Understanding the impact of ‘wish-granting’ interventions on the health and well-being of children with life-threatening health conditions and their families: A systematic review

Abstract

This review aimed to explore how wish-granting interventions impact on the health and well-being of children with life-threatening health conditions and their families, using any study design. Six electronic databases (Medline; PsycINFO; CINAHL; Embase; AMED and HMIC) were systematically searched to identify eligible research articles. Studies were critically appraised using a Mixed Methods Appraisal Tool. Findings were synthesized narratively. 10 papers were included, reporting studies conducted across five countries, published from 2007 to 2019. Study designs were diverse (four quantitative; two qualitative and four mixed method). Results indicated improvements to physical and mental health, quality of life, social well-being, resilience and coping for wish children, parents and siblings. In conclusion, wish-granting interventions can positively impact health and therefore should not be discouraged; however, more research is needed to define and quantify the impact of wish fulfilment and to understand how it can be maximized.

Keywords

Child health psychology positive quality of life systematic review

Background

More than 49,000 children and young people in the United Kingdom alone live with a serious, life-threatening or life-limiting illness (Fraser et al., 2012). This figure continues to rise annually. Life-limiting conditions in children and young people can be defined as conditions for which there is no cure, or for which curative treatment may be feasible but can fail and from which children or young people will, at some point, die prematurely (Together for Short Lives, 2018). While some children with serious illness will die young, others will live for many years, albeit with restrictions and almost inevitably dependent on intensive treatment regimens to prolong life.

Despite increasing survival rates for children with serious illness, physical symptoms of living with a life-threatening condition (e.g. pain and fatigue), burden of managing these conditions (e.g. worry, daily hassles and family conflict), restrictions to participation in everyday activities (e.g. lost days from school, fewer contacts with peers and difficulties in accessing activities) and feelings of difference to healthy peers can lead to significantly poorer quality of life (Barthel et al., 2018; Lambert and Keogh, 2015; Moreira et al., 2013). Parenting a child with additional health care needs also significant impacts on parental stress and family functioning (Lewandowski et al., 2010), commonly implying a substantial economic load for families (Groenewald et al., 2014).

There is a need for interventions to support families of children living with life-threatening health conditions (Siden and Steele, 2015). Positive psychological approaches strive to do more than reduce distress, and they seek to promote positive emotions and personal growth, aiming to build strengths and resources that enable individuals to thrive (Joseph and Linlet, 2005). Evidence suggests that positive psychology interventions are considered feasible and acceptable by patients (Ghosh and Deb, 2017) and can enhance psychological well-being as well as reduce negative symptoms (Bolier et al., 2013; Sin and Lyubomirsky, 2009). Emerging research further demonstrates associations between enhancing subjective well-being (including happiness, hope and optimism) and improved physical health outcomes (Diener and Chan, 2011; Schiavon et al., 2017). In the paediatric context, this comprises programmes aimed at cultivating positive emotions, behaviours and cognitions. Examples include ‘clown doctor’ interventions (Costa-Fernandes and Arriaga, 2010; Dionigi et al., 2014), play and music therapy (Hendon and Bohon, 2007) and hope-based therapy (Venning et al., 2008).

One form of positive psychological intervention delivered to children with life-threatening health conditions is wish-granting. Often carried out by charitable organizations (e.g. Make-A-Wish; Rays of Sunshine; Dreams Come True; Starlight and When You Wish Upon a Star), wish-granting seeks to improve the lives of children with life-threatening medical conditions and their families by fulfilling a wish of their choice. Examples include meeting a celebrity, going on a special holiday or shopping spree and being a train driver for a day. In doing so, wishes aim to enhance children’s subjective well-being and psychological resources for coping with their condition (Chaves et al., 2016b). It is suggested that improving these domains could also impact on increased engagement with treatment and thus improve clinical outcomes (Chaves et al., 2016b). For parents, wish-granting is anticipated to provide respite from dealing with their child’s situation thus briefly alleviating their experience of emotional pain (Chaves et al., 2016a). While these benefits to child and family health have been reported in individual research studies, to date there has been no attempt to systematically review the evidence for such benefits.

Aim

To explore how wish-granting interventions impact on the health and well-being of children with life-threatening health conditions and their families, using any study design.

Methods

Protocol and registration

A review protocol was developed following PRISMA-P guidelines. It was registered with Prospero international prospective register of systematic reviews related to health care and social sciences (registration number: CRD42018092960) and can be accessed on the Prospero website (https://www.crd.york.ac.uk/prospero).

Eligibility criteria

Studies had to report findings of research exploring the effect of wish-granting interventions on children and young people (from birth to 18 years) with a clinically diagnosed, life-threatening health condition and/or on parents/guardians or other close family members. ‘Wish-granting’ was defined as an act that provided sick children and their families with a desired event or item. Studies had to report outcomes relating to the child or families’ physical well-being (e.g. mobility, sleep, pain and medication adherence) or psychosocial well-being (e.g. mood, stress levels and feelings of isolation). Outcomes also included measures of quality of life. Interventions could be delivered in any setting, worldwide. No health conditions were excluded. No restrictions were placed on the type of study; thus, qualitative, quantitative and mixed methodologies were included, as were studies with no or any comparison groups. No restrictions were placed on date of publication; however, only studies published in English were included.

Information sources and systematic search

Six electronic databases (Medline; PsycINFO; CINAHL; Embase; AMED and HMIC) were searched from 1980 until September 2019. Reference lists and forward citations of included studies and relevant literature reviews were hand-searched, and publication lists of key authors checked. Grey literature were identified by searching Google Scholar, ProQuest Dissertations and Theses database, and Conference Proceedings Citation Indices for Science, and for Social Science and Humanities, available through Web of Science.

A comprehensive search strategy was developed and adapted for use with each electronic database. It included a combination of free-text terms, index headings and Boolean operators (OR and AND) to combine synonyms and key concepts including population (children with life-threatening health conditions and their families), intervention (wish-granting) and outcome (impact on physical well-being; psychosocial well-being; quality of life and health). Authors of included studies were contacted to identify additional studies. Supplementary material presents the final search strategy.

Study selection

Full references (including abstracts) of all articles returned by the searches were retrieved and saved using reference management software (EndNote X8 Clarivate^TM). Following removal of duplicate studies, titles and abstracts were screened for relevance by the review team. Papers that clearly did not meet the inclusion criteria were excluded. Full text copies of all other studies were independently assessed against the inclusion criteria by two reviewers. Uncertainties were resolved through discussion with a third reviewer.

