Hope and hoping in the talk of dying cancer patients

Abstract

Hope is the subject of increasing research and discussion within the healthcare literature. However, although deemed of vital import to patient welfare, there is little examination of how hope features within patients' speech. This qualitative study presents the discursive properties of hope as it emerged unprompted during semi-structured interviews with 28 patients in the final phase of terminal cancer recruited from the oncology clinic of the Royal Adelaide Hospital, Australia. In the context of discussions about decision-making at the end of a terminal illness, when used as a noun, hope invariably referenced the medical domain--focussing either on the objective probability of medical cure (typically taking the negative form "there is no hope"), or the subjective possession of the patient, needed to fight their disease. Positioning the patient as relatively powerless and subject to external forces, this hope was most commonly associated with absolute solutions, and life-and-death stakes. Hope as a verb emphasised the patient's active engagement in life, identifying what was good and positive for them. It was used to assign responsibility to others, to indicate and establish solidarity or agreement between the speaker and others, effectively strengthening interpersonal ties between individuals. Through hoping, patients established connection with others and with the future. In the context of interactions between patients and clinical staff, we conclude that the use of hope-as-a-verb may have benefits, enabling the patient--even when dying--to focus on the positive, to connect to others, and to continue to engage with life.Australia Hope Discourse analysis Bioethics Clinical interaction Cancer