Mammographic features and screening outcome in a randomized controlled trial comparing digital breast tomosynthesis and digital mammography.

PURPOSE: To compare the distribution of mammographic features among women recalled for further assessment after screening with digital breast tomosynthesis (DBT) versus digital mammography (DM), and to assess associations between features and final outcome of the screening, including immunohistochemical subtypes of the tumour. METHODS: This randomized controlled trial was performed in Bergen, Norway, and included 28,749 women, of which 1015 were recalled due to mammographic findings. Mammographic features were classified according to a modified BI-RADS-scale. The distribution were compared using 95 % confidence intervals (CI). RESULTS: Asymmetry was the most common feature of all recalls, 24.3 % (108/444) for DBT and 38.9 % (222/571) for DM. Spiculated mass was most common for breast cancer after screening with DBT (36.8 %, 35/95, 95 %CI: 27.2-47.4) while calcifications (23.0 %, 20/87, 95 %CI: 14.6-33.2) was the most frequent after DM. Among women screened with DBT, 0.13 % (95 %CI: 0.08-0.21) had benign outcome after recall due to indistinct mass while the percentage was 0.28 % (95 %CI: 0.20-0.38) for DM. The distributions were 0.70 % (95 %CI: 0.57-0.85) versus 1.46 % (95 %CI: 1.27-1.67) for asymmetry and 0.24 % (95 %CI: 0.16-0.33) versus 0.54 % (95 %CI: 0.43-0.68) for obscured mass, among women screened with DBT versus DM, respectively. Spiculated mass was the most common feature among women diagnosed with non-luminal A-like cancer after DBT and after DM. CONCLUSIONS: Spiculated mass was the dominant feature for breast cancer among women screened with DBT while calcifications was the most frequent feature for DM. Further studies exploring the clinical relevance of mammographic features visible particularly on DBT are warranted.

Changes in pain, stiffness and physical function in patients with osteoarthritis waiting for hip or knee joint replacement surgery.

OBJECTIVE: Little has been reported on changes in health status in patients with osteoarthritis (OA) while waiting for hip or knee replacement surgery. In this study we assessed (1) changes in self-reported pain, stiffness and physical function in patients with OA of the hip or knee, from the decision to undergo surgery to 14 days prior to surgery, and (2) the determinants of these changes. METHODS: Among 353 baseline respondents, 170 waited >30 days for surgery, completed the Western Ontario and McMaster Universities Arthritis Index (WOMAC) before surgery and were included in the analysis of changes; 120 with OA of the hip and 50 of the knee. We analyzed changes in WOMAC scores using the paired t test and determinants of the changes using multiple linear regression. RESULTS: Patients with OA of the hip did not change on any WOMAC scale before surgery. Knee patients deteriorated with time on the WOMAC stiffness and total scales, but not on the pain or physical function subscales. In both patient categories, higher baseline WOMAC scores were associated with smaller changes on all subscales and the total score, and female sex was associated with deterioration on the pain subscale. CONCLUSIONS: Patients with OA of the hip reported no change in pain, stiffness or physical function while waiting for joint replacement surgery, whereas patients with OA of the knee deteriorated on the stiffness and total scales of the WOMAC. This suggests a difference in patient selection, referral pattern or disease development between the patient categories.

Postoperative pain and convalescence in living kidney donors-laparoscopic versus open donor nephrectomy: a randomized study.

The aim of the present study was to compare postoperative pain and convalescence in patients randomized to laparoscopic or open donor surgery in a prospective, controlled trial. The donors were randomly assigned to undergo laparoscopic (n = 63) or open (n = 59) donor nephrectomy. Our end points were amount of administered analgesics in the recovery period, postoperative pain on the second postoperative day and at one month after surgery and duration of sick leave. There was a significant difference in favor of the laparoscopic group regarding administered analgesics on day of surgery (p < 0. 02). No difference was observed between groups regarding self-reported pain on the second postoperative day. One month post donation, significantly fewer donors in the laparoscopic group reported pain (p < 0. 02) or had used analgesics (p < 0.05). The duration of sick leave was significantly shorter in the laparoscopic group (p = 0.01). The laparoscopic group experienced a more rapid convalescence and a shorter period of sick leave. Although immediate postoperative pain can be managed efficiently regardless of procedure, a lower consumption of opioids and incidence of pain in the convalescent period suggest a clinically relevant patient-experienced benefit from a successful laparoscopic procedure.

