Children with cancer and their parents experience high levels of stress and can struggle with their mental health during active treatment. Pediatric oncology nurses are well positioned to establish therapeutic relationships with children/parents and offer support. Since trust is the foundation of therapeutic relationships, the purpose of this review was to provide a comprehensive overview of how pediatric oncology nurses develop trust with children and their parents.
Method
A sub-analysis of 28 articles retrieved from a large scoping review using the Joanna Briggs methodology was completed to synthesize evidence on how trust is established between pediatric oncology nurses and children/parents. Data from included studies were extracted and thematically analyzed to present key themes.
Results
Trust was foundational to the provision of quality, patient- and family-centered nursing care. Key themes include: relationships, communication, nurses’ approach, nurses’ expertise, parental support, partnership, and mistrust.
Discussion
Pediatric oncology nurses should be made aware of the trust-building strategies identified in this review. Findings from this review should be utilized to inform future research that further investigates how trust is established between pediatric oncology nurses and children/parents, including how trust creates an environment for establishing therapeutic relationships and the provision of psychosocial support.
Alves Teixeira Fernandes Dos SantosG. R. A. D.De Magalhães OliveiraA.De Oliveira DiasK.Saraiva CostaB.de Souza BatistaP. (2020). Palliative care in oncology: Nurses’ experience in caring for children in the final stages of life. Revista de Pesquisa: Cuidado e Fundamental, 12(1), 689–695. https://doi.org/10.9789/2175-5361.rpcfo.v12.9463
CantrellM. A. (2007). The art of pediatric oncology nursing practice. Journal of Pediatric Oncology Nursing, 24(3), 132–138. https://doi.org/10.1177/1043454206298842
4.
CarterM. A. (2009). Trust, power, and vulnerability: A discourse on helping in nursing. Nursing Clinics of North America, 44(4), 393–405. https://doi.org/10.1016/j.cnur.2009.07.012
5.
ChenC.HuangF.ChenY.WangI. F.HuangY. (2020). Maternal caregiving for children newly diagnosed with acute lymphoblastic leukemia: Traditional Chinese mothering as the double-edged sword. Journal of Pediatric Nursing, 53, e64–e71. https://doi.org/10.1016/j.pedn.2020.02.008
6.
CoughtreyA.MillingtonA.BennettS.ChristieD.HoughR.SuM. T.ConstantinouM. P.ShafranR. (2018). The effectiveness of psychosocial interventions for psychological outcomes in pediatric oncology: A systematic review. Journal of Pain Symptom Management, 55(3), 1004–1017. https://doi.org/10.1016/j.jpainsymman.2017.09.022
7.
CoyneI.AmoryA.KiernanG.GibsonF. (2014). Children’s participation in shared decision-making: Children, adolescents, parents and healthcare professionals’ perspectives and experiences. European Journal of Oncology Nursing, 18(3), 273–280. https://doi.org/10.1016/j.ejon.2014.01.006
8.
DaviesS.SalmonP.YoungB. (2017). When trust is threatened: Qualitative study of parents’ perspectives on problematic clinical relationships in child cancer care. Psycho-Oncology, 26(9), 1301–1306. https://doi.org/10.1002/pon.4454
9.
DaviesS.YoungB.SalmonP. (2016). Towards understanding problems in the parent–practitioner relationship when a child has cancer: Meta-synthesis of the qualitative literature. Psycho-Oncology, 25(11), 1252–1260. https://doi.org/10.1002/pon.4285
10.
de FlonM.GlaffeyG.JarlL.SellbrantK.NilssonS. (2021). The childhood cancer centre is coming home: Experiences of hospital-based home care. International Journal of Environmental Research and Public Health, 18(12), Article 6241. https://doi.org/10.3390/ijerph18126241
11.
DelemereE.GitongaI.MaguireR. (2022). Utility, barriers and facilitators to the use of connected health to support families impacted by paediatric cancer: A qualitative analysis. Supportive Care in Cancer, 30(8), 6755–6766. https://doi.org/10.1007/s00520-022-07077-4
EnskärK.DarcyL.BjörkM.KnutssonS.HuusK. (2020). Experiences of young children with cancer and their parents with nurses’ caring practices during the cancer trajectory. Journal of Pediatric Oncology Nursing, 37(1), 21–34. https://doi.org/10.1177/1043454219874007
14.
FrançaJ. R. F. S.da CostaS. F. G.LopesM. E. L.da NóbregaM. M. L.de FrançaI. S. X. (2013). The importance of communication in pediatric oncology palliative care: Focus on humanistic nursing theory. Revista Latino-Americana de Enfermagem, 21(3), 780–786. https://doi.org/10.1590/S0104-11692013000300018
15.
