Open Access Open Badges Research article

Evaluation of the living with hope program for rural women caregivers of persons with advanced cancer

Wendy Duggleby1*, Allison Williams2, Lorraine Holstlander3, Dan Cooper4, Sunita Ghosh5, Lars K Hallstrom6, Roanne Thomas McLean7 and Mary Hampton8

Author Affiliations

1 Nursing Research Chair Aging and Quality of Life, Faculty of Nursing University of Alberta, 3rd Level ECHA 11403 87th Ave, Edmonton, AB T6G 1C9, Canada

2 CIHR ECHO/IGH Mid Career Scientist, School of Geography and Earth Sciences, McMaster University, 1280 Main Street, West Hamilton ON L8S 4K1, Canada

3 College of Nursing, University of Saskatchewan, Office Rm 343 Ellis Hall 107 Wiggins Rd, Saskatoon, SK S7N5E5, Canada

4 RQHR Palliative Care Services, Clinical Practice Leader (Spiritual Care), Spiritual Care Educator, Research, QI and Special Projects Manager, 4F - 4101 Dewdney Ave, Regina, SK S4T 1A5, Canada

5 Medical Oncology, University of Alberta, Cross Cancer Institute, 11560 - University Ave NW, Edmonton, AB T6G 1Z2, Canada

6 University of Alberta, Augustana Campus, Room 2-134 Augustana Forum, 4901-46 Ave, Camrose, AB T4V 2R3, Canada

7 Chaire de recherche du Canada, Professeure agrégée, École des sciences de la réadaptation Université d'Ottawa, Guindon Hall, Room 3068, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada

8 Psychology, Luther College, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada

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BMC Palliative Care 2013, 12:36  doi:10.1186/1472-684X-12-36

Published: 9 October 2013



Hope has been identified as a key psychosocial resource among family caregivers to manage and deal with the caregiver experience. The Living with Hope Program is a self-administered intervention that consists of watching an international award winning Living with Hope film and participating in a two week hope activity (“Stories of the Present”). The purpose of this study was to examine the effects of the Living with Hope Program on self-efficacy [General Self-Efficacy Scale], loss and grief [Non-Death Revised Grief Experience Inventory], hope [Herth Hope Index] and quality of life [Short-Form 12 version 2 (SF-12v2)] in rural women caring for persons with advanced cancer and to model potential mechanisms through which changes occurred.


A time-series embedded mixed method design was used, with quantitative baseline outcome measures repeated at day 7, day 14, and 3, 6 and 12 months. Qualitative data from the hope activity informed the quantitative data. Thirty-six participants agreed to participate with 22 completing all data collection. General estimating equations were used to analyze the data.


Herth Hope Index scores (p=0.05) had increased significantly from baseline at day 7. General Self Efficacy Scale scores were significantly higher than baseline at all data time points. To determine the mechanisms of the Living with Hope Program through which changes occurred, results of the data analysis suggested that as General Self Efficacy Scale scores increased (p<0.001) and Non-death Revised Grief Experience Inventory scores decreased (p=0.01) Herth Hope Index scores increased. In addition as Herth Hope Index scores increased (p<0.001) and Non-death Revised Grief Experience Inventory scores decreased (p=0.01), SF-12v2 mental health summary scores increased. Qualitative data suggested that through the hope activity (Stories of the Present) the participants were able to find positives and hope in their experience.


The Living with Hope Program has potential to increase hope and improve quality of life for rural women caregivers of persons with advanced cancer. The possible mechanisms by which changes in hope and quality of life occur are by decreasing loss and grief and increasing self-efficacy.

Trial registrations

Registration, NCT01081301.

Hope; Caregivers; Palliative care; Intervention