Context: End-of-life palliative care aims at healing physical, psychological, social and existential distress for patients with incurable illness. In the philosophy of palliative care, death is considered a natural process that shouldn’t be hastened or prolonged.  In western societies, often regarded as “death-denying”, the palliative care movement tends to promote social maturity and the acceptance of finiteness.  Consequently, death denial is identified as an obstacle to good palliative care in clinical practices as well as in research literature.  Most importantly, the term “denial” tends to be overused by professional caregivers and is often confused with the concept of hope, whether that hope is realistic or not. Aims: This research has three objectives: 1) to review the literature on the concept of hope in palliative care; 2) to examine the use of the concept of hope in palliative care and its relationship with the concept of denial and; 3) to translate those findings into clinical recommendations for palliative care practice. Method: A MEDLINE search (2002-2012) was performed with the terms “hope” and “palliative care” in combination. The search was restricted to English-written articles and to adult palliative care. The 450 articles initially retrieved were screened based on their relevance, yielding 41 publications for analysis. Articles were summarised, elements of definitions of hope were extracted and a qualitative thematic analysis was conducted. Results: Main findings revealed that: 1) Hope appears to be a multidimensional concept often described either as a state of being or as a state of wanting. 2) Hope evolves during the illness trajectory. 3) Most studies describe hope in palliative care as a way to adapt to and to transcend suffering. 4) Hope tends to be confused with wish, denial and unrealistic hope. Discussion: Clinical implications of the confusion between hope and denial are discussed and recommendations are provided for health care professionals.