Data extraction and management

Information were extracted from each included article using a specially designed data extraction form by one researcher and reviewed by another (Jahan et al., 2016). Data were extracted in accordance with the context and methodology of the study and the review aim. This included information on country and setting, research aim, study design, participant details, intervention, comparator (where relevant), data collection and analysis methods, outcomes and all reported findings. As we were expecting to deal with high heterogeneity, a descriptive narrative review was planned (Popay et al., 2006).

Data synthesis

The narrative synthesis approach was selected for its ability to bring together broad knowledge from a variety of methodologies (Jahan et al., 2016). In synthesizing study findings, guidelines set out by Popay et al. (2006) were followed. These included (i) developing a preliminary synthesis, (ii) exploration of relationships within and between studies and (iii) assessment of the robustness of the synthesis. Preliminary synthesis consisted of extracting and reporting descriptive characteristics of included studies in a table and producing a textual summary of findings for each study. Findings across studies were then compared and categorized into broad, descriptive themes (e.g. wish experience; positive/negative impact on wish – child, families and others and evaluation of wish-making organizations). These initial categories were then interrogated and refined to specify the impact of wishes on different aspects of health and well-being (e.g. physical, mental and social) for children and their families. Explanations for how and why wishes produced these specific effects were also discussed and developed in accordance with the data (e.g. distraction, respite and re-conceptualization of self). Only those themes which answered the review question were included in the final synthesis. The robustness of synthesis findings was assessed both in terms of the quality of individual studies (see Quality assessment) and the strength of evidence for each outcome, across the data set as a whole.

Quality assessment

Study quality was evaluated using a Mixed Methods Appraisal Tool (MMAT) (Pluye et al., 2009). MMAT appraises and describes methodological quality using three domains: mixed, qualitative and quantitative (subdivided into three subdomains: randomized controlled, nonrandomized and descriptive). Two researchers independently assessed included studies for quality. Discrepancies were resolved through discussion with a third reviewer.

Findings

Searches

Articles were retrieved for assessment against the inclusion criteria (N = 1012), with 10 included in the review (Figure 1). Studies were conducted across five countries (Canada, the United States, Israel, Spain and the Netherlands), published between 2007 and 2019. Participants included children, parents, health professionals and volunteers. Study designs comprised four quantitative studies (wait-list controlled trials and retrospective chart review), two qualitative studies (ethnography and interviews and drawing analysis) and four mixed method studies (surveys, interviews, focus groups and nominal group technique). Sample sizes ranged from N = 66–124 participants in randomized controlled trials, N = 235–711 in questionnaire studies, N = 8–55 in qualitative studies and N = 992 in the case-controlled retrospective chart review (Table 1).

Figure 1.

PRISMA flow chart.

Table 1.

Characteristics of included studies.

