Hope as moral accompaniment: a framework for palliative care practice

Growing evidence underscores the importance of hope in shaping patients' experiences. In the context of illness, hope regulates emotions, supports resilience, helps patients face uncertainty, and sustains the belief that life remains meaningful and worth living, even in adversity. While its relevance is well documented, very few approaches actively cultivate hope for its possible indirect therapeutic impact at a psycho-physical level. Among them, some positive psychology contributions seems to be particularly significant. Drawing on Snyder's model, hope is conceptualized as the combination of agency-the motivation to pursue goals-and pathways thinking-the perceived capacity to identify and adapt routes toward these goals. Specifically, hope therapy exhibits significant effectiveness in chronic illness, which requires the ability to reorganize one's activities and goals, although its clinical applications remain largely confined to cancer care. This paper argues for a broader application of hope therapy within palliative care, a field marked by complex, multidimensional vulnerability. Palliative care itself can be understood as a paradigmatic form of accompaniment: an ongoing, compassionate presence that supports patients and families. Within this relational framework, hope, understood as a moral virtue, becomes a central element, sustaining meaning, purpose, and dignity. The aim of this paper is thus to illustrate the role of the virtue of hope within the experience of illness and to argue that fostering hope in palliative care can enhance patients' quality of life and psychosocial wellbeing. It also aims to examine the theoretical foundations and practical applications of Snyder's hope-based intervention, highlighting its relevance in this context. Finally, it explores how cultivating hope through professional education can sustain compassionate accompaniment within palliative care systems. In this perspective, caring for vulnerability and creating new protocols for strengthening patients' character-so that they may experience greater wellbeing even in the face of serious illness-can be understood as an expression of shared civic responsibility, involving healthcare professionals, institutions, and the wider community in a collective commitment to care.