These concepts were also PF2341066 described in a metasynthesis study of the hope experience of family caregivers of persons with chronic illness [3]. The concept of ‘hope against hope’ has not been previously found in the research on hope and family caregivers. As such it can enhance the ‘hanging onto hope’ model, in that it illustrates how caregivers persevere and continue Inhibitors,research,lifescience,medical to find hope when possibilities for the future have not yet been recognized. “Hoping against hope” has been described in a conceptual analysis of hope as a typology of hope [45]. It reflected the continuous process of hoping to get through different barriers that repeatedly emerged by women with breast cancer. Our study findings

however, suggest that “Hoping against hope” was descriptive of the hope experience of family caregivers of persons with advanced cancer. This concept was related to the tension of hope for a cure and hope for peace and comfort at the end of life. The tension was also described in a study of Inhibitors,research,lifescience,medical persons at the end of life [46]. Further research is required to determine if this concept is similar to that

presented in the typology. The concept of “hoping against hope” highlights how seemingly contradictory Inhibitors,research,lifescience,medical experiences and emotions can coexist: caregivers chose to hold onto their hopes no matter what the circumstances, but this also coincided with feelings of fear, loneliness and hopelessness. Although hope is a very different concept than coping [47] the dynamic nature of “hoping against hope” maybe similar to the tension and dynamic between coping and resilience in caregiving versus the effects of caregiver burden is documented in other research Inhibitors,research,lifescience,medical [22,48]. This however requires further research. Each of the caregivers who participated in this study are on their own unique journeys, and the narrative

of Inhibitors,research,lifescience,medical ‘hope against hope’ demonstrates a thread that brings their stories together and allows us as researchers and those who read this story to bear witness to their experiences. In bearing witness to the caregiver narrative(s), we must acknowledge and honour the chaos that is within it; that there are days and periods of time when it seems that there is no way forward, that there is no purpose, that there is no longer any hope. As Frank writes, “Chaos is never transcended but must be accepted before new lives can be built and new stories told” (42, p. 110). When one is inside the chaos, they Mannose-binding protein-associated serine protease are not yet in a place to be able to articulate and share what they are going through; there is no language to match the experience. Reflective space is required to emerge from the chaos; the journaling provided that space of reflection, and caregivers used it to both answer the precise questions of the study (what fosters hope and what are their challenges), and to write down whatever was in their hearts and minds at the time.