Study	Country/setting	Study aim	Study design	Sample	Data collection (+measures)	Data analysis	Main findings	Quality assessment
Chaves et al. (2016a)	Spain/hospital	To investigate whether granting a wish of a child with life-threatening illness promotes well-being in his or her parents	Wait-list control trial	38 fathers and 86 mothers. In 24 cases, both parents participated	Wish group children and parents completed self-report measures at time 1 (2–3 days pre-wish) and time 2 (3 weeks post-wish). The waiting list control group was assessed following an equivalent time-lag. Measures used: Positive and Negative Emotional Style Scale; The Benefit Finding Scale for Children; Beliefs in the Benevolence of the World Scale; the Life Orientation Test and Values in Action Inventory of Strengths	A series of mixed between – within subject analyses of variance were used to compare scores on the measures of well-being between the wish group and the waiting list control group across two time periods (T1 and T2) Univariate F tests were examined for each dependent variable (confidence intervals adjusted by the Bonferroni procedure)	Wish-granting interventions successfully promoted positive emotion in parents and had effects that lasted for several weeks. Both fathers and mothers in the wish group increased their beliefs in the benevolence of the world compared to those in the control group. In addition, mothers in the wish group reported significantly higher benefit finding, gratitude and love after the granting of the wish than those in the comparison group	Clear research questions? Yes Data addresses research questions? Yes Appropriate randomization? Can’t tell Baseline comparable? Yes Outcome data complete? Yes Outcome assessors blinded? Can’t tell Adherence to intervention? Yes
Chaves et al. (2016b)	Spain/hospital	To investigate whether granting wishes promotes positive psychological responses and positive physical changes (i.e. reductions in pain and nausea) in children with a life-threatening illness	Wait-list control trial	78 children with severe physical illnesses. Child ages ranged from 5 to 18 years. All children were Caucasian, and 45 children were male. 38 fathers and 86 mothers also participated. The mean age was 43.08 and 40.75, respectively	Wish group children completed self-report measures. Parents completed proxy-report measures for their child. Measures were completed at time 1 (2–3 days pre-wish) and time 2 (3 weeks post-wish). All measures were used at both T1 and T2. The waiting list control group was assessed following an equivalent time-lag. Measures used: Positive and Negative Emotional Style Scale; Student Life Satisfaction Scale; Brief Multidimensional Students’ Life Satisfaction Scale and Paediatric Quality of Life Scale; Benefit Finding Scale for Children; Beliefs in the Benevolence of the World Scale and Youth Life Orientation Test; Values in Action Inventory of Character Strengths for Youth; Health-Related Paediatric Quality of Life Scale; Centre for Epidemiologic Studies Depression Scale	A series of repeated measures mixed between–within subject ANOVAs were used to compare scores on the measures of well-being between the wish group and the waiting list control group across two time periods (T1 and T2)	The wish intervention significantly increased levels of positive emotions, satisfaction with life, personal strengths (higher gratitude and love) and reduced rates of nausea compared with the control group. Mothers in the wish group also perceived positive changes in children’s benefit finding and general quality of life, especially in physical, school and emotional domains. Mothers in the wish group also reported a perceived decrease in their child’s concerns about the disease	Clear research questions? Yes Data addresses research questions? Yes Appropriate randomization? Can’t tell Baseline comparable? Yes Outcome data complete? Yes Outcome assessors blinded? Can’t tell Adherence to intervention? Yes
Darlington et al. (2013)	Netherlands/community	To investigate the experience of children and parents during and after a wish is granted	Mixed methods	17 sets of parents completed semi-structured interviews. 235 parents completed a postal questionnaire. 174 questionnaires completed by parents whose child was still alive at the time of study. 79.6% of questionnaires completed by mothers. Mean age of the parents was 44.5 years	Semi-structured interviews with parents. Postal questionnaire developed for the study based on interviews; contained questions on experiences during and after the wish, changes in well-being (such as physical and psychological functioning and quality of life) and coping during and after the event, and possible negative feelings about the wish	Interviews were independently analysed by two researchers to inform development of a questionnaire. Questionnaire analyses were run using SPSS, version 17	The wish is a positive experience that is thoroughly enjoyed by patients and parents. Conversely, the event is accompanied by negative feelings, as the life-threatening nature of the child’s illness is continuously confirmed. Overall, the positive impact seems to prevail indicating that, from an ethical point of view, these activities should not be discouraged. Lasting psychological effects, apart from having an important positive memory, are only observed by a minority	Clear research questions? Yes Data addresses research questions? Yes Adequate rationale for mixed methods? Yes Components effectively integrated? Yes Components effectively interpreted? No Inconsistencies addressed? Can’t tell Components adhere to methodological quality criteria? Can’t tell
Deschenes (2009)	Canada/community	To conceptualize/understand ill children’s wish granting and its impact on the relationships among the various actors as they are deployed throughout the process	Qualitative	Various actors involved in the fulfilment of wishes (wish charity staff, donors, volunteers, ill children, their families and friends and healthcare professionals)	8 months full-time ethnographic fieldwork: Observations of daily activities and gatherings within the Children’s Wish Foundation of Canada (complemented by 2 years of sporadic data collection) + informal and formal interviews with various actors. Information gathered on the wish foundation itself, the wishes and their process of realization, and the various actors' roles and perspectives	Data analysed following Arnould and Wallendorf’s (1994) recommendations. Observations, interviews and document review formed basis of a systematic analysis of behaviours and discourse at an emic level in order to gain an experiential understanding of the actors and the process. Gronroos' (2004) relationship framework was used to organize, categorize and analyse the flow of information to account for the process-based nature of the phenomenon	The Wish Factory manifests itself as a process that engages a large and diversified network of actors, all involved in the creation of an extraordinary event for families facing the turmoil of childhood illness. The wish is felt as an experience that can have deep existential impacts on families. Such impacts can be experienced at two levels. First, the wish is a highly anticipated event that can reignite a state of hopefulness in a situation where hope was dwindling. Hope in the wish is infectious and has the power to extend its reaches beyond the wish itself. It can also have a highly emotional impact on other actors, such as the wish coordinator or volunteers	Clear research questions? Yes Data addresses research questions? Yes Qualitative approach appropriate? Yes Appropriate data collection? Yes Findings derived from data? Yes Interpretation wsubstantiated by data? Yes Coherence in methodology/method? Yes
Ewing (2007)	USA/community	To understand how children with a life-threatening illness experience having a wish. To understand the needs and problems of the child who has a life-threatening illness	Qualitative	Twelve pictures drawn by children who had received a wish were given to the researcher, and eight were selected for the study. The children whose drawings were selected ranged from 6 to 14 years of age	Young people’s drawings of what having a wish fulfilled means to them	Hermeneutic inquiry was used to unveil the meaning of having a wish fulfilled for children with a life-threatening illness. Each drawing was ‘transcribed’ into a written text by the researcher. Drawings were analysed according to a modification of an analysis process described by Diekelmann and Ironside (1998)	The findings of this study are summarized by the constitutive pattern ‘living in limbo’. This constitutive pattern represents a common idea found in all selected drawings. In addition, five themes were identified: Being a child – playing, wishing and hoping; ‘why can’t I be like the rest of the kids?’; ‘I am trying to balance things’; ‘I am all alone’ and ‘I need to find a comfortable place to be’.	Clear research questions? Yes Data addresses research questions? Yes Qualitative approach appropriate? Yes Appropriate data collection? Yes Findings derived from data? Can’t tell Interpretation substantiated by data? Can’t tell Coherence in methodology/method? Yes
Galinsky (2014)	USA/community	To investigate the views of families, staff, and key informants involved with Dreams Come True (organization facilitating wishes) To identify positive and less positive aspects of Dreams Come True	Mixed methods	10 charity staff; 10 parents whose child had experienced dream/wish fulfilment within the previous year; 18 health professionals who had made three or more wish referrals over the previous 3 years	Focus group meetings using the nominal group technique were held for parents and staffFocus group meetings using the nominal group technique were held for parents and staff Email survey sent to health professionals	Nominal group technique and thematic analysis	Wishes boost morale and provide goals for young people during difficult periods. Although Dreams Come True provides wishes to young people up to age 21 years (unlike most paediatric services), many would like this to be extended to age 25 years. Polite, approachable and empathetic staff mean a lot to families of children and young people with life-limiting and long-term conditions	Clear research questions? Yes Data addresses research questions? Yes Adequate rationale for mixed methods? Yes Components effectively integrated? Yes Components effectively interpreted? Yes Inconsistencies addressed? Can’t tell Components adhere to own methodological quality criteria? Yes
Make A Wish USA (2011)	USA/community	To measure how wishes ‘enrich the human experience with hope, strength and joy’. To define constituent outcomes related to the MAW mission	Mixed methods	Discovery phase to identify outcomes: 11 family members; 12 staff and volunteers; 8 donors/sponsors; 7 medical professionals and 17 stakeholders (n = 55) Survey to measure outcomes: 405 volunteers; 306 parents of children who had their wish granted within the last year (n = 711)	Discussion groups and interviews to identify wish outcomes Two surveys developed for the study, designed to assess and measure the outcomes that volunteers, wish children and families gain through their wish experiences (the volunteer outcomes survey and family/child outcomes survey)	Exploratory factor analyses were conducted to examine outcome constructs used in the surveys	Survey responses indicated that the wish impact is not limited to the immediate emotional effects on wish children. Rather, wishes broadly impact a wide community, known to encompass the many people involved with or exposed to wish-granting. Positive effects include emotional and social benefits, life enrichment, social awareness, inspiration, enhanced resilience and coping ability and gratification, and for wish children, improved strength and desire to overcome their illnesses	Clear research questions? Yes Data addresses research questions? Yes Adequate rationale for mixed methods? Yes Components effectively interpreted? Yes Inconsistencies addressed? Can’t tell Components adhere to own methodological quality criteria? No
Patel et al. (2019)	USA/hospital	To evaluate the impact of receiving a wish on patient healthcare utilization and savings benefit measures	Case control chart review	496 wish children and 496 controls matched on gender, disease category and complexity. Wish children were younger and had a higher disease complexity than controls	Data (demographics; emergency department visits; urgent care facility visits; unplanned hospitalizations; length of stay and hospital charges) were extracted from patient’s electronic health records	Conditional logistic regression models were used to compare the proportion of patients whose unplanned hospital admissions decreased from year one to year two. Conditional logistic regression was used to compare the odds of achieving cost-effectiveness	Patients who received a wish were 2.5 and 1.9 times more likely to experience a drop in unplanned hospital admissions and ED visits, respectively, compared to patients who did not receive a wish. These decreases were associated with a higher likelihood (2.3-fold and 2.2-fold greater odds) of the wish achieving a savings benefit compared to hospital charges	Clear research questions? Yes Data addresses research questions? Yes Appropriate sampling strategy? Yes Representative sample? Yes Appropriate measurements? Yes Low risk of bias? Yes Appropriate statistical analysis? Yes
Schilling & Sarigiani (2014)	USA/community	To explore the perceived benefits of wishes granted by the Make-A-Wish Foundation of Michigan from the perspective of children who are ill, siblings and caregivers	Mixed methods	A total of 682 surveys were completed and returned from a pool of 3000. The majority of those completing the surveys were mothers of wish children (83.5%), followed by fathers (8.3%), both parents (1.5%), legal guardians (1.8%) and others (3.9%)	A survey was designed by the research team to explore the beneficial effects of wishes granted to families. Questions focused on families with children coping with life-threatening or chronic illness. Surveys were mailed by the MAW foundation to all wish family households, followed by a reminder postcard. Completed surveys were returned to the investigator in enclosed self-addressed stamped envelopes. Surveys included both closed and open questions	ANOVAs were used to compare the relationship between the wish benefits to the type of wish offered, wish child diagnosis, health of the wish child and wish child age when the gift was implemented. Where appropriate, a post-hoc Games-Howell test was used to determine the differences between groups and account for unequal group sizes. An independent sample t-test was used to compare perceived benefits of wish experience for siblings and caregivers. Content analysis used to analyse open-ended question responses	Benefits to wish child: Fun, excitement and adventure; time to relax and enjoy; distraction from medical treatment; comfort and assurance related to illness; enhanced emotional well-being; feelings of normalcy – thought less about illness; something to look forward to; positive memories; sense of hope and optimism; time to engage with/enjoy family and friends; enhanced interactions with family; eased communication about the illness and enhanced concern for others (less egocentricity) Benefits to siblings: Positive memories; greater sharing with the wish child; greater sense of comfort and assurance about their sibling’s illness Benefits to parents: Greater sense of emotional well-being	Clear research questions? Yes Data addresses research questions? Yes Adequate rationale for mixed methods? Yes Components effectively integrated? Yes Components effectively interpreted? Yes Inconsistencies addressed? Yes Components adhere to methodological quality criteria? Yes
Shoshani et al. (2016)	Israel/hospital	To evaluate the efficacy of the make a wish intervention for children with life-threatening cancer	Wait-list control trial	66 Israeli-born Jewish children with cancer, aged 5–12 years. 32 children in the wish fulfilment intervention group and 34 children in the waiting list control group	Questionnaires administered pre-intervention (time 1) Brief Symptom Inventory 18 (BSI-18); Paediatric Quality of Life Inventory (PedsQLTM4.0); the Positive and Negative Affect Schedule for Children (PANAS-C) Post-test data collection took place 5 weeks after wish fulfilment (time 2). Measures included The Life Orientation Test-Revised (LOT-R) and Herth Hope Index (HHI)	Repeated measures ANOVAs were used to examine the overall intervention effect and change for the outcome variables in the intervention and control groups at the two assessment points (baseline and after wish fulfilment)	Children who received the wish intervention had higher levels of hope regarding their future; increased positive emotions and health-related quality of life; and a better psychological profile manifested by lower levels of depression, anxiety, and psychological symptomatology	Clear research questions? Yes Data addresses research questions? Yes Appropriate randomization? Yes Baseline comparable? Yes Outcome data complete? Yes Outcome assessors blinded? Yes Adherence to intervention? Yes

