The story of ‘hope against hope’, and the themes that emerged from the participant journals highlights a need for psychosocial, peer, and bereavement support for family caregivers, which has also been recommended in previous research [50-52]. One participant described the need to connect with a “soul sister” who is on a similar journey. Other participants wrote about how they do

not have the time or energy to reach out for their own support, but were nevertheless overwhelmed by the emotional burden of P/EOL care. Some wrote about the difficulty of change in their partnership. Others struggled Inhibitors,research,lifescience,medical with coming to grips with the idea of life without the care receiver. Journaling and a narrative approach in general is a step forward in providing support; a strength of the LWHP is Inhibitors,research,lifescience,medical that it allows those who can benefit from reflection of this kind to so without requiring professional facilitation. Journaling as a therapeutic strategy has been long recognized [53] and may be particularly relevant in rural communities, where caregivers and their families experience various forms of isolation given their geographical location; this includes less contact with health

professionals/service providers and less peer support. To make the Stories of Hope resource accessible to more people, we plan to make it available on the Inhibitors,research,lifescience,medical LWHP website and on the website of the Canadian Hospice Palliative Care Association. Limitations One of the foremost limitations in this work is the study design. The particular narrative approach utilized in the study was descriptive in nature because of the limitation of the overall study design and data collection method. For example, the data was collected from Inhibitors,research,lifescience,medical a mixed method study, where the emphasis was quantitative; thereby the data was collected within a positivist study paradigm. The study design limited the co-construction of knowledge between the participant and researcher and, as such, future research should Inhibitors,research,lifescience,medical include an interpretive design with in-depth qualitative interviews. Related to this, a further limitation is that the ‘hope against hope’ story presented in the results did not and could

not encompass all of the different expressions of the participants’ Fossariinae journey and their hopes and challenges. “ Stories of the Present” limited the act of journaling by providing instructions to take only 5 minutes at the end of each day and what was to be included. The findings then are a Verteporfin description of the experience of caregivers and what fosters their hope, which is consistent with the study purpose, but limits a more in-depth analysis of the possible therapeutic nature of this activity. Future research may include the use of “Stories of the Present”, coupled with in-depth qualitative interviews to understand possible benefits from this type of narrative. Every experience is unique, and caregivers experienced hope or a lack of hope in different ways.