Spiritual Interventions Among Pediatric Patients With Cancer: A Systematic Review And Meta-Analysis

Context. Although spiritual intervention is crucial in the care of childhood cancer patients (CCPs), its effectiveness has not yet been systematically evaluated. Objectives. To determine the effectiveness of existing spiritual interventions on psychological, spiritual outcomes, and quality of life (QoL) in CCPs. Methods. We searched eight databases to identify relevant randomized controlled trials and quasi -experimental studies. Risk of bias was assessed using the Cochrane risk -of -bias tool for randomized trials. Results were either synthesized in a systematic narrative synthesis or a meta -analysis using a random effects model, where appropriate. The pooled treatment effect was estimated using the standardized mean difference (SMD) and 95% con fi dence interval (CI). Results. Twelve studies with 576 CCPs were included. Eight studies showed a high risk of bias. The overall effect of existing spiritual interventions on QoL (Z = 1.05, SMD = 0.64, 95%CI = - 0.15 to 1.83, P = 0.29), anxiety (Z = 1.11, SMD = - 0.83, 95%CI = - 2.30 to 0.64, P = 0.28) and depressive symptoms (Z = 1.06, SMD = - 0.49, 95%CI = - 1.40 to 0.42, P = 0.12) were statistically nonsigni fi cant. The nonsigni fi cant fi ndings could be attributed to the high heterogeneity among the included studies (QoL: I 2 = 85%; anxiety: I 2 = 90%; depressive symptoms: I 2 = 58%). Conclusion. Evidence to support the positive effects of existing spiritual interventions on psychological and spiritual outcomes and QoL in CCPs is insuf fi cient. Future studies should adopt a more rigorous design and unify the outcome measures to reduce the risk of bias and heterogeneity, respectively. J Pain Symptom Manage 2024;68:e8 - e20. (c) 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.