Quality appraisal

All studies were assessed as having a clear research question with appropriate data collection processes. Qualitative studies generally scored well, although one (Ewing, 2007) was unclear on how findings derived from the data. This was because data constituted drawings, not all of which were presented in the article. One randomized trial scored highly (Shoshani et al., 2016), the other two (Chaves et al. 2016a, 2016b) did not adequately describe randomization or blinding processes. Mixed method studies scored highly on methodological quality, although three (Darlington et al., 2013; Galinsky, 2014; Make-A-Wish USA (MAWUSA, 2011) did not address inconsistencies between qualitative and quantitative data (Table 1).

Synthesis of findings

Wish experience

Wish interventions afforded positive, joyful experiences for children with life-threatening illnesses and their families (Darlington et al., 2013; Galinsky, 2014). ‘To go’ wishes were most frequently requested (Patel et al., 2019), with holidays and trips to Disney World/land most popular (Ewing, 2007; Schilling and Sarigiani, 2014). Other wish types included ‘To have’ (e.g. a computer), ‘To meet’ (e.g. a celebrity) and ‘To be’ (e.g. a fireman). Wishes were described as ‘extraordinary’ (Deschenes, 2009), ‘more than expected’ (Schilling and Sarigiani, 2014) and once in a lifetime experience. Wishes were also constructed as a sign of hope (Deschenes, 2009; Shoshani et al., 2016). Hope associated with the child’s eligibility to receive a wish; hope for positive wish-related outcomes (e.g. positive experiences); hope for improved illness-related outcomes (e.g. positive effects on a child’s health/condition) and hope for a brighter future.

Wishes were found to generate special and lasting memories, an experience that families would never forget (Deschenes, 2009; Galinsky, 2014; MAWUSA, 2011; Schilling and Sarigiani, 2014). Memories were protected and evoked through use of photographs and mementos (Schilling and Sarigiani, 2014). Most parents and many siblings participated in wishes, meaning that benefits extended beyond wish children to other family members (Chaves et al., 2016a; Darlington et al., 2013; Deschenes, 2009; MAWUSA, 2011; Schilling and Sarigiani, 2014), as well as wish charity volunteers (MAWUSA, 2011).

