Hope, Gratitude, and Spirituality--What They Mean to Patients with Cancer

Sonia Pacheco, MSW, LSW, LCSW, Hispanic Outreach Program Coordinator, CancerCare

As a social worker, I have come to understand the different ways patients redefine hope, gratitude, and spirituality after being diagnosed with cancer. I define hope as a belief that no matter how bleak things are at present, there is still reason for optimism and a belief it will get better; that what patients want can/will happen. Gratitude is being thankful for the things you have rather than focusing on the problems. Gratitude can change the way we deal with the world, promoting thoughts and behaviors that are supportive of those around us. In turn, gratitude inspires positive feelings of compassion and love, offering healing for ourselves.

I define spiritualty as the belief that there is something more powerful than ourselves to help us overcome adversity, and that our spirit is connected to a larger power. Newly-diagnosed patients with cancer search for understanding of what their life is going to be like in treatment and after it ends. During this time, they often reevaluate past experiences and worry about what their future might look like. I work with patients searching for stability, or what they once called normal, while struggling with the stress and crisis of cancer. During this journey, a new reality sets in, and what was once meaningful and important in life can suddenly change. Some patients struggle harder to hang onto who they were, and others find peace in letting go of control and opening up to what is often called “the new normal.” Those who let go, while remaining involved, often discover new meaning in life, which helps them move forward.

Throughout this process, I view my work as helping patients grieve the loss of who they were and help them to see that, while cancer might define who they are now, it will eventually become just a part of their life; with potential to strengthen their purpose or open the door to new possibilities of who they want to be. The cornerstone is reminding my clients of the importance of hope and helping them explore what it means to them.

In working with multi-cultural clients, as a bilingual social worker, I have the knowledge to help them look at spirituality, gratitude, and hope through their cultural lens and language. Multicultural clients have similar ways of coping, but different ways of viewing their situation: Rituals, disclosure, illness, and death are all shaped by our culture. Being bilingual, I find it fascinating to witness the many cross-cultural tools people use to help them survive a crisis of cancer and get to the place where they can ask: Where do I go from here? My reward comes in helping them explore hope as a way back home.

Helping patients to find a way back home and back to homeostasis, or peace, is my role. Using hope, spirituality, and gratitude, however they perceive them, provides a foundation to build on for the next steps to a new normal. In my work, I focus on helping patients first build on existing coping skills. I help them understand the process and educate them to the roles of everyone in the medical team, which is especially important for those whose primary language is not English. Perhaps most importantly, I provide a safe place to confront fears and resistance, often founded on old experiences with cancer or cultural connotations; remembering always that for each patient it is a process. Some come to the realization that no matter how much we try to control our lives, uncertainty is always there. In this process, many people I’ve worked with find new meaning in enjoying their life with family and friends. Others find new paths, or even change what wasn’t working before cancer. While in treatment and fighting for their lives, patients and caregivers can become overwhelmed. Hope and spirituality help get them through and define meaning. After treatment, gratitude helps put meaning into action.

There are many different ways of coping, and dealing with stress, traumatic events, and adversity; some destructive (alcohol, drugs) and others productive (prayer, exercise, meditation). The first is running away from the challenge. The second is confronting it. The first depletes your strengths. The second builds on them through a healthy mind and body. While the second is focused on surviving cancer and being hopeful, it also provides healthy tools for letting go of negative feelings such as anger, guilt, and sadness. Studies have shown positive actions lead to better outcomes, improved survival, and a reinvestment in the things that bring individuals joy in life. As a social worker, I know that normalizing feelings (good and bad) helps my patients deal with change.

At times, I see patients who lose their coping skills or they no longer work and they descend into depression and hopelessness. They lose interest in what was pleasing in the past, and find cancer has stolen their joy for life. They lose their sense of identity, which in turn, raises concerns among family and spouses who in turn become frightened of what they see in their loved ones. At these times, the whole family/friend system needs help to redefine who they are and how to discover new meaning in life. Social workers can use the same tools to help loved ones rely on hope and spirituality to find a way to gratitude and onto meaning sometimes by simply becoming role models for others.

I’ve discerned transition steps that can help those impacted by cancer move on with life:

• Helping explore what they are thankful for gives them respite from the struggle and can contribute to a more positive attitude; even if infrequent humor is an underestimated tool to challenge a negative mindset, even if self-deprecating, to make others in the room comfortable with your cancer.
• Prayer, whether religious or universal, can lead to a spiritual awakening.
• Recognizing none of this comes easy is important to validating the uncertainty patients and caregivers confront. Sometimes a healthy dose of denial can go a long way to providing respite from trauma.
• Looking at their life from a different perspective as a survivor, incorporating joyful events to stay aware of the positive things in life, and taking one day at a time to enjoy life with loved ones, family, and friends is so important for patients, and a gift they share with each other.

Nurses, doctors, social workers, and the rest of the medical team and facility staff at treatment centers have the ability to bring hope, gratitude, peace, and love, all part of spirituality—a force that recognizes us as individual human beings while keeping us connected as a community.