Age-appropriate interventions to address illness perceptions in paediatric oncology: Findings from an expert Delphi...

Paediatric cancer patients face psychosocial challenges, with illness perceptions (IP) playing a central role in coping and health‑related behaviour. While evaluated interventions targeting IP are available in adult oncology, comparable age‑appropriate approaches are lacking in paediatric oncology. This study presents an expert‑derived pool of puppet‑based play therapy interventions aimed at fostering adaptive IP in children aged four to ten years, appraised with regard to suitability and practical implementation.

As a first analytic step informing a two‑round Delphi process, 21 theory‑guided fictional case vignettes were developed, incorporating the patient's medical treatment context. Psychosocial experts in paediatric oncology proposed puppet‑based play therapy interventions for each vignette and appraised their suitability and practical implementation. Consensus was determined using the median, supported by descriptive analyses for fine‑grained interpretation.

Nineteen psychosocial experts participated in Delphi study 1 and, based on 21 fictional case vignettes, generated 151 intervention suggestions. In Delphi study 2, 22 experts reached consensus on the suitability of all 151 interventions and on the implementability with a puppet of 86 interventions. All interventions were included in the intervention pool.

The findings indicate expert consensus on the clinical relevance of IP‑focused interventions, while highlighting the need for context‑sensitive application. Puppet play emerged as a valuable option within a broader repertoire of age‑appropriate therapeutic techniques.

The study provides an initial foundation for a structured, needs‑based approach to addressing illness perceptions in paediatric oncology with age‑appropriate methods (e.g., puppet play) and informs future development and evaluation of theory‑guided interventions across treatment settings.