis. Emotion, 2002;2(1):52-74.
[ii] Garfami H, Shafi Abadi A, Sanai Zaker B. Effectiveness of group logo therapy in reducing
symptoms of mental health problems in women with breast cancer. Andisheh va Raftar. 2009; 4(13):35-42
[iii] Farhadi M, Reisi-Dehkordi N, Kalantari M, Zargham-Boroujeni A. Efficacy of group meaning centered hope therapy of cancer patients and their families on patients’ quality of life. Iranian Journal of Nursing and Midwifery Research. 2014;19(3):290-294.
[iv] Hoseinyan E, Soudani M, Mehrabizadeh Honarmand M. Efficacy of group logotherapy on cancer patients' life expectation. Journal of Behavioral Sciences. 2010; 3(4):287-92.
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