Objectives/Purpose
End of life conversations can often diminish hope and fuel hopelessness, they are therefore complex to navigate for clinicians. Balancing hope and hopelessness for Adolescent and Young Adult (AYA) cancer patients when nearing end of life is challenging especially due to their specific psychosocial needs. Often, AYA are hope focused due to their age, goals and dreams for the future. We aimed to describe the experience of hope and hopelessness for AYA cancer patients and their families in the context of end of life and establish recommendations based on current psychological and social work theories and clinical practice.
Procedures
We conducted a narrative review, including both literature research and clinical expertise. Key words used in literature search included; AYA, cancer, hope, hopelessness and end of life. We reviewed and included 31 peer-reviewed publications, encompassing 29 scholarly articles, a singular report, and one book. We extracted key themes and recommendations for practice with AYA with cancer.
Results
Recommendations for practice include i) how health professionals can best support AYA cancer patient’s developmental needs at end of life whilst balancing both hope and hopelessness, ii) the importance of introducing palliative and supportive care early with AYAs to allow time to express hopes, worries and make medical decisions and iii) the common experiences of hope and hopelessness for parents and caregivers of AYAs facing end and how to best support them. Theories and frameworks including contingent hope theory and Acceptance and Commitment Therapy (ACT) will also be reviewed alongside case studies and practice examples.
Conclusion and clinical implications
Early palliative involvement and tailored psychosocial support empower patients and families, enhancing communication and decision-making while addressing unique developmental and emotional needs effectively.