” Other influences on the participants’ hope included the specific circumstances of each day, social support and faith and spirituality, Specific

circumstances such as accessing health care was a theme found in all the journals the participants lived in rural areas, travel to obtain health care added to their stress and decreased their hope. For example one participant described her day: “have to spend the whole day driving 6 hours & waiting 3 for chemo & then a doctor’s appointment after that. It’s a hard job & it’s hard to stay calm till we’re all done”. Financial stress was evident as well: “have been Inhibitors,research,lifescience,medical paying bills – bills – bills – it is very hard to be hopeful” As well the caregivers’ level of hope was influenced by the mood of the care recipient and the care receiver’s state of health. For example one participate wrote: “He is confused and it hurts so much to hear him!” Social support was described as fostering

Inhibitors,research,lifescience,medical hope, whether this was support from family members, friends or health professionals such as Inhibitors,research,lifescience,medical doctors and nurses. For example as one participant wrote: “We have such wonderful friends and family. They bring PF-04691502 nmr supper almost every day.” This support, brought hope to their day and to their lives. Some participants also found hope through their faith and spirituality. The belief in something bigger than them was experienced as supportive. For example, one participant wrote: “I know God is in charge & we have to trust him, his ways are not always the way we want them to be”. The findings of the full narrative analysis of the qualitative Inhibitors,research,lifescience,medical data was submitted for publication in a separate

manuscript. Discussion The study findings suggest that the Living with Hope Program shows promise in increasing hope in rural women caregivers of persons with advanced cancer after one week compared to baseline scores. Several hope focused interventions have been found to be effective in fostering hope Inhibitors,research,lifescience,medical in other populations such as persons with advanced cancer [16], recurrent cancer [36] and newly diagnosed cancer patients [37]. A recent review of intervention studies for caregivers of persons with cancer, however, did not identify any psychosocial hope focused interventions [38]. Thus the Living with Hope Program is unique and may address this gap in knowledge. Changes in the hope score occurred at day 7 and 12 months. Although Etomidate the sample size was small, there is the possibility that the Living with Hope Program has a short effect and does not have an impact over time. In Herth’s [17] evaluation of a hope intervention for persons with recurrent cancer, there were significant positive changes in hope and quality of life over time (3, 6 and 12 months). Herth’s intervention consisted of eight two hour hope focused interventions with a skilled health care professional over an eight week time period.