FuringstenL.SjögrenR.ForsnerM. (2015). Ethical challenges when caring for dying children. Nursing Ethics, 22(2), 176–187. https://doi.org/10.1177/0969733014533234
16.
Garcia RodriguesJ. R.Siqueira JuniorA. C.Cerantola SiqueiraF. P. (2020). Nursing consultation in pediatric oncology: A tool for empowering parents. Rev Fun Care Online, 12(1), 211–221. https://doi.org/10.9789/2175-5361.rpcfo.v12.7569
17.
GilS.HookeM. C.NiessD. (2016). The limited English proficiency patient family advocate role: Fostering respectful and effective care across language and culture in a pediatric oncology setting. Journal of Pediatric Oncology Nursing, 33(3), 190–198. https://doi.org/10.1177/1043454215611082
18.
Gómez-GamboaE.Rodrigo-PedrosaO.San-MillánM.Saz-RoyM. A.Negre-LoscertalesA.Puig-LlobetM. (2022). The perceptions of children and adolescents with cancer regarding nurses' communication behaviors during needle procedures. International Journal of Environmental Research and Public Health, 19(15), 9372. https://doi.org/10.3390/ijerph19159372
19.
GonzalezK. M. (2017). Trust: A concept analysis with Watson’s theoretical perspective. Nursing Science Quarterly, 30(4), 356–360. https://doi.org/10.1177/0894318417724446
20.
GraetzD. E.RivasS.WangH.VedarajuY.FerraraG.FuentesL.Cáceres-SerranoA.Antillon-KlussmannF.DevidasM.MetzgerM.Rodriguez-GalindoC.MackJ. W. (2022). Cancer treatment decision-making among parents of paediatric oncology patients in Guatemala: A mixed-methods study. BMJ Open, 12(8), Article e057350. https://doi.org/10.1136/bmjopen-2021-057350
21.
HallJ.NayarS. (2014). Building trust to work with children after a severe traumatic accident. Contemporary Nurse, 46(2), 161–169. https://doi.org/10.5172/conu.2014.46.2.161
22.
HartlageH. N. (2012). Exploring boundaries in pediatric oncology nursing. Journal of Pediatric Oncology Nursing, 29(2), 109–112. https://doi.org/10.1177/1043454212438965
23.
HindsP. S.OakesL.FurmanW.QuargnentiA.OlsonM. S.FoppianoP.SrivastavaD. K. (2001). End-of-life decision making by adolescents, parents, and healthcare providers in pediatric oncology: Research to evidence-based practice guidelines. Cancer Nursing, 24(2), 122–136. https://doi.org/10.1097/00002820-200104000-00007
24.
HoogheA.RosenblattP. C.De JonghS.BakkerE.NijkampM.RoberP. (2018). “The child is our focus”: On couple issues in child oncology treatment. Psycho-Oncology, 27(10), 2482–2487. https://doi.org/10.1002/pon.4855
25.
HopiaH.Heino-TolonenT. (2019). Families in paediatric oncology nursing: Critical incidents from the nurses’ perspective. Journal of Pediatric Nursing, 44, e28–e35. https://doi.org/10.1016/j.pedn.2018.10.013
26.
HuX.GrosseS. D.HanX.MarchakJ. G.JiX. (2024). Mental health care utilization among parents of children with cancer. JAMA Network Open, 7(4), Article e244531. https://doi.org/10.1001/jamanetworkopen.2024.4531
27.
HuangT.-Y.MuP.-F.ChenY.-W. (2022). The lived experiences of parents having a child with a brain tumour during the shared decision-making process of treatment. Cancer Nursing, 45(3), 201–210. https://doi.org/10.1097/NCC.0000000000000979
28.
KarsM. C.GrypdonckM. H. F.van DeldenJ. J. M. (2011). Being a parent of a child with cancer throughout the end-of-life course. Oncology Nursing Forum, 38(4), E260–E271. https://doi.org/10.1188/11.ONF.E260-E271
29.
KazakA. E.AlderferM. A.StreisandR.SimmsS.RourkeM. T.BarakatL. P.GallagherP.CnaanA. (2004). Treatment of posttraumatic stress symptoms in adolescent survivors of childhood cancer and their families: A randomized clinical trial. Journal of Family Psychology, 18(3), 493–504. https://doi.org/10.1037/0893-3200.18.3.493
30.
KiernanG.MeylerE.GuerinS. (2010). Psychosocial issues and care in pediatric oncology: Medical and nursing professionals’ perceptions. Cancer Nursing, 33(5), E12–E20. https://doi.org/10.1097/NCC.0b013e3181d5c476
31.
