A Dutch clinical practice guideline for paediatric palliative care: a systematic review and recommendations on psychosocial care including preloss and bereavement care.

Abstract

Background: Children with life-threatening and life-limiting conditions and their families are confronted with many uncertainties, incremental losses, and difficult decisions. Attentiveness to psychosocial care, including psychological, social, and spiritual concerns, is essential during the child's life until end-of-life and during bereavement and determines quality of life and wellbeing of child and family. However, use and integration of psychosocial care is found to be challenging. In this paper, we provide recommendations that aim to optimise psychosocial care including preloss and bereavement care in paediatric palliative care.

Methods: A multidisciplinary guideline development panel of 25 experts in paediatric palliative care and nine parents was established to develop recommendations on psychosocial care including preloss and bereavement care. We performed a systematic literature search to identify evidence focussing on effectivity of interventions described in systematic reviews (SRs) of randomised controlled trials (RCTs) and RCTs. From the search, we also derived evidence from SRs of observational, qualitative, or mixed-method studies on preloss and bereavement care. The GRADE methodology was used for appraising evidence. We used existing guidelines to deal with lack of evidence. Recommendations were formulated based on evidence, existing guidelines, clinical expertise, and patient and family values.

Results: We identified a total two SRs of RCTs and six RCTs that reported on the effect of psychological interventions, spiritual support interventions, and bereavement care intervention. The evidence showed that only some of the interventions improve certain psychosocial outcomes in children or parents. We were unable to draw conclusions on which intervention is most effective, due to the high variability in interventions and measured outcomes. The evidence from ten SRs of observational, qualitative, or mixed-method studies was used as a basis for preloss and bereavement care recommendations. In total, we formulated 48 recommendations.

Discussion: With the provided recommendations, we aim to optimise psychosocial care for children with life-threatening and life-limiting conditions and their families. Psychosocial care should be tailored to the child and family. We found a lack of evidence on psychosocial care including preloss and bereavement care. Although very challenging, we propose implementing strategies to improve research and thereby further optimise quality of paediatric palliative care. These strategies include the development of a standard set of outcomes and to conduct well-designed multisite RCTs.