Receiving wishes within the context of a child’s illness also led to conflicted emotions for some families, serving as a reminder of the child’s health status (Ewing, 2007; Darlington et al., 2013). Other negative factors included timing of the wish, barriers in accessibility (e.g. for wheel chairs), too much to do in the time (rushed wishes), difficulties with travel and family dynamics (Schilling and Sarigiani, 2014). For some, wishes were experienced as emotionally and physically draining. Nevertheless, wish fulfilment was, in all studies described as a positive experience, with several benefits identified for families. These included improvements to physical health, mental health, quality of life, social well-being, coping and resilience.

Impact on wish children

Physical health

Benefits of receiving a wish included improvements to physical health, including a reduction in unplanned hospitalizations (Patel et al., 2019). These post-wish changes were reported by wish children (Chaves et al., 2016b; Ewing, 2007; Shoshani et al., 2016) and their parents (Chaves et al., 2016b; Darlington et al., 2013; MAWUSA, 2011; Schilling and Sarigiani, 2014). Both waiting list–controlled trials found improvements in physical health for the intervention group compared with the control group, from baseline to time two (Chaves et al., 2016b; Shoshani et al., 2016). Statistically significant improvements to physical health included reduced nausea in wish children compared with non-wish children (Chaves et al., 2016b), increased energy levels post-wish (Darlington et al., 2013; MAWUSA, 2011), improved physical strength (MAWUSA, 2011; Schilling and Sarigiani, 2014) and improved functional skills (Chaves et al., 2016b; Schilling and Sarigiani, 2014). Seventy-five percent of parents in one study described improvements in their child’s health condition and physical mobility (MAWUSA, 2011). Patel et al. (2019) reported fewer unplanned hospital admissions and emergency department visits for children who had received a wish compared with matched controls.

Mental health and emotional well-being

Wish group children were generally found to have improved mental health and emotional well-being; displaying more positive emotions and fewer symptoms of depression, sadness, anxiety and fear than non-wish children. This was reported from the wish child perspective (Chaves et al., 2016b; Ewing, 2007; Shoshani et al., 2016) and their parents (Darlington et al., 2013; MAWUSA, 2011; Schilling and Sarigiani, 2014). In the two controlled trials, intervention group children exhibited a significant reduction in general distress, depression and anxiety at time two compared with the control group (Shoshani et al., 2016), as well as showing higher positive emotion scores (Chaves et al., 2016b). An increased sense of joy, happiness, hope and optimism in wish children was reported in a further three studies (MAWUSA, 2011; Schilling and Sarigiani, 2014; Shoshani et al., 2016). Explanations for this finding could be that wish fulfilment eased the burden of living with a life-limiting condition (Shoshani et al., 2016) or because it enabled children to temporarily not feel ill during their wish (Darlington et al., 2013). Providing an opportunity for respite or distraction from the illness, clinical care and treatment, even if only for a short period of time, was described by parents as contributing to their child’s improved mental health and emotional well-being (Galinsky, 2014; MAWUSA, 2011; Schilling and Sarigiani, 2014).

Quality of life

Improvements to child quality of life were reported by wish group children (Chaves et al., 2016b; Ewing, 2007; Shoshani et al., 2016) and parents (Darlington et al., 2013; MAWUSA, 2011; Schilling and Sarigiani, 2014), with children reporting increased satisfaction with life after the wish, where no increases were seen in waiting list comparators (Chaves et al., 2016b; Shoshani et al., 2016). From a parent perspective, wishes facilitated feelings of normalcy for their children, both in terms of an opportunity to experience ‘normal life’ activities and be part of a ‘normal’ family (MAWUSA, 2011; Schilling and Sarigiani, 2014). Wishes were also reported to provide something to look forward to (MAWUSA, 2011; Schilling and Sarigiani, 2014), enabling a shift in focus away from illness and treatment, towards wish anticipation. Finally, wishes were perceived to create positive, happy memories for families (Deschenes, 2009; Galinsky, 2014; MAWUSA, 2011; Schilling and Sarigiani, 2014).

Social well-being

Improved social well-being as indicated by increased scores on scales of gratitude, love, communication and benefit finding were reported by children receiving wishes and their parents, where no increases were seen in waiting list controls (Chaves et al., 2016b). Improvements in wish child social skills were also reported. Parents in one study (Schilling and Sarigiani, 2014) reported that wishes contributed to improved child communication with family and friends, better communication about the illness and enhanced concern for others (less egocentricity). Wish children in the MAWUSA (2011) study were reported to show increased desires to ‘give back’ or help others or someone else’s family by taking up volunteering activities.

Resilience and coping

Parents reported wish children to demonstrate improvements in coping and resilience (Darlington et al., 2013; Galinsky, 2014; MAWUSA, 2011; Schilling and Sarigiani, 2014). This included increases in child self-esteem and confidence (MAWUSA, 2011; Schilling and Sarigiani, 2014) as well as boosting morale (Galinsky, 2014). Such changes are suggested to indicate improved resilience and coping in children, including an increased ability to cope with their illness and an increased sense of empowerment (MAWUSA, 2011).

Health choices and actions

In one study (MAWUSA, 2011), between 79 and 89% of parents agreed that improvements in children’s health choices, attitudes and actions accompanied or followed a wish experience. Specifically, these parents supported that wishes increased their child’s willingness to work towards improved health outcomes; willingness and effort to improve physical strength and an increased willingness to comply with, and actual compliance with, treatment regimen. Such changes could have been a factor in the reduction of unplanned hospital visits for wish children reported by Patel et al. (2019).

Impact on wish child’s parents/guardians

Mental health and emotional well-being

Of the four studies reporting parent’s views of how their child’s wish experience impacted their own health, three described improvements to parental mental health and emotional well-being (Chaves et al., 2016a; Darlington et al., 2013; MAWUSA, 2011). In a controlled trial, Chaves et al. (2016a) reported higher positive emotion scores for wish intervention parents compared with control group parents, as well as increased positive emotion between time one and time two, where control group parents did not. MAWUSA (2011) further reported 98% of parents in their sample agreed that wish fulfilment had generated a sense of hope in them as parents, an improved outlook and positive forward thinking and generally enhanced their own mental health, including decreased feelings of anxiety and fear. Improved emotional well-being was perceived to have resulted from a feeling of respite from the illness and experience of things being better, if only for a short period of time; a distraction from the medical environment and its demands; a change in environment and confirmation that their child was experiencing ‘life’ beyond illness and treatment.