KowalczykJ. R.SamardakiewiczM.FitzgeraldE.EssiafS.LadensteinR.VassalG.KienesbergerA.Pritchard-JonesK. (2014). Towards reducing inequalities: European standards of care for children with cancer. European Journal of Cancer, 50(3), 481–485. https://doi.org/10.1016/j.ejca.2013.11.004
32.
LiH. C.LopezV.Joyce ChungO. K.HoK. Y.ChiuS. Y. (2013). The impact of cancer on the physical, psychological and social well-being of childhood cancer survivors. European Journal of Oncology Nursing, 17(2), 214–219. https://doi.org/10.1016/j.ejon.2012.07.010
33.
LinB.GutmanT.HansonC. S.JuA.ManeraK.ButowP.CohnR. J.Dalla-PozzaL.GreenzangK. A.MackJ.WakefieldC. E.CraigJ. C.TongA. (2020). Communication during childhood cancer: Systematic review of patient perspectives. Cancer, 126(4), 701–716. https://doi.org/10.1002/cncr.32637
34.
MacKayL.BenziesK.BouchalS.BarnardC. (2022). Parental and health care professionals’ experiences caring for medically fragile infants on pediatric inpatient units. Children's Health Care, 51(2), 119–138. https://doi.org/10.1080/02739615.2021.1973900
35.
MacKayL. J.ChangU.KreiterE.NickelE.KamkeJ.BahiaR.ShantzS.MeyerhoffH. (2024). Exploration of trust between pediatric nurses and children with a medical diagnosis and their caregivers on inpatient care units: A scoping review. Journal of Pediatric Nursing, 78(2), e1–e30. https://doi.org/10.1016/j.pedn.2024.05.030
36.
McHaroS. K.BallyJ.SpurrS. (2022). Nursing presence in pediatric oncology: A scoping review. Journal of Pediatric Hematology/Oncology Nursing, 39(2), 99–113. https://doi.org/10.1177/10434542211041939
MonterossoL.KristjansonL. J. (2008). Supportive and palliative care needs of families of children who die from cancer: An Australian study. Palliative Medicine, 22(1), 59–69. https://doi.org/10.1177/0269216307084608
39.
MorganJ. E.PhillipsR. S.StewartL. A.AtkinK. (2020). Sharing roles and control in pediatric low risk febrile neutropenia: A multicenter focus group discussion study involving patients, parents, and health care professionals. Journal of Pediatric Hematology/Oncology, 42(5), 337–344. https://doi.org/10.1097/MPH.0000000000001827
40.
NehariM.BieloraiB.TorenA. (2008). Palestinian Children in the hemato-oncology ward of an Israeli hospital. Clinical Medicine. Oncology, 2, 1–6. https://doi.org/10.4137/cmo.s346
41.
NunesI. M.DuarteM. L. C.SilvaD. G. D.D'ÁvilaA. P.PavaniF. M.TrindadeK. D. R. (2024). The routine and mental health of hospitalized children with cancer: Family perspectives. Revista Gaúcha de Enfermagem, 45, Article e20230238. https://doi.org/10.1590/1983-1447.2024.20230238.en
42.
PavlishC.CeronskyL. (2009). Oncology nurses’ perceptions of nursing roles and professional attributes in palliative care. Clinical Journal of Oncology Nursing, 13(4), 404–412. https://doi.org/10.1188/09.CJON.404-412
43.
PetersM. D. J.GodfreyC. M.KhalilH.McInerneyP.ParkerD.SoaresC. B. (2015). Guidance for conducting scoping reviews. International Journal of Evidence-Based Healthcare, 13(3), 141–146. https://doi.org/10.1097/XEB.0000000000000050
44.
PetersM. D. J.GodfreyC.McInerneyP.MunnZ.TriccoA. C.KhalilH. (2020). Scoping reviews. In AromatarisE.MunnZ. (Eds.), JBI manual for evidence synthesis. Joanna Briggs Institute. https://doi.org/10.46658/JBIMES-20-12
45.
PetersenC. L. (2014). Spiritual care of the child with cancer at the end of life: A concept analysis. Journal of Advanced Nursing, 70(6), 1243–1253. https://doi.org/10.1111/jan.12257
46.
PhillipsC. R.HaaseJ. E.BroomeM. E.CarpenterJ. S.FrankelR. M. (2017). Connecting with healthcare providers at diagnosis: Adolescent/young adult cancer survivors’ perspectives. International Journal of Qualitative Studies on Health and Well-Being, 12(1), Article 1325699. https://doi.org/10.1080/17482631.2017.1325699
47.
