Bereaved Parents, Hope, and Realism.

* Abbreviation: HOPE — : Hear Our Parent Experiences Parents of children with serious illness often maintain hope across a child’s illness journey. Historically, the conflict between parental hope and prognostic acceptance has been described as a pendulum oscillating between antithetical states of awareness. In this commentary, bereaved parents partner with interdisciplinary pediatric palliative care clinicians to discuss and challenge the conventional theory in which hope and realism exist as diametrically opposing spaces within which parents vacillate. As parents and clinicians, we offer a reconceptualized model that validates a parent’s ability to experience hope and prognostic awareness simultaneously, avoiding assumptions that conflate hope as misinterpretation or denial. In our discussion, we advocate for health care professionals to consider this framework when partnering with patients and families who carry coexisting hope and prognostic awareness in the context of a child’s progressive illness. For parents of children with serious illness, hope is a uniquely powerful mechanism that enables coping and promotes resilience.1,2 Parents describe hope as a life-sustaining factor,2,3 one that impacts decision-making processes across their child’s illness journey.1,4 Recent data reveal parental hopes to be fluid, evolving across the illness trajectory5,6 and persisting in the face of critical illness and at the end of life.1,6,7 In the setting of serious pediatric … Address correspondence to Erica C. Kaye, MD, MPH, Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children’s Research Hospital, 262 Danny Thomas Pl, Mail Stop 260, Memphis, TN 38105. E-mail: erica.kaye{at}stjude.org