Hope in Pediatric Palliative Care: A Systematic Review

Context: Previous studies and reviews in adult patients have shown that hope is an important coping mechanism in patients with serious health problems. Although there are individual studies in pediatric patients, there is a lack of a systematic review of how hope manifests and how it can be supported in children with life-threatening illnesses and their families. Objectives: This systematic review aims to identify the key factors that are associated with the experience of hope in pediatric palliative care. It examines how hope is fostered or diminished in children with life-limiting illnesses, their parents, and other family members. Methods: A systematic search was conducted across major medical databases for studies published between 1990 and 2024. Thematic analysis was used to identify factors associated with hope. The quality of the included studies was critically appraised. Results: Out of 1373 identified records, 105 studies met the inclusion criteria. Most studies were qualitative in design and met a high proportion of the applicable criteria in their respective design-specific appraisal tools. Factors associated with increased hope included open and empathetic communication, trusting relationships with healthcare providers, strong social and family support, spiritual and religious faith, effective symptom management, involvement in care decisions, and access to practical resources. Conversely, reduced hope was associated with poor communication, social isolation, uncontrolled symptoms, uncertainty, caregiver distress, financial strain, and negative healthcare experiences. These factors were consistent across cultural and diagnostic contexts, with some variation in emphasis. Conclusions: Hope in pediatric palliative care is associated with relational, psychological, spiritual, and systemic factors. Many of these are modifiable. A family-centered and multidisciplinary approach is essential to sustaining hope in pediatric palliative contexts.