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Age-appropriate interventions to address illness perceptions in paediatric oncology: Findings from an expert Delphi
Jessy Herrmann1, Franziska Fangmeier2, Anna Winter3
1Department of Paediatric Oncology, Haematology and Haemostaseology, Leipzig University, Leipzig, Germany; Parents Association for Children with Cancer Leipzig, Leipzig, Germany.
Insights
Childhood cancer patients need tailored support for psychosocial challenges. This study developed expert-approved puppet play interventions to help children aged 4-10 manage illness perceptions (IP) and improve coping skills.
Area of Science:
- Psychosocial Oncology
- Child Psychology
- Therapeutic Interventions
Background:
- Paediatric cancer patients experience significant psychosocial challenges impacting coping and behavior.
- Illness perceptions (IP) are central to managing these challenges, yet age-appropriate interventions are scarce in pediatric oncology.
- Existing interventions for adult oncology are not directly transferable to children.
Purpose of the Study:
- To develop and appraise a pool of puppet-based play therapy interventions for children aged 4-10 years.
- To foster adaptive illness perceptions (IP) in pediatric cancer patients.
- To assess the suitability and practical implementation of these interventions by psychosocial experts.
Main Methods:
- A two-round Delphi process was employed, informed by 21 theory-guided fictional case vignettes.
- Psychosocial experts in pediatric oncology proposed and evaluated puppet-based play therapy interventions for each vignette.
- Consensus on suitability and implementability was determined using median scores and descriptive analyses.
Main Results:
- Nineteen experts generated 151 intervention suggestions in the first Delphi round.
- Twenty-two experts in the second round reached consensus on the suitability of all 151 interventions.
- Consensus was achieved on the implementability with a puppet for 86 interventions, forming the final intervention pool.
Conclusions:
- Expert consensus confirms the clinical relevance of interventions targeting illness perceptions (IP) in pediatric oncology.
- Puppet play is identified as a valuable, age-appropriate therapeutic technique within a broader intervention repertoire.
- The study provides a foundation for developing and evaluating theory-guided, needs-based interventions for pediatric cancer patients.
Background:
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.
Methods:
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.
Results:
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.
Discussion:
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.
Conclusion:
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.
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