Quality of life

Parents also reported improvements to their own quality of life, revealing that wishes created important, positive memories for parents (Darlington et al., 2013; Galinsky, 2014) which supported a process of recovery and healing throughout their child’s illness or following their child’s passing (MAWUSA, 2011). Wishes were further considered to provide an opportunity to experience life as much more than their child’s illness; an opportunity for a ‘normal life’ experience and a positive wish experience with minimal family effort (MAWUSA, 2011).

Social well-being

Parents of children who received a wish were found to show benefits in social well-being. Chaves et al. (2016a) reported benefits to parents separately, finding mothers to have more benefits than fathers as a result of their child’s wish-granting experience. Mothers showed increased benefit finding scores between time one and time two, where control group mothers did not; increased beliefs in benevolence in the world between time one and time two, where control group mothers did not; increased personal strengths (gratitude and love) in comparison with the control group and increased personal strengths (gratitude and love) between time one and time two where the control group did not. Fathers of wish group children showed higher levels of calm and well-being and increased beliefs in benevolence in the world in comparison with the control group and increased beliefs in benevolence in the world between time point one and time point two, where control group fathers did not. MAWUSA (2011) also described post-wish parents (reported as one unit) as having increased social well-being, demonstrated through an increased desire to give back to others, an increased sense of compassion towards others; a reinforced sense of trust in others; an increased desire to volunteer and an increased sense of social acceptance. In addition, parents in this study described a feeling of an extended network of support through the wish-granting charity and a sense of decreased isolation, in part through the opportunity to experience life alongside others coping with a life-threatening condition.

Resilience and coping

Two studies identified the role of wishes in helping parents cope with bereavement (Darlington et al., 2013; MAWUSA, 2011). Of the parents included in the MAW USA study, 83% percent acknowledged that the experience assisted them with the grieving process, in grieving over the illness and/or the possible loss of the child. Ninety-three percent of parents also attested to an increased sense of empowerment following their child’s wish when much seemed out of control, and an improved ability to cope with their child’s illness and situation.

Impact on other family members

Three studies reported benefits to wish child siblings (Deschenes, 2009; MAWUSA, 2011; Schilling and Sarigiani, 2014). For Schilling and Sarigiani (2014) these included that wishes provided siblings with positive memories, greater sharing with the wish child and greater assurance about their sibling’s illness. In one study (MAWUSA, 2011), 92% of parents affirmed a reduction in fear and anxiety among the wish child’s siblings. Wishes were also seen by parents as providing something to look forward to, to boost family spirits, keeping them going through tough times, as well as a sense that the wish experience strengthened the family, gave them an increased ability to cope with the illness and/or situation and an opportunity to celebrate the end of a child’s treatment. Volunteers further endorsed statements regarding benefits for family members, suggesting that the wish experience provided stress relief and support to the family and strengthened the family unit during difficult times. Volunteers also suggested that wishes provided opportunities for siblings to connect with parents and to celebrate the uniqueness of the wish child.

Discussion

This systematic review examined the impact of wish-granting interventions on child and family health and well-being, from an international perspective. A narrative synthesis of evidence from 10 studies revealed that this kind of intervention has a positive influence on several indicators of child and family health, including improvements in physical health, mental health and emotional well-being, quality of life, social well-being, resilience and coping. Effects were reported to extend beyond wish children to include parents and siblings. While is it difficult to quantify the impact from such a small number of studies with diverse study designs, it is clear that this kind of positive intervention is affording benefits to children and families of children with life-limiting conditions, not least providing positive, memorable experiences.

A key finding is that wish fulfilment has a positive effect on aspects of the wish child’s well-being, including improvements to physical and mental health, quality of life, communication and social well-being and better coping with their medical condition. Such effects are important given strong evidence that living with a serious illness significantly increases the risk of poor mental health, with children who have a life-threatening condition experiencing higher levels of anxiety and depression compared with healthy peers (Ferro and Boyle, 2015; Nazari et al., 2017; Pinquart and Shen, 2011). Moreover, it has been shown that the frequency, intensity and course of physical symptoms are affected by psychosocial factors; thus, mental health problems can also exacerbate physical illness, leading to worse health outcomes and increased treatment costs (Thompson et al., 2011).

Given the potential benefits afforded by wish fulfilment, questions are raised regarding the mechanism by which wish-granting interventions have their effects. By offering a child the possibility of experiencing a different way of being from the one in which they currently find themselves (a child with a life-threatening health condition), Ewing (2007) proposes that wish fulfilment gives the wish child opportunities to re-conceptualize their ability to live and cope with a life-threatening illness. Interventions rooted in positive psychology, which focus on enhancing subjective well-being (happiness, hope and optimism) for children with potentially limited capabilities, can thus support adaptive coping responses and positive adjustment to challenges arising from their condition, enabling them to participate more fully in everyday activities (Chaves et al., 2016b; Shoshani et al., 2016). Because children with life-threatening conditions often live with multiple hospitalizations, technical procedures and separation from family, the effects of wish fulfilment could also be attributed to helping children recognize alternative ways of being, cultivating hope for the future. Increasing motivation to comply with treatment may be a contributing factor in the reduction in unplanned hospitalizations for children receiving wishes as observed by Patel et al. (2019).

The finding that wish-granting for children with serious medical conditions has a positive impact on parents, particularly with regards improved mental health, is also an important one. Research tells us that parenting a child diagnosed with a life-threatening illness has a serious negative effect on several dimensions of parental well-being (Hatzmann et al., 2008). A recent review described parenting in this context as ‘a relentless roller coaster of highs and lows in which they contemplated their child’s survival along with their own and ruminated over their child’s possible death’ (Bally et al., 2018: 95). The parenting experience is therefore characterized by feelings of uncertainty, fear, loss and grief, anxiety, lack of control, isolation and other intense emotions (Bally et al., 2018). Woodgate et al. (2015) have referred to the extra efforts required of parenting a child with complex care needs as ‘intense parenting’, a phenomenon that leads to physical and mental exhaustion for parents, isolation and loss of adult friendships due to their child’s condition (Goodwin et al., 2017). By providing distraction and respite from the illness, as well as something to look forward to and happy memories, fulfilling a child’s wish appears to afford significant benefits to the well-being of parents themselves, which may also contribute to improved coping with their child’s condition and improved family functioning and resilience (Black and Lobo, 2008).

