Culturally Embedded Conceptualization of Hope in End-of-Life Cancer Care: The Hope Tree as a Reflective Educational Tool in the Italian Healthcare Context

Hope is a central component of quality communication in palliative cancer care. However, limited educational strategies exist to help healthcare workers reflect on their own understanding of hope and how culturally embedded understandings of hope influence communication with patients at the end-of-life. This study explored the use of the Hope Tree as a reflective educational tool within a communication training program, aiming to examine how healthcare professionals conceptualize hope for people with advanced cancer and how these representations are shaped by cultural, personal, and organizational factors. Following a structured communication training program, Northern Italian healthcare workers were asked to write one hope for their patients with advanced cancer on individual notes and place them on a symbolic tree displayed in the classroom. Notes were transcribed and analyzed using inductive thematic analysis consistent with Interpretive Description. Eighty-nine healthcare workers participated. Seven thematic domains emerged. Hopes mediated by cultural or spiritual beliefs were the most frequent, whereas concrete hopes related to symptom relief, sustainable goals, or quality-of-life priorities were less represented. The Hope Tree enabled participants to externalize implicit attitudes and emotional responses, revealing gaps between healthcare workers’ intentions (e.g., giving support, being present) and patients’ concrete needs (e.g., relief from suffering). The adapted Hope Tree proved to be useful for fostering emotional awareness and reflective practice among healthcare workers. By illuminating how hope is shaped by cultural and organizational aspects, this study highlights the importance of culturally informed educational approaches to support more patient-centered communication in palliative care. Although rooted in a specific national context, the Hope Tree may be transferable to other cultural and healthcare settings to promote reflective practice in patient education and counseling.