Hope in the face of despair Dr Suzy Jordache Many people feel hopeless when faced with terminal illness, says Dr Suzy Jordache. But when in such despair, it's vital to look at the reality of the situation and face up to facts - only then can hope reappear.

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Facing despair

Setting achievable goals

Hope is based in reality - it's not optimism, wishing or dreaming. Facing up to dark and difficult truths enables hope to emerge and new doors to open.

For example, when cancer is first diagnosed the hope is for a cure. If the cancer spreads or the treatment doesn't work then the hope changes - one hopes that the cancer can be held at bay for as long as possible with few symptoms. Hopes for family holidays, reunions and anniversaries can be worked on and achieved. This can be a special time.

If the cancer spreads further and it becomes clear that it'll cause death then hope shifts again. The hope is for a peaceful, pain-free death, for good endings with friends and family, for reconciliations - and for preparation with spouses and children who'll be left behind. Memory boxes and books, letters and photographs can be used to pass on pearls of wisdom and hopes for the future of those left behind. Beliefs beyond death can be examined and spiritual issues never normally discussed can lead to deep and meaningful moments with huge intimacy and understanding.

When despair creeps in it's often because expectations are unrealistic. Goals can be set that are impossible to achieve and the person repeatedly fails and becomes frustrated and hopeless. Re-setting goals and accepting limitations means that plans go ahead and pleasure and fulfilment allow hope to return - and despair vanishes.

For instance, many people dream of a holiday somewhere warm and sunny. However, holiday insurance can be difficult to obtain, travelling by air can be fraught with obstacles and it seems that one barrier after another is put in the way. Altering the goal slightly to travel within Europe by train or a visit to the beautiful Devon coast, for example, can suddenly make this dream a reality, and hope is back.

Day to day, it's important to attempt activities that are achievable - it may no longer be possible to dig over the entire garden, but it may be hugely rewarding to plant out summer bedding plants and transform the garden with colour.

Hope is real and gives huge comfort

Dreams and wishes are important but can disappoint and frustrate. Hope is real and gives huge comfort and peace - leaving no room for despair.