The results further indicate that the effects of wish-granting interventions extend to wish children’s siblings. This is important because the psychosocial impact of having a sibling with a physical chronic health condition has been well documented. Several reviews have identified that siblings of children with physical chronic disease are more likely to experience depression and anxiety and report less quality peer activities than siblings of otherwise healthy children (Barlow and Ellard, 2006; Vermaes et al., 2012). Siblings of children with life-threatening or severe chronic health conditions are therefore suggested to be at greatest risk for impaired health-related quality of life (Limbers and Skipper, 2014; Vermaes et al., 2012). Thus, interventions which target the psychological health of siblings of children with life-threatening conditions should be encouraged and explored.

Strengths and limitations

This is the first review to systematically collate and synthesize research exploring how wish-granting interventions impact on child and family health. Findings suggest that wish fulfilment can lead to improvements in child health and well-being, with benefits extending to other family members. However, the review does have limitations. First, it is limited by the small number of studies eligible for inclusion, with only three having robust, controlled study designs (Chaves et al. 2016a, 2016b; Shoshani et al., 2016). Second, three full text articles were inaccessible to the review team, meaning an incomplete retrieval of potentially eligible studies. Limiting the review to studies reported in English also led to one potentially eligible study being excluded. Finally, bringing together all available research on the topic led to a diverse range of study designs being included. This led to challenges in integrating qualitative and quantitative data, making it impossible to achieve the depth of synthesis that could have been achieved with homogeneous data.

Implications for practice

Findings of this review hold implications for wish recipients and charities within the wish-granting sector. First, while wishes were experienced as positive overall, there are areas in which wish-granting organizations could work on to improve. These include the timing of wishes, rushed wishes, difficulties with travel and support for those who experience wishes as emotionally and physically exhausting. Second, wish-granting interventions are clearly shown to have effects which are far reaching, not least extending to other family members; the impact of wishes on parents and siblings is particularly striking. Family participation in wishes should therefore be encouraged and supported where possible. Finally, increasing the evidence-base related to the impact of wish-granting interventions on health and well-being is important not only from the perspective of improving health outcomes and reducing healthcare costs, but it can also be used to support fundraising and income generation. Wish-granting organizations are therefore encouraged to participate in research and develop their own research priorities.

Future research

Further research using robust, waiting list–controlled designs is needed to support existing evidence, although this may be difficult given the health status of some children with life-threatening conditions and potentially unethical given the indication of benefit afforded by wishes. Only two studies (Darlington et al., 2013; MAWUSA, 2011) collected data on how wishes impacted parental bereavement. This is an area worthy of further research given the prevalence and complexity of psychological difficulties associated with losing a child (Bogensperger and Lueger-Schuster, 2014). Future research could also make better use of longitudinal designs following families throughout the wish making and granting process, with longer-term follow-up on wish receivers to understand the impact more fully. Further research is needed to understand any differences between the impact achieved by wish type and by health condition. None of the included studies shed light on such potential differences. The lack of any kind of theory in the included studies also means that understanding of the mechanism by which wish-granting interventions have their effects is also limited. Developing our understanding of how and why interventions work is crucial to maximizing their effects for future recipients.

Conclusion

Through the creation of positive, joyful experiences, wish-granting interventions appear to benefit children with life-threatening conditions and their families by generating improvements in physical health and emotional well-being, quality of life, social well-being, coping and resilience. These findings suggest that interventions which promote subjective well-being can positively impact physical and mental health and therefore should not be discouraged. However, more research is needed to further define and quantify the impact of wish fulfilment and understand how it can be maximized.

Supplemental Material

sj-pdf-1-chc-10.1177_13674935211016712 – Supplemental Material for Understanding the impact of ‘wish-granting’ interventions on the health and well-being of children with life-threatening health conditions and their families: A systematic review

Supplemental Material, sj-pdf-1-chc-10.1177_13674935211016712 for Understanding the impact of ‘wish-granting’ interventions on the health and well-being of children with life-threatening health conditions and their families: A systematic review by Gemma Heath, Cassandra Screti, Helen Pattison and Rebecca Knibb in Journal of Child Health Care

Footnotes

Declaration of conflicting interests

The authors have received funding from Make-A-Wish UK for empirical research to evaluate the impact of wishes on child health and well-being. This systematic review did not form part of that work package. This review presents independent research and the views expressed are those of the authors and not those of Make-A-Wish UK.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author contributions

Gemma Heath conceived the study. Gemma Heath and Cassandra Screti conducted searches, screening, data extraction and synthesis. Gemma Heath drafted the manuscript. Helen Pattison and Rebecca Knibb provided comment, review and suggested revisions to the manuscript. All authors reviewed and revised the final manuscript before submission.

ORCID iD

Gemma Heath

Supplemental material

Supplemental material for this article is available online.

References

Arnould

Wallendorf

(1994) Market-oriented ethnography: interpretation building andmarketing strategy formulation. J Mark Res 31(4): 484–504.

Bally

JMG

Smith

Holtslander

, et al. (2018) A metasynthesis: uncovering what is known about the experiences of families with children who have life-limiting and life-threatening illnesses. Journal of Pediatric Nursing 38: 88–98.

Barlow

Ellard

(2006) The Psychosocial well-being of children with chronic disease, their parents and siblings: an overview of the research evidence base. Child: Care, Health and Development 32: 19–31.

Barthel

Ravens-Sieberer

Nolte

, et al. (2018) Predictors of health-related quality of life in chronically ill children and adolescents over time. Journal of Psychosomatic Research 109: 63–70.

Black

Lobo

(2008) A conceptual review of family resilience factors. Journal of Family Nursing 14: 33–55.

Bogensperger

Lueger-Schuster

(2014) Losing a child: finding meaning in bereavement. European Journal of Psychotraumatology 5: 1–9.

Bolier

Haverman

Westerhof

, et al. (2013) Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC Public Health 13: 1–20.

Chaves

Hervas

Vazquez

(2016a) Granting wishes of seriously ill children: effects on parents' well-being. Journal of Health Psychology 21: 2314–2327.

Chaves

Vázquez

Hervás

(2016b) Positive interventions in seriously-ill children: effects on well-being after granting a wish. Journal of Health Psychology 21: 1870–1883.

10.

Costa Fernandes

Arriaga

(2010) The effects of clown intervention on worries and emotional responses in children undergoing surgery. Journal of Health Psychology 15: 405–415.

11.

Darlington

A-S

Heule

Passchier

(2013) Granting wishes: parents' perception of a wish fulfilment for a child with a life-threatening illness. Acta Paediatrica 102: e480–e482.

12.

Deschenes

(2009) Exploring the Wish Factory: Ethnographic Insights into the Charitable Business of Wish-granting. Doctor of Philosophy. Concordia University.

