Some of the most hopeful people on the planet know exactly how their story ends.
I didn't believe this when Ian Pettigrew said it on Corey-osity Unleashed. Ian researches hope for a living. He's interviewed people about hope in end of life care. And he told Debra and me something I keep turning over.
People who are terminally ill still hope. Not because they think the doctors got the diagnosis wrong. They hope because they take control of the cards they've been dealt. Ian described people focusing on a good death. Dying on their own terms. Surrounded by the people they love.
It sounds like a strange thing to bring into a leadership blog. Stay with me. I think it's the most useful lesson on hope I've heard all year.
Hope Doesn't Need a Happy Ending
Most of us treat hope as a bet on the outcome. I hope the deal closes. I hope the restructure misses my team. I hope the scan comes back clear.
Take the good outcome off the table and, by this logic, hope dies with it.
The research says otherwise. Back in 1990, the nursing researcher Kaye Herth studied 30 terminally ill adults. She tracked some of them over time as their illness progressed. Hope levels were high. And they stayed stable over time. The one exception in her sample was the group diagnosed with AIDS.
How does a dying person keep hope steady? A 2009 review of 34 studies on hope in palliative care found two threads running through patients' accounts. "Hoping for something." And "living with hope." The object changes. The hope stays.
You stop hoping for a cure. You start hoping for a good week with your grandchildren. A clear head for one more conversation. A say in where you spend your last days.
Ian's Definition Explains Why
On the episode, Ian drew the line between optimism and hope. Optimism is a good feeling about things outside your control. Hope is believing the future will be better and knowing what you'll do to make it so. You're a stakeholder.
I wrote about my own confusion between the two in I Confused Hope With Optimism for Years. This end of life example made it click for me in a new way.
Optimism needs the outcome. Hope needs agency. When the outcome is gone, optimism has nothing left to hold. Hope moves to whatever you still control.
In the conversation, I said you have to be "pragmatic and observant of where you truly are today." You won't get anywhere you want to go if you refuse to look at where you're standing. Terminally ill patients who keep hope have done the hardest version of this. They've looked.
What the Studies Show
Ian told us hope interventions in end of life care reduce anxiety and depression. I went and checked, because I'd rather be precise than inspiring.
A 2021 meta-analysis in Palliative Medicine pulled together 35 studies covering 3,296 palliative care patients. Hope-fostering interventions raised hope with a medium effect size. They reduced depression. They did not make a significant difference to anxiety, quality of life or symptoms. The authors rated the overall quality of evidence as low.
Then there's the Serious Illness Care Program trial, published in JAMA Internal Medicine in 2019. The programme trained clinicians to hold structured conversations with patients about goals, fears and priorities. 278 patients with advanced cancer took part. The median conversation lasted 19 minutes. The trial's main goals came back null. But the share of patients with moderate to severe anxiety roughly halved compared with the control group, and the gap held at 24 weeks. Depression dropped at 14 weeks too, though the difference didn't last.
So Ian's claim holds up in part. Depression, yes, in both. Anxiety, yes in the conversation trial, no in the wider meta-analysis. Hope itself goes up. Nobody is promising miracles here.
Nineteen minutes of honest conversation. A measurable drop in anxiety for people facing the worst news there is.
According to Ariadne Labs, who built the programme, only about one third of patients in their last year of life report having these conversations at all.
Now Bring It to Work
Nobody at work is dying. I'm not pretending a redundancy round compares to a terminal diagnosis.
But leaders face fixed endings all the time. The office is closing. The product is going away. The project you've spent eighteen months on got cancelled on Thursday. A team member's role won't exist in March.
Watch what most managers do in these moments. They grab for optimism. "It'll all work out." "Something will come up." "Let's stay positive." I made the case against this in Stop Telling Your Team It'll Be Over by Christmas. False hope breaks people when reality arrives.
The other common move is silence. Say nothing until HR has the paperwork ready. Let people guess.
Palliative care shows a third path. Name the ending plainly. Then move hope to the things still in play.
Borrow the Questions
The Serious Illness Conversation Guide from Ariadne Labs and Dana-Farber is short. A few of its patient-tested questions:
- "What are your most important goals if your health situation worsens?"
- "What are your biggest fears and worries about the future with your health?"
- "What gives you strength as you think about the future with your illness?"
Strip out the medical words and you have a one-to-one for someone whose job is ending:
- What matters most to you between now and your last day here?
- What worries you most about what comes next?
- What gives you strength right now?
- What would make you proud of how this chapter ends?
Then act on the answers. Write the reference. Make the introduction. Give them the time off for interviews. Let them finish the thing they care about and put their name on it. Those are the cards still in play.
I'm not sure about this part: I haven't found a study testing these questions in redundancy or closure conversations. The evidence comes from serious illness care. I think the logic carries over, but treat my workplace version as an experiment, not a proven method.
Find Your Own Footing First
Ian's first piece of advice to leaders on the episode was blunt. Find your own hope first. He said you won't fake it. He'd tried standing up to rally people around something he didn't believe in, and he wasn't doing it again.
This matters more when the news is bad. If you're pretending, your team will feel it. Before you walk into the room, answer the four questions for yourself.
Ian knows this from the inside. After a serious accident, he remembers thinking he'd be annoyed with how he'd let work shape his life if he didn't pull through. The moment pushed him to leave AstraZeneca and start his own business. I wrote about his recovery in The Physio Gave Him Homework. He Did It Fifty Times a Day.
He didn't get his old life back. He built a different one, on purpose.
The Question to Take Away
Hope was never about the ending being happy. It's about having a say in what happens before it.
Think of the hardest ending you're facing at work right now. A closure, a cancellation, a goodbye. What's still in your control... and who on your team needs to hear you name it?