Coping with exacerbation in psoriasis and eczema prior to admission in a dermatological ward.

Chronic dermatologic diseases, such as psoriasis and eczema, may cause significant psycho-social problems and stress. Our objectives were to characterize how hospitalised patients coped with psoriasis and eczema, and to investigate the relationship between coping and quality of life. Data are based on survey forms completed upon admission to the dermatology ward from 212 patients with chronic dermatological diseases, 146 with psoriasis and 66 with eczema. 108 were men, average age 48 years. The Norwegian versions of the standardized survey questionnaires, Jalowiec Coping Scale and Dermatological Life Quality Index, were used to evaluate coping and quality of life. We found that optimism, belief-in-oneself and confrontational coping strategies were most frequently used. Long duration of the disease was correlated to the belief-in-oneself strategy, while short duration was related to supportive strategies. More frequent use of confrontational and optimistic modes was significantly related to better quality of life. More frequent use of emotional and evasive modes was significantly related to poorer quality of life. There was no significant difference between the psoriasis and eczema groups in terms of use of coping strategies, with exception of emotional strategies. Knowledge of coping strategies and quality of life among patients with chronic dermatological diseases is important for improvement in health services for these patients.

Evaluation of a programme of group visits and computer-assisted consultations in the treatment of adolescents with Type 1 diabetes.

AIM: To examine the effects of group visits and computer-assisted consultations on quality of life and glycaemic control in adolescents with Type 1 diabetes. METHODS: A total of 116 adolescents, aged 11-17 years, and their parents were randomly assigned to an intervention (n = 62) or a control group (n = 54). The intervention group was invited to a 15-month programme comprising group visits and computer-assisted consultations. The control group was offered traditional out-patient consultations. Outcomes included changes in HbA(1c) and the adolescents' assessment of generic and disease-specific health-related quality of life measured by the Child Health Questionnaire (CHQ-CF87) and the Diabetes Quality of Life Questionnaire (DQOL), respectively. RESULTS: One hundred and one adolescents (55/46) agreed to participate, mean age 14.2 years (sd 1.5), mean diabetes duration 6.5 years (sd 3.6, range 1-16 years), mean HbA(1c) 9.3% (sd 1.4, range 6.1-12.8%). Eighty-three (72%) completed the questionnaires at follow-up (intervention/control 45/38). There were significant age by randomization group interactions for diabetes-related impact (P = 0.018), diabetes-related worries (P = 0.004), mental health (P = 0.046) and general behaviour (P = 0.029), implying that the intervention was effective in older adolescents (above 13-14 years). No significant effects on mean HbA(1c) were identified. CONCLUSIONS: Group visits and computer-assisted consultations had beneficial effects on health-related quality of life in older adolescents, the role of this intervention being questionable in younger adolescents.

How important are men's lower urinary tract symptoms (LUTS) and their impact on the quality of life (QOL)?

PURPOSE: To investigate the extent to which symptom severity and related factors contribute to the explained variance of the quality of life (QOL) of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). METHODS: Data from 480 men awaiting urological assessment were collected by questionnaires shortly after referral by their general practitioners in 1997-2000. The World Health Organization's QOL questionnaire (WHOQOL-bref), International Prostate Symptom Score (I-PSS), Symptom Problem Index (SPI), International Continence Society Benign Prostatic Hyperplasia questionnaire (ICS-BPH), the Sandvik Incontinence Severity Index, and BPH Specific Impact on Activity (BSIA) were used. RESULTS: Regression analyses with WHOQOL-bref scores as dependent variables (physical, psychological, social relations, environmental domains, as well as overall QOL and general health) showed that symptom severity predicted only physical health. The severity of urinary incontinence was predictive of all domains except general health. Sexual function was predictive of all domains. Regression coefficients were close to zero. The explained variance of WHOQOL-bref scores was low (5-17%). CONCLUSIONS: The WHOQOL-bref might be too comprehensive to identify associations between specific symptom-related factors. Alternatively, our results indicate that LUTS suggestive of BPH and LUTS-associated factors are not very important determinants of QOL.

Diversity of urinary symptoms in patients tentatively diagnosed with benign prostatic hyperplasia referred to a urologic clinic in Norway.