13.

Diener

Chan

(2011) Happy people live longer: subjective well-being contributes to health and longevity. Applied Psychology: Health and Well-being 3: 1–43.

14.

Diekelmann

Ironside

(1998) Hermeneutics. In: Fitzpatrick

(ed) Encyclopedia of Nursing Research. New York: Springer, 243–245.

15.

Dionigi

Sangiorgi

Flangini

(2014) Clown intervention to reduce preoperative anxiety in children and parents: a randomized controlled trial. Journal of Health Psychology 19: 369–380.

16.

Ewing

(2007) Wish fulfillment for children with life-threatening illnesses. In: Johnston

Scholler-Jaquish

(eds), Meaning in suffering: Caring practices in healthcare and the human sciences. Madison WI: University of Wisconsin Press.

17.

Ferro

Boyle

(2015) The impact of chronic physical illness, maternal depressive symptoms, family functioning, and self-esteem on symptoms of anxiety and depression in children. Journal of Abnormal Child Psychology 43: 177–187.

18.

Fraser

Miller

Hain

, et al. (2012) Rising national prevalence of life-limiting conditions in children in england. Pediatrics 129: e923–e929.

19.

Galinsky

(2014) What do families, staff, and stakeholders think about children's dream fulfilment? Issues in Comprehensive Pediatric Nursing 37: 203–211.

20.

Ghosh

Deb

(2017) Positive psychology interventions for chronic physical illnesses: a systematic review. Psychological Studies 62: 213–232.

21.

Goodwin

McCormack

Campbell

(2017) “You don't know until you get there”: the positive and negative “lived” experience of parenting an adult child with 22q11.2 deletion syndrome. Health Psychology 36: 45–54.

22.

Groenewal

Essner

Wright

, et al. (2014) The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the United States. The Journal of Pain 15: 925–933.

23.

Gronroos

(2014) The relationship marketing process: Communication, interaction, dialogue, value. Journal of Business and Industrial Marketing 19(2): 99–113.

24.

Hatzmann

Heymans

HSA

Ferrer-I-Carbonell

, et al. (2008) Hidden consequences of success in pediatrics: parental health-related quality of life-results from the care project. Pediatrics 122: e1030–e1038.

25.

Hendon

Bohon

(2007) Hospitalized children's mood differences during play and music therapy. Child: Care, Health and Development 34: 141–144.

26.

Jahan

Naveed

Zeshan

, et al. (2016) How to conduct a systematic review: a narrative literature review. Cureus 8: 11. DOI: 10.7759/cureus.864.

27.

Joseph

Linley

(2005) Positive psychological approaches to therapy. Counselling and Psychotherapy Research 5: 5–10.

28.

Lambert

Keogh

(2015) Striving to live a normal life: a review of children and young people's experience of feeling different when living with a long term condition. Journal of Pediatric Nursing 30: 63–77.

29.

Lewandowski

Palermo

Stinson

, et al. (2010) Systematic review of family functioning in families of children and adolescents with chronic pain. The Journal of Pain 11: 1027–1038.

30.

Limbers

Skipper

(2014) Health-related quality of life measurement in siblings of children with physical chronic illness: a systematic review. Families, Systems, & Health 32: 408–415.

31.

Make-A-Wish USA (2011) Wish Impact Study Results. USA: Make-A-Wish Foundation of America.

32.

Moreira

Carona

Silva

, et al. (2013) Psychological and quality of life outcomes in pediatric populations: a parent-child perspective. The Journal of Pediatrics 163: 1471–1478.

33.

Nazari

Bakhshi

Kaboudi

, et al. (2017) Comparison of quality of life, anxiety and depression in children with cancer and healthy children, Kermanshah-Iran. International Journal of Pediatrics 5: 5305–5314.

34.

Patel

Glynn

Falke

, et al. (2019) Impact of a make-a-wish experience on healthcare utilization. Pediatric Research 85: 634–638.

35.

Pinquart

Shen

(2011) Anxiety in children and adolescents with chronic physical illnesses: a meta-analysis. Acta Paediatrica 100: 1069–1076.

36.

Pluye

Gagnon

M-P

Griffiths

, et al. (2009) A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in mixed studies reviews. International Journal of Nursing Studies 46: 529–546.

37.

Popay

Roberts

Sowden

, et al. (2006) Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. Available at: https://www.lancaster.ac.uk/media/lancaster-university/content-assets/documents/fhm/dhr/chir/NSsynthesisguidanceVersion1-April2006.pdf (accessed May 2020).

38.

Schiavon

Marchetti

Gurgel

, et al. (2017) Optimism and hope in chronic disease: a systematic review. Frontiers in Psychology 7: 1–10.

39.

Schilling

Sarigiani

(2014) The impact of a wish: caregiver perceptions of the benefits of granted wishes for children with life-threatening illnesses and their families. Children's Health Care 43: 16–38.

40.

Shoshani

Mifano

Czamanski-Cohen

(2016) The effects of the make a wish intervention on psychiatric symptoms and health-related quality of life of children with cancer: a randomised controlled trial. Quality of Life Research 25: 1209–1218.

41.

Siden

Steele

(2015) Charting the territory: children and families living with progressive life-threatening conditions. Paediatrics & Child Health 20: 139–144.

42.

Sin

Lyubomirsky

(2009) Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis. Journal of Clinical Psychology 65: 467–487.

43.

Thompson

Delaney

Flores

, et al. (2011) Cognitive-behavioral therapy for children with comorbid physical illness. Child and Adolescent Psychiatric Clinics of North America 20: 329–348.

44.

Together for Short Lives (2018) A guide to children's palliative care. file:///C:/Users/yvonn/Downloads/TfSL-A-Guide-to-Children%E2%80%99s-Palliative-Care-Fourth-Edition-FINAL-SINGLE-PAGES.pdf.

45.

Venning

Eliott

Wilson

, et al. (2008) Understanding young peoples' experience of chronic illness: a systematic review. International Journal of Evidence-Based Healthcare 6: 321–336.

46.

Vermaes

IPR

Van Susante

AMJ

Van Bakel

HJA

(2012) Psychological functioning of siblings in families of children with chronic health conditions: a meta-analysis. Journal of Pediatric Psychology 37: 166–184.

47.

Woodgate

Edwards

Ripat

, et al. (2015) Intense parenting: a qualitative study detailing the experiences of parenting children with complex care needs. BMC Pediatrics 15: 97.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.11 MB