Shifting the narrative: reframing paediatric palliative care to enable earlier engagement

Paediatric palliative care (PPC) provides holistic support for babies, children and young people with chronic and complex conditions and their families when facing uncertainty about the future. Although early PPC involvement improves symptom management, quality of life and shared decision-making, referral often occurs late. Misconceptions that equate PPC with end-of-life care, alongside clinicians' discomfort and concerns about diminishing hope, contribute to these delays. Communication is a modifiable barrier, and applying framing science may help clinicians introduce PPC earlier and with greater confidence. The aim of this paper is to outline evidence-informed framing strategies that support clearer, more constructive communication about PPC and encourage earlier engagement with palliative care services.

This narrative review synthesised literature relating to referral practices, professional barriers and communication in PPC alongside relevant insights from cognitive psychology and communication science. A structured search of MEDLINE, CINAHL and PsycINFO was conducted. Published narrative perception research examining public understanding of PPC was incorporated as contextual evidence. Findings were integrated using a narrative synthesis approach guided by Scale for the Assessment of Narrative Review Articles principles.

Evidence indicates that referral timing is influenced not only by clinical uncertainty and systemic barriers but also by entrenched narratives surrounding palliative care. Studies of paediatric consultations demonstrate that variation in communication approaches can contribute to misaligned expectations and delayed engagement. Framing science suggests that intentional language, metaphor and narrative structure can reshape understanding, reduce discomfort and promote more constructive mindsets.

Language and framing strongly shape perceptions of PPC and influence referral behaviour. Consistent use of evidence-informed framing strategies can help clinicians communicate more clearly and compassionately about PPC, reduce discomfort around referral conversations and support earlier access to services. Embedding these approaches across clinical teams, training programmes and organisations may contribute to more equitable, timely and family-centred palliative care.