Objectives/purpose: Different perspectives of hope can obstruct communication between patients living with advanced cancer and their treating clinicians, particularly when there is concern of taking away hope or offering 'false' hope. Hence, there is a need to understand the different conceptions of hope and the possibility of positive and negative functions of hope, to improve clinical communication. However, there is currently a lack of consensus on how hope should be conceptualised, measured or utilised in the context of advanced cancer.
Aim: We aimed to identify different conceptions of hope, and how they contribute to discourses in the context of advanced cancer.
Sample and setting: A systematic search of online databases identified sixty-five articles focusing on hope and advanced cancer.
Procedures: A discourse analysis was conducted on the included articles. Texts were coded and analyzed using Foucault’s (1972) and Parker’s (1992) criteria for distinguishing discourses.
Results: The analysis revealed three discourses relating to the meaning and usage of hope in advanced cancer: (1) instrumentalised hope as a psychological resource; (2) hope within the biomedical framework and; (3) hope as an ethical activity. The first two discourses represent attempts to instrumentalise hope, often framing it as something to be measured or managed. In contrast, the third discourse encompassed the ambiguity of hope, acknowledging its complex and dynamic nature. Within each discourse there was broad consensus on the source of hope, the responsibilities placed on different individuals to maintain hope, and the challenges in maintaining hope.
Conclusions and clinical implications: Recognising that patients and clinicians may simultaneously engage with multiple hope discourses can help explain communication challenges and apparent contradictions in expressed hopes. Understanding the different hope discourses and how individuals navigate them may support healthcare professionals in navigating difficult conversations.