OBJECTIVE: Lower urinary tract symptoms (LUTS) has become the preferred term used to classify the urinary symptoms of elderly men. This term places more emphasis on clinical appearance rather than being restricted to the functional pathophysiology. The objective of this study was to investigate this new concept in a group of patients who had been tentatively diagnosed with benign prostatic hyperplasia (BPH). The range of urinary symptoms, incontinence, sexual function and impact on daily living were registered. MATERIAL AND METHODS: Data from a group of 480 men awaiting urologic assessment were collected by questionnaire shortly after referral from their general practitioner between 1997 and 2000. The questionnaires used were the International Prostate Symptom Score (IPSS), the Symptom Problem Index, the International Continence Society-BPH, the Sandvik Incontinence Severity Index and the BPH-specific Interference with Activities. RESULTS: The mean age of the subjects was 67.0 years. As assessed by the IPSS, 15%, 54% and 31% of the men had mild, moderate and severe symptoms, respectively. Men who gave positive answers to questions regarding the frequency, amount and type of leakage were considered to have urinary incontinence (UI), which was found in 37% of cases. The majority of men had mild or moderate UI. Influence on daily living varied with the severity of symptoms. However, no significant differences in influence on daily living were found between groups with different degrees of severity of incontinence as all groups reported a relatively high impact. CONCLUSIONS: Our results show that UI is fairly common, very bothersome and socially embarrassing in male LUTS patients waiting for urologic evaluation. Although UI is not typically associated with BPH and is not regarded as a crucial component of LUTS, this study indicates that more emphasis should be placed on UI in the terminology of LUTS. UI may also act as an indicator of a need for healthcare.

Measuring self-reported, health-related, quality of life in adolescents with type 1 diabetes using both generic and disease-specific instruments.

AIMS: To describe perceived functional health and well-being and diabetes-related impact, worry and satisfaction with life in relation to demographic and clinical variables in a population of adolescents with type 1 diabetes. To compare perceived functional health and well-being between adolescents with diabetes and a group of healthy controls and to analyse the relationship between generic functional health and well-being and diabetes-related impact, worry and satisfaction with life. METHODS: A total of 130 adolescents were invited to complete the Child Health Questionnaire (CHQ-CF87) and the Diabetes Quality of Life (DQOL) questionnaire modified for youths. A total of 115 (88.5%) subjects participated in the study; mean age 14.5 y (SD 1.86), mean duration of diabetes 6.99 y (SD 3.77, range 1-16 y), mean HbA1c 9.3% (SD 1.62, range 6.2-14.0%). Forty-eight percent of the subjects were girls. RESULTS: When compared with healthy adolescents, subjects with diabetes reported a significantly lower degree of general health. The CHQ-CF87 scales showed that higher age in adolescents with diabetes was associated with lower scores for mental health (p < 0.001), self-esteem (p < 0.001), behaviour (p = 0.004) and general health (p < 0.001). Findings from the DQOL questionnaire showed that older adolescents were more worried (p < 0.001), perceived a greater impact of diabetes on daily life (p = 0.008) and lower diabetes-related life satisfaction (p < 0.001). The scores for girls were lower than those for boys in assessment of mental health (p < 0.001), self-esteem (p = 0.004) and family cohesion (p = 0.002). Girls also reported a greater impact of diabetes (p = 0.028), more worries (p = 0.001) and less satisfaction with life (p = 0.006) than boys. Neither HbA1c, nor other clinical variables could sufficiently explain the variations in DQOL or CHQ-CF87. CONCLUSIONS: Health-related quality of life varied significantly by age and gender, but less so by HbA1c and other clinical variables. Adolescents with diabetes reported a significantly lower degree of general health than that reported by healthy controls. The CHQ-CF87 is a valuable supplement to DQOL, allowing for comparisons with the general population.

Validation of a Norwegian version of the Burn Specific Health Scale.

