The hope paradox in advance care planning communication and decision making in oncology nursing practice

Advance care planning (ACP) is a core component of high-quality oncology nursing, yet its implementation is frequently challenged by a persistent communicative tension known as the “hope paradox.” Patients and families often express hope oriented toward cure or recovery, while clinicians must simultaneously facilitate realistic discussions about future care preferences and potential clinical decline. This narrative review examines how oncology nurses navigate this paradox in ACP communication, positioning hope not as a barrier to decision making but as a dynamic psychological resource that can be ethically aligned with realism. Drawing on psycho oncology theory, person centred care models, and palliative care literature, the review conceptualises hope as multidimensional and evolving, encompassing not only cure oriented goals but also relational, existential, and comfort-based aspirations. We propose a nursing focused “hope coordination” framework in which nurses act as facilitators who elicit patient values, integrate emotional and informational support, and guide shared decision making without extinguishing hope. Evidence based communication strategies are synthesized, including values focused questioning, acknowledgment of concurrent hope and uncertainty, and iterative ACP discussions embedded within routine care. The review further highlights implications for oncology nursing education, system level documentation, and outcome evaluation. Reframing ACP as an extension of hope centred care may enhance patient understanding, ethical decision making, and perceived quality of communication in oncology practice.