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How should realism and hope be combined in physician–patient communication at the end of life? An online focus-group study among participants with and without a Muslim background

  • Mariska G. Oosterveld-Vlug (a1), Anneke L. Francke (a1) (a2), H. Roeline W. Pasman (a1) and Bregje D. Onwuteaka-Philipsen (a1)



Maintaining false hope may result in prolonged curative aggressive treatments until the very last stage of life. In this study, we sought to explore how people think that realistic and hopeful information should best be combined in physician–patient communications at the end of life.


During a period of 15 days, participants of five online focus groups (OFGs) could log in onto a closed discussion site and offer responses to several topics. A variety of people participated: patients, older people, relatives, and healthcare professionals with and without a Muslim background. Participants with a Muslim background constituted a separate group, because previous research indicated that they might have distinct views on good end-of-life care and communication. Transcripts were analyzed following the principles of thematic analysis.


Participants from all focus groups preferred that physicians provide realistic information in an empathic way, stating that the patient would never be left on his own and that withholding curative treatment was not equal to withholding care, explicitly asking how the patient could be helped during the time remaining, and involving other professionals in the care process and communications. As such, physicians could support patients' transition from “hope for a cure” to “hope for a good death.” Muslims specified the way they wished to receive realistic information: first from a relative, and not by using the term “incurable illness,” but rather by informing the patient that they had no remaining curative treatments available.

Significance of results:

Realism and hope are not necessarily mutually exclusive and can be combined when providing realistic information in a delicate and culturally sensitive way. This study provides suggestions on how physicians can do so. Communication skills training as well as anchoring knowledge of the diversity of cultural and religious views into physicians' education could improve end-of-life communication.


Corresponding author

Address correspondence and reprint requests to Mariska G. Oosterveld-Vlug, VU University Medical Center, Department of Public and Occupational Health, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. E-mail: or