BACKGROUND: The abbreviated Burn Specific Health Scale (BSHS-A) is an 80-item questionnaire that has proven useful in measuring physical, mental, social and general health in burn survivors. The aim of this study was to adapt the BSHS-A into Norwegian, including assessing reliability and validity. METHODS: Standard procedures for forward and backward translation including discussions with professionals and patients to ensure conceptual equivalence were used. A pilot study (11 burn patients) confirmed that the Norwegian version (BSHS-N) was clear, understandable and easy to self-administer. Subsequently, 95 adults admitted to the Burn Center, Haukeland University Hospital, between 1995 and 2000 entered a validation study by completing the BSHS-N and the general health measure SF-36. Sixty-nine of the 95 (72%) responders completed a retest. RESULTS: The overall internal consistency reliability (Cronbach's alpha=0.97) and the test-retest reliability (ICC=0.95) for the BSHS-N were satisfactory. Tests for criterion validity showed expected patterns for association between comparable domains in the BSHS-N and the SF-36, with correlations ranging from r=0.61 to 0.81. Tests for construct validity showed that patients with full thickness injury (P=0.003), patients hospitalised more than 10 days (P=0.003), patients undergoing more than two operations (P=0.001) and patients unemployed at the time of study (P<0.001), had significantly lower total scores than the rest of the patients. CONCLUSION: BSHS-N seems to be a reliable and valid instrument for use in the Norwegian population. The translation and cross-cultural adaptation of this instrument allows for comparative international studies.

Use and misuse of the concept of quality of life in evaluating surgical treatments for lower urinary tract symptoms.

OBJECTIVE: To investigate how quality of life (QoL) components measured by given instruments direct the QoL perspective in treatment studies of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). METHODS: Computer searches were conducted in Medline, CINAHL and Psychinfo; MeSH terms covering QoL and surgical treatments for BPH and LUTS were combined for the search. The analysis was based on a framework linking components of QoL to patient outcome. RESULTS: Of the 74 papers meeting the inclusion criteria, 48 were published in 1997-2001, showing the increase of interest of the topic. Most of the papers reported the change in QoL by a one-item scale, whilst only a few reported results from several of the components in the QoL concept. Some papers regarded the change in general health status or parts of health status as changes in QoL. Functional status and symptoms, and the bother of symptoms, were often regarded as indicators of a change in QoL. CONCLUSION: These analyses show an increasing interest in measuring QoL after surgery for LUTS and BPH. In most of the studies analysed, the batteries of instruments selected were too narrow in scope to study the complexity of QoL. Most papers are based on instruments sensitive to change, but the reports do not distinguish the basic assumptions for understanding relationships important in QoL research and as a result, the reason for change is open to question.

The burden of psoriasis: a study concerning health-related quality of life among Norwegian adult patients with psoriasis compared with general population norms.

BACKGROUND: The reduction of disability caused by psoriasis is an important issue in dermatology. It is thus important to assess the patients' appraisal of their health-related quality of life. OBJECTIVE: The aim of the present study was to assess health-related quality of life among patients with psoriasis and to compare these estimates with population norms. METHODS: The samples comprised 283 patients and 2323 control subjects representative of the general Norwegian population. Health-related quality of life was assessed by means of the SF-36. RESULTS: Both demographic and clinical variables, such as age, gender, educational level, hospital setting, comorbidity, and physical symptoms, affected the different SF-36 scales among the patients. After adjustments had been made for age, gender, and educational level, it was seen that psoriasis patients reported significantly lower scores than the normal controls on all scales. The greatest difference was found on the role emotional scale. The smallest difference was found on the health transition scale. CONCLUSION: These results show that psoriasis patients report poorer health-related quality of life than the general population. Therefore patient care of psoriasis must give attention to the impact of the disease on different life domains.

Type I interferons and the quality of life of multiple sclerosis patients. Results from a clinical trial on interferon alfa-2a.

The objective of the study was to examine whether the beneficial effect of treatment of interferon alfa-2a on multiple sclerosis seen by magnetic resonance imaging is reflected in a corresponding improvement in the quality of life (QoL) and to address the impact of adverse events related to this treatment on the QoL. The study was a randomised double-blinded placebo-controlled treatment trial including 97 relapsing-remitting multiple sclerosis patients. Thirty-two patients received 4.5 MIU recombinant interferon alfa-2a, 32 patients received 9.0 MIU recombinant interferon alfa-2a and 33 patients received placebo treatment for 6 months. All patients were followed up 6 months after end of treatment. QoL was assessed according to the eight scales of the SF-36 Health Survey and measured at baseline, month 3, 6 and 12. The effect found on MRI was not reflected in a corresponding change in the QoL. We found a relationship between the presence of new enhancing lesions and reduced QoL among the placebo patients, whereas this was not found among the patients treated with interferon. The presence of the adverse events fatigue, myalgia, headache and weakness were significantly negatively correlated to several of the QoL dimensions. Conclusively, the treatment with interferon alfa-2a does not seem to improve the patients' QoL after 6 months of treatment, in spite of a marked effect measured by MRI. The treatment is followed by adverse events that negatively affected the QoL.

