Following an initial 4-hour in-person workshop in November 2019, we held eight virtual 1-hour discussion-based focus groups (Zoom.com, accessed on 18 January 2020, 22 February 2020, 14 March 2020, 11 April 2020, 9 May 2020, 13 June 2020, 11 July 2020, and 15 August 2020, San Jose, CA, USA). The focus groups took place between January and August 2020 and aimed to gather additional information about what hope means from the patient and caregiver’s perspective. Focus group discussions were facilitated by two Patient Co-Investigators (RK, CF). Based on workshop participant feedback, sessions were held virtually in order to lower barriers to participation for participants by eliminating travel time and financial cost for the patients and families. To promote connection and community among participants and researchers, focus groups began with brief introductions and check-in activities, all related to the topic of hope (ex: what is something you do that brings you joy or makes you feel hopeful?). Participants were encouraged to keep the video on whenever possible and to contribute however they felt most comfortable (via audio or in the chat box). The poll feature in Zoom was used to conduct virtual voting during the focus groups, and an online survey was disseminated by email between focus group #4 and #5.

A final 3-hour virtual workshop was held in September 2020 to member-check our findings and seek additional insights from a larger group of patients and caregivers. Zoom breakout rooms were used to facilitate smaller group discussions. Voting was performed with virtual sticky dots on an online whiteboard (Miro.com, accessed on 12 September 2020, San Francisco, CA, USA). Participants were asked to review the previously developed list of factors that improve hope, factors that interfere with hope, and activities people do to help themselves improve hope. Through facilitated brainstorming, participants contributed additional ideas. Each participant was provided three virtual sticky dots and instructed to vote for the top three things that they personally felt were most important in the categories of: “things that promote hope” and “things that interfere with hope.”

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