# Effectiveness of psychological interventions for parents of children eligible for paediatric palliative care: a systematic review and meta-analysis

## TL;DR

This study finds that psychological interventions help reduce stress and improve mental health in parents of children with cancer who need palliative care, but more research is needed for other conditions.

## Contribution

The study provides the first meta-analysis on the effectiveness of psychological interventions for parents in palliative care settings, highlighting gaps in non-oncological research.

## Key findings

- Psychological interventions significantly reduce anxiety and depression in parents of children with cancer.
- Cognitive behavioral therapy is the most common and effective intervention approach.
- Long-term benefits are limited, with only post-traumatic stress symptoms showing sustained improvement.

## Abstract

Paediatric palliative care (PPC) is an early, holistic model addressing the physical, psychological, social, and spiritual needs of children with life-limiting or life-threatening conditions and their families. Parents frequently experience high psychological distress, and although psychological support is a core PPC component, empirical evidence on the effectiveness of interventions within this context remains limited, particularly across non-oncological conditions. This systematic review and meta-analysis aimed to evaluate the effectiveness of psychological interventions for parents of children eligible for PPC.

A systematic search of MEDLINE, Embase, CINAHL, APA PsycINFO, and CENTRAL was conducted in July 2024 and updated in Embase in November 2025. Randomized controlled trials evaluating psychological interventions for parents of children under 18 years eligible for PPC were included. Methodological quality was assessed using the Cochrane Risk of Bias tool for randomized trials (RoB 2). The review was conducted in accordance with PRISMA guidelines, and random-effects meta-analyses were performed where appropriate.

Thirty-six studies were included. Although the review aimed to capture studies involving parents of children with various life-limiting conditions eligible for PPC, the evidence base was almost exclusively oncology-focused: only one study was conducted within a PPC context, and all studies involved parents of children with cancer. The psychological interventions were heterogeneous and frequently multimodal, with cognitive-behavioural therapy being the most common approach. Meta-analyses showed primarily short-term significant moderate-to-large effect sizes, indicating improvements in anxiety (g = −1.00; 95% CI: −1.49, −0.52; I2 = 94%), depression (g = −0.77; 95% CI: −1.15, −0.39; I2 = 85%), psychological distress (g = −0.39; 95% CI: −0.75, −0.04; I2 = 0%) and hope (g = 0.73; 95% CI: 0.20, 1.26; I2 = 0%). Evidence of long-term effects was limited, with improvements observed only for post-traumatic stress symptoms (g = −0.29; 95% CI: −0.55, −0.03; I2 = 0%).

The findings suggest that psychological interventions, particularly those based on cognitive behavioural approaches, are effective in reducing psychological distress and enhancing positive psychological outcomes in the short term among parents of children with cancer who are eligible for PPC. However, the scarcity of studies explicitly conducted within PPC settings highlights the need for further high-quality trials across a wider range of life-limiting and life-threatening conditions.

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024594171, CRD42024594171