Coping and quality of life in patients with psoriasis.

The aim of the present study was to investigate the relationship between coping dimensions and overall quality of life, disability and health status in patients' with psoriasis. Psoriasis is one of several chronic diseases which requires self-management in order to ensure an enhanced quality of life. The sample comprised 334 patients who were treated consecutively at three dermatology departments in eastern Norway. A total number of 273 patients completed the questionnaire, yielding a response rate of 82% (20% in-patients and 80% out-patients). The following questionnaires were used: The Jalowiec Coping Scale, the Psoriasis Disability Index, the Quality of Life Scale, and the SF-36. Results showed that patients who used combined emotive coping strategies reported more disability, poorer mental health and worse overall quality of life. Furthermore, patients who more frequently used normalising/optimistic coping reported higher levels of mental health. However, the variance explained by coping effort was low to moderate. Coping explained the variance in mental health and overall quality of life to a greater extent than that in physical health. Knowledge about the relationships between coping and quality of life dimensions is important with regard to the establishment and implementation of appropriate psychosocial interventions for patients with psoriasis.

Adapting the Jalowiec Coping Scale in Norwegian adult psoriasis patients.

The aim of the present study was to adapt the Jalowiec Coping Scale (JCS) to accommodate adult patients with psoriasis. The sample comprised 334 patients who were treated consecutively at three dermatology departments in the eastern Norway. A total number of 273 hospitalised patients (20%) and out-patients (80%) completed the questionnaire, yielding a response rate of 82%. The study assessed the reliability and the face, content and construct validity of the Norwegian version of the JCS. In addition, researchers investigated the most frequently used/effective coping strategies, the relationships between demographic/clinical variables, self-reported physical symptoms and the use of coping strategies. The results (correlational coefficients and interitem alpha s) indicated that there was an overlap in substantive content among the original JCS subscales, due either to measurement error (bias or response style) and/or because the patients in the present study were in a demanding situation in relation to their disease, which may have activated a variety of coping strategies. A factor analysis resulted in a three-factor solution (confrontive problem-solving, normalising/optimistic and combined emotive) with satisfactory internal consistency. This factor solution comprised 31 items with an explained variance of 37% of the total pool of items. The most frequently used and effective coping strategies could be labelled as emotion-focused (optimistic/maintain control). Significant correlations were found between age, hospital setting, self-reported physical symptoms and different coping subscales. However, further studies are needed to assess the validity and reliability of the JCS among different population groups in Norway.

The relationship between demographic and clinical variables, and quality of life aspects in patients with psoriasis.

There is a strong need for health care programmes to promote functioning and quality of life in patients suffering from psoriasis. The aim of the present study is to highlight the relationships between demographic and clinical variables and disease-specific disability, health status, the perception of living with a chronic disease and the overall quality of life in patients suffering from psoriasis. A further aim is to examine the extent to which the effects of demographic and clinical variables on mental health and the overall quality of life are mediated by disability, physical health and the perception of living with psoriasis. The sample examined in this study comprised 334 patients (20% in-patients and 80% out-patients) who were treated consecutively at three dermatology departments in eastern Norway. A total of 282 patients completed the testing procedures, yielding a response rate of 85%. The following questionnaires were used: The Psoriasis Disability Index, the Sf-36 and the Quality of Life Scale. Correlation and multiple linear regression analyses were performed to address the core issue. Results show that demographic and clinical variables combine to explain variance in health status, the perception of living with psoriasis and overall quality of life. While most of the variance is explained by the clinical variables, the disease-specific disability variable seems to be an important mediating factor.

Quality of life in newly diagnosed cancer patients.