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Back, A.L., Arnold, R.M. & Quill, T.E. (2003). Hope for the best, and prepare for the worst. Annals of Internal Medicine, 138(5), 439443. Available from
Benzein, E., Norberg, A. & Saveman, B. (2001). The meaning of the lived experience of hope in patients with cancer in palliative home care. Palliative Medicine, 15(2), 117126.
Boyatzis, R.E. (1998). Transforming qualitative information: Thematic analysis and code development. Thousand Oaks, CA: Sage.
Buiting, H.M., Rurup, M.L., Wijsbek, H., et al. (2011). Understanding provision of chemotherapy to patients with end stage cancer: Qualitative interview study. BMJ, 342, d1933. Available from
Chen, A.B., Cronin, A., Weeks, J.C., et al. (2013). Expectations about the effectiveness of radiation therapy among patients with incurable lung cancer. Journal of Clinical Oncology, 31(21), 27302735. Available from
Clayton, J.M., Butow, P.N., Arnold, R.M., et al. (2005). Fostering coping and nurturing hope when discussing the future with terminally ill cancer patients and their caregivers. Cancer, 103(9), 19651975. Available from
Clayton, J.M., Hancock, K., Parker, S., et al. (2008). Sustaining hope when communicating with terminally ill patients and their families: A systematic review. Psycho-Oncology, 17(8), 641659.
Curtis, J.R., Wenrich, M.D., Carline, J.D., et al. (2002). Patients' perspectives on physician skill in end-of-life care: Differences between patients with COPD, cancer and AIDS. Chest, 122(2), 356362.
Curtis, J.R., Engelberg, R., Young, J.P., et al. (2008). An approach to understanding the interaction of hope and desire for explicit prognostic information among individuals with severe chronic obstructive pulmonary disease or advanced cancer. Journal of Palliative Medicine, 11(4), 610620.
de Graaff, F.M., Francke, A.L., van den Muijsenbergh, M.E.T.C., et al. (2010). “Palliative care”: A contradiction in terms? A qualitative study of cancer patients with a Turkish or Moroccan background, their relatives and care providers. BMC Palliative Care, 9, 19. Epub ahead of print Sep 10. Available from
de Graaff, F.M., Mistiaen, P., Devillé, W.L., et al. (2012 a). Perspectives on care and communication involving incurably ill Turkish and Moroccan patients, relatives and professionals: A systematic literature review. BMC Palliative Care, 11(1), 17. Available from
de Graaff, F.M., Francke, A.L., van den Muijsenbergh, M.E.T.C., et al. (2012 b). Talking in triads: Communication with Turkish and Moroccan immigrants in the palliative phase of cancer. Journal of Clinical Nursing, 21(21–22), 31433152.
de Haes, H. & Koedoot, N. (2003). Patient-centered decision making in palliative cancer treatment: A world of paradoxes. Patient Education and Counseling, 50(1), 4349.
Hagerty, R.G., Butow, P.N., Ellis, P.M., et al. (2005). Communicating with realism and hope: Incurable cancer patients' views on the disclosure of prognosis. Journal of Clinical Oncology, 23(6), 12781288. Available from
KNMG (Royal Dutch Medical Association), Stuurgroep Passende zorg in de laatste Levensfase (2015). Rapport: Niet alles wat kan, hoeft [Report: Not everything possible needs to be done] [in Dutch]. Utrecht, The Netherlands: KNMG.
Lin, H.R. & Bauer-Wu, S.M. (2004). Psycho-spiritual well-being in patients with advanced cancer: An integrative review of the literature. Journal of Advanced Nursing, 44(1), 6980.
Mattes, M.D. & Sloane, M.A. (2015). Reflections on hope and its implications for end-of-life care. Journal of the American Geriatrics Society, 63(5), 993996. Epub ahead of print May 4.
McClement, S.E. & Chochinov, H.M. (2008). Hope in advanced cancer patients. European Journal of Cancer, 44(8), 11691174. Epub ahead of print Mar 21.
Oksüzoğlu, B., Abali, H., Bakar, M., et al. (2006). Disclosure of cancer diagnosis to patients and their relatives in Turkey: Views of accompanying persons and influential factors in reaching those views. Tumori, 92(1), 6266.
Olsman, E., Leget, C., Onwuteaka-Philipsen, B.D., et al. (2014). Should palliative care patients' hope be truthful, helpful or valuable? An interpretative synthesis of literature describing healthcare professionals' perspectives on hope of palliative care patients. Palliative Medicine, 28(1), 5970. Epub ahead of print Apr 15, 2013.
Olsman, E., Willems, D.L. & Leget, C. (2015). Solicitude: Balancing compassion and empowerment in a relational ethics of hope. An empirical–ethical study in palliative care. Medicine, Health Care, and Philosophy, 19(1), 1120. Available from
Olver, I.N. (2005). Bioethical implications of hope. In Interdisciplinary perspectives on hope. Elliott, J. (ed.), pp. 241256. New York: Nova Science.
Ozdogan, M., Samur, M., Bozcuk, H.S., et al. (2004). “Do not tell”: What factors affect relatives' attitudes to honest disclosure of diagnosis to cancer patients? Supportive Care in Cancer, 12(7), 497502. Epub ahead of print Apr 16.
Ozdogan, M., Samur, M., Artac, M., et al. (2006). Factors related to truth-telling practice of physicians treating patients with cancer in Turkey. Journal of Palliative Medicine, 9(5), 11141119.
Pattison, N.A. & Lee, C. (2011). Hope against hope in cancer at the end of life. Journal of Religion and Health, 50(3), 731742. Epub ahead of print Jun 16, 2009.
Robinson, C.A. (2012). “Our best hope is a cure”: Hope in the context of advance care planning. Palliative & Supportive Care, 10(2), 7582. Epub ahead of print Feb 24.
Rustoen, T. (1995). Hope and quality of life, two central issues for cancer patients: A theoretical analysis. Cancer Nursing, 8(5), 355361.
Spiegel, W., Zidek, T., Maier, M., et al. (2009). Breaking bad news to cancer patients: Survey and analysis. Psycho-Oncology, 18(2), 179186. Epub ahead of print Aug 1, 2008.
Tates, K., Zwaanswijk, M., Otten, R., et al. (2009). Online focus groups as a tool to collect data in hard-to-include populations: Examples from paediatric oncology. BMC Medical Research Methodology, 9, 15. Available from
van Vliet, L.M. (2013). Balancing explicit with general information and realism with hope: Communication at the transition to palliative breast cancer care. Doctoral dissertation. Utrecht, The Netherlands: Netherlands Institute for Health Services Research.
van Vliet, L., Francke, A., Tomson, S., et al. (2013). When cure is no option: How explicit and hopeful information can be given? A qualitative study in breast cancer. Patient Education and Counseling, 90(3), 315322. Epub ahead of print May 8, 2013.
Weeks, J.C., Catalano, P.J., Cronin, A., et al. (2012). Patients' expectations about effects of chemotherapy of advanced cancer. The New England Journal of Medicine, 367(17), 16161625. Available from
Zwaanswijk, M. & van Dulmen, S. (2014). Advantages of asynchronous online focus groups and face-to-face focus groups as perceived by child, adolescent and adult participants: A survey study. BMC Research Notes, 7, 756. Available from



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