Rethinking hopelessness and the role of spiritual care when cure is no longer an option.

Increasingly in the U.S., health care clinicians fail to recognize and accept when curative goals are no longer realistic. At this point, futile efforts at cure can fuel false hopes in patients and their loved ones. The clinician's need to be "doing something" may result in treatment that violates the dignity and well-being of the patient and this can lead to the patient's ultimate hopelessness and despair. This article uses a personal narrative to explore the hopelessness of a patient diagnosed with nonresectable pancreatic cancer and the challenge it raised for the author, who was a friend and a nurse to the patient. Hope is described as a virtue that takes as its object "a future good, difficult but possible to obtain," and that sits squarely between false hopes and despair. Spiritual care that addresses three universal spiritual needs (meaning and purpose, love and relatedness, and forgiveness) is recommended as a valuable intervention to address hopelessness.