RabineauK. M.MabeP. A.VegaR. A. (2008). Parenting stress in pediatric oncology populations. Journal of Pediatric Hematology/Oncology, 30(5), 358–365. https://doi.org/10.1097/MPH.0b013e318168e76b
48.
RingnérA.OlssonC.ErikssonE.FromI.BjörkM. (2021). A moment just for me—Parents’ experiences of an intervention for person-centred information in paediatric oncology. European Journal of Oncology Nursing, 51, Article 101923. https://doi.org/10.1016/j.ejon.2021.101923
49.
RitchieM. A. (2001). Psychosocial nursing care for adolescents with cancer. Issues in Comprehensive Pediatric Nursing, 24(3), 165–175. https://doi.org/10.1080/01460860121107
50.
RørtveitK.HansenB. S.LeiknesI.JoaI.TestadI.SeverinssonE. (2015). Patients’ experiences of trust in the patient–nurse relationship—A systematic review. Open Journal of Nursing, 5(3), 195–209. https://doi.org/10.4236/ojn.2015.53024
51.
SandebergM.JohanssonE.BjörkO.WettergrenL. (2008). Health-related quality of life relates to school attendance in children on treatment for cancer. Journal of Pediatric Oncology Nursing, 25(5), 265–274. https://doi.org/10.1177/1043454208321119
52.
SeitzD. C.BesierT.DebatinK. M.GrabowD.DieluweitU.HinzA.KaatschP.GoldbeckL. (2010). Posttraumatic stress, depression and anxiety among adult long-term survivors of cancer in adolescence. European Journal of Cancer, 46(9), 1596–1606. https://doi.org/10.1016/j.ejca.2010.03.001
53.
ShepherdE. J. W.WoodgateR. L. (2011). A journey within a journey: The lived experience of parents who do not live near their child’s tertiary cancer center. Journal of Pediatric Oncology Nursing, 28(4), 231–243. https://doi.org/10.1177/1043454211409583
54.
SiskB.KeenanM. A.BlazinL. J.KayeE.BakerJ. N.MackJ. W.DuBoisJ. M. (2021a). “Don’t be afraid to speak up”: Communication advice from parents and clinicians of children with cancer. Pediatric Blood & Cancer, 68(8), Article e29052. https://doi.org/10.1002/pbc.29052
55.
SiskB.SchulzG. L.BlazinL. J.BakerJ. N.MackJ. W.DuBoisJ. M. (2021b). Parental views on communication between children and clinicians in pediatric oncology: A qualitative study. Supportive Care in Cancer, 29(9), 4957–4968. https://doi.org/10.1007/s00520-021-06047-6
56.
SteeleA. C.KaalJ.ThompsonA. L.BarreraM.CompasB. E.DaviesB.FaircloughD. L.FosterT. L.Jo GilmerM.HoganN.VannattaK.GerhardtC. A. (2013). Bereaved parents and siblings offer advice to health care providers and researchers. Journal of Pediatric Hematology/Oncology, 35(4), 253–259. https://doi.org/10.1097/MPH.0b013e31828afe05
57.
SteeleA. C.MullinsL. L.MullinsA. J.MurielA. C. (2015). Psychosocial interventions and therapeutic support as a standard of care in pediatric oncology. Pediatric Blood Cancer, 62(5), S585–S618. https://doi.org/10.1002/pbc.25701
58.
StremlerR.HaddadS.PullenayegumE.ParshuramC. (2017). Psychological outcomes in parents of critically ill hospitalized children. Journal of Pediatric Nursing, 34, 36–43. https://doi.org/10.1016/j.pedn.2017.01.012
59.
TriccoA. C.LillieE.ZarinE.O'BrienK. K.colquhounH.LevacD.MoherD.PetersM. D.HorsleyT.WeeksL.HempelS. (2018). PRISMA Extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/10.7326/M18-0850
60.
van der PlasE.DarjiH.SrivastavaD. K.SchapiroM.JeffeD.PerkinsS.HowellR.LeisenringW.ArmstrongG. T.OeffingerK.KrullK.EdelsteinK.HayashiR. J. (2024). Risk factors for neurocognitive impairment, emotional distress, and poor quality of life in survivors of pediatric rhabdomyosarcoma: A report from the childhood cancer survivor study. Cancer, 130(12), 2224–2236. https://doi.org/10.1002/cncr.35236
61.
YamajiN.SutoM.TakemotoY.SuzukiD.LopesK. d. S.OtaE. (2020). Supporting the decision making of children with cancer: A meta-synthesis. Journal of Pediatric Oncology Nursing, 37(6), 431–443. https://doi.org/10.1177/1043454220919711
