Open Access Research article

Hope against hope: exploring the hopes and challenges of rural female caregivers of persons with advanced cancer

Allison Williams1*, Wendy Duggleby2, Jeanette Eby1, Reverend Dan Cooper3, Lars K Hallstrom4, Lorraine Holtslander5 and Roanne Thomas6

Author Affiliations

1 School of Geography and Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4 K1, Canada

2 Nursing Research Chair Aging and Quality of Life, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, University of Alberta, Edmonton, AB T6G 1C9, Canada

3 Palliative Care Services, Regina Qu'Appelle Health Region, 410w Dewdney Ave, Regina, SK S4T 1A5, Canada

4 Alberta Centre for Sustainable Rural Communities (ACSRC), Political Studies (Augustana Faculty) and REES (ALES), University of Alberta, 2-135 Augustana Forum, Edmonton, AB T4V 2R3, Canada

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

6 Qualitative Health Research with Marginalized Populations, School of Rehabilitation Sciences, 451 Smyth Road (3068), Ottawa, ON K1H 8 M5, Canada

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BMC Palliative Care 2013, 12:44  doi:10.1186/1472-684X-12-44

Published: 17 December 2013



This paper focuses on the qualitative component of a study evaluating a hope intervention, entitled Living with Hope Program (LWHP), designed to foster hope in female caregivers of family members living with advanced cancer. The purpose of this research is to share, in the form of a story, the experiences of rural female caregivers caring for family members with advanced cancer, focusing on what fosters their hope. Hope is a psychosocial and spiritual resource that has been found to help family caregivers live through difficult transitions and challenges.


Twenty-three participants from rural Western Canada completed daily journal entries documenting their hopes and challenges. Cortazzi’s (2001) method of narrative analysis was used to analyze the data, which was then transcribed into a narrative entitled ‘hope against hope.’


The journal entries highlighted: the caregivers’ hopes and what fostered their hope; the various challenges of caregiving; self-care strategies, and; their emotional journey. Hope was integrated throughout their entire experience, and ‘hope against hope’ describes how hope persists even when there is no hope for a cure.


This research contributes to the assessment of caregiver interventions that impact hope and quality of life, while illustrating the value of a narrative approach to both research and practice. Journaling may be particularly valuable for rural caregivers who are isolated, and may lack direct professional and peer support. There is an opportunity for health professionals and other providers to foster a relationship of trust with family caregivers, in which their story can be told openly and where practitioners pay closer attention to the psychosocial needs of caregivers.

Hope; Palliative and end of life care; Caregiving; Rural; Narrative research