The aim of this study was to examine which domains of quality of life are most strongly affected in patients with newly diagnosed cancer, and to examine if quality of life was related to gender, age, educational level, cohabitation, time since diagnosis, treatment or type of cancer in these patients. Ferrans and Powers Quality of Life Index and the Cancer Rehabilitation Evaluation System, short form, were completed by 131 newly diagnosed Norwegian adult cancer patients. The patients had different cancer diagnoses, with breast cancer being the most common type. None of them were terminally ill, and 80% had been diagnosed within the last 6 months. The patients turned out to be satisfied with their lives, especially with the family and marital domains. They were least satisfied with health, functioning and sex life. Analyses of variance and multiple regression analysis were conducted to examine the impact on quality of life of cohabiting, age, gender, educational level, cancer diagnosis, treatment and time since diagnosis. Those cohabiting had significantly higher quality of life compared with those living alone. In contrast the younger group (19-39 years) living alone had significantly lower quality of life than the older groups living alone. Although age was only significantly associated with quality of life in one sub-scale, the elderly people reported their quality of life to be better in almost all sub-scales. Time since diagnosis was not associated with quality of life, while treatment was associated with quality of life as measured by Ferrans and Powers Quality of Life Index. Gender and educational level were only associated with one or two domains in quality of life, respectively.

Validity and reliability of the Norwegian version of the Ferrans and Powers Quality of Life Index.

The purpose of this study was to examine the validity and reliability of the Norwegian version of the Ferrans and Powers Quality of Life Index in a sample of 131 men and women with newly diagnosed cancer. The Quality of Life Index was translated into Norwegian using a standardized international approach, including back-translation. The findings showed high internal consistency reliability for the global score (alpha = 0.93 (test)) as well as for the following domains: health and functioning (alpha = 0.88), socio-economic (alpha = 0.82), psychological/spiritual (alpha = 0.82) and family (alpha = 0.79). The test-retest reliability after 3-4 weeks was 0.78 for the global score. A factor analysis partially confirmed the different subscales. In conclusion, the Quality of Life Index was found to be reliable and had sufficient validity to be used for measuring quality of life in Norwegian cancer patients.

The norwegian version of the psoriasis disability index--a validation and reliability study.

OBJECTIVE: The aim of this study was to translate the Psoriasis Disability Index (PDI) into Norwegian and validate it in a Norwegian setting. The PDI is a measure that was developed to assess the impact of psoriasis on the patient's life. METHODS: Two hundred and eighty-two patients with psoriasis were included in the study (80% outpatients, and 20% hospitalized). RESULTS: Face and content validity were assessed as satisfactory. The PDI seems to capture issues of importance to patients. The results indicate that the PDI does not capture a unidimensional concept. A factor analysis (principal component with orthogonal rotation) resulted in three factors (physical, social, and hygienic) that were substantially different. All three factors had satisfactory internal consistency. Altogether they explained 58% of the variance. In addition, there were differing patterns of correlations with external criteria, such as dimensions of SF-36, as well as with sex, age, and education. CONCLUSIONS: The PDI has been found to have acceptable reliability in this study. However, further validation is necessary to estimate the sensitivity to change.

Nursing intervention to increase hope and quality of life in newly diagnosed cancer patients.

The aim of this study was to evaluate the effect of nursing intervention on hope and quality of life in cancer patients. The sample consisted of 96 newly diagnosed Norwegian cancer patients ages 26 to 78 years, the majority of them women (71%). Breast cancer was the predominant type of cancer in this sample. The study used an experimental design in which patients were randomly allocated to three different groups. The first group was the experimental group, for which the intervention was designed to increase hope. The second group (attention control group) participated in the "Learning to Live with Cancer" program. The last group was a control group. The Nowotny Hope Scale was used to measure hope, and the Ferrans and Powers Quality of Life Index and the Cancer Rehabilitation and Evaluation Systems, short form, were used to measure quality of life. The questionnaires were completed four times: twice before, then 2 weeks and finally 6 months after the intervention. The level of hope was significantly increased (p = 0.020) for the members of the hope group just after the intervention, but not after 6 months. Despite the patients' positive evaluation of the intervention, there was no impact on quality of life.

Nursing intervention to increase hope in cancer patients.

Hope is considered to be of great significance for people diagnosed as having cancer, and is thus an important aspect of nursing care. It is therefore of value to document ways in which hope can be strengthened in these patients. An intervention programme based on Nowotny's (1986) definition of hope and designed to increase hope in groups of cancer patients with the nurse as the group leader was developed. The intervention was divided into eight sessions, each of which focused on a different aspect of hope. These included: belief in oneself and one's own ability, emotional reactions, relationships with others, active involvement, spiritual beliefs and values, and acknowledging that there is a future. By focusing on these aspects through interactional processes in the group, it was thought that the participants' hope could be strengthened.