Modes of Hoping: Understanding Hope and Expectation in the Context of a Clinical Trial of Complementary and Alternative Medicine for Chronic Pain

Abstract

This article explores the role of hope in participants’ assessments of their expectations, experiences and treatment outcomes. Data analysis focused on semi-structured, open-ended interviews with 44 participants, interviewed 3-5 times each over the course of a study evaluating Traditional Chinese Medicine (TCM) for Temporomandibular Disorders (TMD, a form of chronic orofacial pain). Transcripts were coded and analyzed using qualitative and ethnographic methods. A “Modes of Hoping”1 framework informed our analysis. Five modes of hoping emerged from participant narratives: Realistic Hope; Wishful Hope; Utopian Hope; Technoscience Hope; and Transcendent Hope. Using this framework, hope is demonstrated as exerting a profound influence over how participants assess and report their expectations. This suggests that researchers interested in measuring expectations and understanding their role in treatment outcomes should consider hope as exercising a multifaceted and dynamic influence on participants’ reporting of expectations and their experience and evaluation of treatment.

Ways of Hoping: Navigating the Paradox of Hope and Despair in Chronic Pain

“…We found no such pattern, however, and were faced with a conundrum of how to make sense of varied response and expressions of surprise or disappointment that seemed unrelated to either initial expectations or the reported “outcome” of TCM treatment in terms of pain relief. Further, as has been reported in other studies of expectations, participants were often forthcoming with expressing hopes, but reluctant to voice expectations (Eaves, et al, 2014b; Kaptchuk, et al, 2009; Stone, et al, 2005). Helen, below, explained that her expectations were low but she had hopes before starting treatment.…”

“…Multiple ways of hoping are key features in the work of both being hopeful—a balancing act required for daily coping and seeking treatment—and appearing to be hopeful—living up to the often conflicting expectations of significant others and cultural ideals (see also Eaves et al 2014b for a preliminary typology). For heuristic purposes, we have divided hope into overarching categories.…”

New perspectives on patient expectations of treatment outcomes: results from qualitative interviews with patients seeking complementary and alternative medicine treatments for chronic low back pain

“…Further, hopes may be a central factor in determining how patients assess and report their expectations, although this factor has been inadequately considered in research on patient expectations [21–23]. …”

Works of Illness and the Challenges of Social Risk and the Specter of Pain in the Lived Experience of TMD

“…5 Too much information could undermine one’s ability to hope and to live “in the subjunctive mode” (Good and DelVecchio Good 1991; Simpson 2004). Participants worked to remain hopeful and “open” to the future by focusing on daily existence and not on prognosis (Eaves et al 2014). …”