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.’ This study aimed to understand various conceptions of hope and their functions to improve clinical communication, addressing current ambiguity surrounding hope in advanced cancer.
Methods: A discourse analysis was conducted to identify different formulations of hope, how they function, and how they contribute to dominant discourses in advanced cancer. Literature was assembled through a systematic search of online biomedical databases. Articles were coded and analysed using Foucault’s (1972) criteria for distinguishing discourses.
Results: Sixty-five articles focusing on hope and advanced cancer were identified. The analysis revealed three discourses relating to the meaning and usage of hope in advanced cancer: instrumentalised hope as a psychological resource; hope within the biomedical framework and; hope as an ethical activity. The first two discourses attempted to instrumentalise hope, often framing it as something to be measured or managed. The third discourse presented hope as having a complex, dynamic nature, appealing to subjective and intersubjective experiences. Within each discourse there was broad consensus on the source of hope, individual responsibilities in maintaining hope, and associated challenges.
Conclusion: 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 move between them may support healthcare professionals in navigating difficult conversations.