Iran Journal of Nursing

Introduction
Leukemia is a type of malignancy originating from hematopoietic stem cells that inhibits the normal function of hematopoiesis. This disease includes about 8% of all human cancers and its prevalence is increasing in Iran. Long-term treatments such as chemotherapy can cause changes in the patient’s body image and disrupt the quality of life. One of the important components in adapting to diseases is the illness perception, which refers to the patient’s cognitive evaluation and personal understanding of a medical condition and its potential consequences. In the study by Fanakidou et al. [12], low quality of life was correlated with negative illness perception in women with breast cancer. Having a proper knowledge and perception of the disease is one of the factors that can influence the adherence to treatment regimen and instructions. In addition to the illness perception, the patient’s hope can increase compliance with treatment. Hope is a practical indicator that shows how the disease affects the future perspectives of patients. With high hope, a person can take steps towards progress in life and reaching goals with great effort and motivation, and believe in a better feeling in the future, which can stimulate a person’s activities to gain new experience. High hope strengthens the ability to bear problems and troubles and better control challenges and increase the resilience. After being diagnosed by cancer, hope gradually decreases in affected patients. Patients with leukemia experience negative emotions and reduced hope which can affect their personal and social life and the treatment outcome. 
The results of the studies have indicated that the illness perception and hope are two important components that affect the quality of life of patients, the ability to manage the disease, and compliance with the treatment regimen; therefore, investigating the relationship between illness perception and hope in patients with leukemia can be the first step in designing effective educational interventions to strengthen their positive perception of illness and improve their hope. Hence, this study aims to determine the relationship between illness perception and hope in patients with leukemia.

Methods
This is a descriptive-correlational study on 200 patients with leukemia in selected hospitals affiliated to Tehran University of Medical Sciences, who were selected using a convenience sampling method. Inclusion criteria were an informed consent to participate in the study, age >18 years, being diagnosed with leukemia for at least two months, and not having a psychological disease. A demographic form, Broadbent et al.’s brief illness perception questionnaire (BIPQ) [26] and Snyder’s adult hope scale (AHS) [27] were used to collect data. 
The BIPQ has 9 items measuring consequences, timeline, personal control, identity, treatment control, concern, understanding, emotional response, and causes. The first 8 questions are rated from 0 to 10. Also, the items 3, 5 and 7 have reversed scoring. The item 9 is open-ended question that is used to determine in rank-order the three main factors perceived to cause the disease. The total scores ranges from 0 to 80 with higher score indicating more negative perception of the disease. The AHS has 12 items that measure two components of agency and pathway. The scoring is based on a five-point Likert scale from 1 (definitely false) to 5 (definitely true). Items 3, 5, 7, 11 are used to measure the correctness of answers and are not scored. The total score ranges from 8 to 40 points, with a higher score indicating a higher hope. The Persian version of these questionnaires have already been psychometrically tested in Iran. The reliability of the Persian AHS using Cronbach’s α in Vakili et al.’s study [31] was reported as 0.75. In Kermani et al.’s study [30], the reliability was reported as 0.82. Karimi Ghasemabad et al. [29] and Basak Nejad et al. [25] reported Cronbach’s α values of 0.90 and 0.84, respectively, for the Persian BIPQ. The collected data were analyzed using descriptive and inferential statistics in SPSS software, version 16.

Results
The mean age of the participants was 36.83‌±‌11.13 years ranged from 18 to 69 years. The majority of them were male (62%) and married (66.5%). The mean total score of BIPQ was 37.45 out of 80. Also, the mean total score of AHS was 32.32 out of 40. The illness perception had a negative and significant relationship with hope (r=-0.489, P<0.001).

Conclusion
There is a negative and significant relationship between illness perception and hope in patients with leukemia. With more positive perception of leukemia, the hope in patients increases. By holding mind and thought management training courses, it is possible to improve the positive illness perception in these patients and take a positive step towards increasing their hope.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of Tehran University of Medical Sciences (Code: IR.TUMS.FNM.REC.1402.012). The study objectives and methods were explained to the participants, and informed consent was obtained from them. They were assured of the confidentiality of their information and were free to leave the study at any time.

Funding
The present article was extracted from the master’s thesis of Moein Salami, approved by Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences (Grant No. 66243-100-2-1402). 

Authors' contributions
Data collection and writing: Moein Salami; Supervision and project management: Azam Ghorbani, Leila Sayadi, Esmaeil Mohammadnejad; Statistical analysis: Shima Haqqani. Approval of the final draft: All authors. 

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
We are grateful to nurse Mina Sadeghi who helped us in conducting this research.



 

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