Effectiveness of play therapy vs non-play interventions in palliative care for children and adolescents with cancer: a systematic review protocol

OBJECTIVE: The objective of this review is to determine the effectiveness of play therapy vs non-play interventions in improving the quality of life, physical and psychosocial functioning, and activity participation of children and adolescents with cancer in palliative care settings. INTRODUCTION: Integrating play interventions early in pediatric palliative care for children and adolescents with cancer, especially in low- to middle-income countries where survival rates are low, is essential for addressing the holistic needs of children and adolescents and their families; however, it remains underutilized. ELIGIBILITY CRITERIA: This review will include studies examining children and adolescents (≤18 years) with cancer who are receiving palliative care. Interventions of interest encompass play therapy, therapeutic play, or play-based activities. Studies will include a comparator group, which will consist of standard palliative care approaches that do not involve play therapy. The primary outcome is patient quality of life; the secondary outcomes encompass physical and psychosocial functions, and activity participation. Eligible study designs will include experimental and quasi-experimental designs, and analytical observational studies. Mixed methods studies that include quantitative data will also be considered. METHODS: This review will follow the JBI methodology for systematic reviews of effectiveness. A comprehensive search will be conducted across PubMed, CINAHL (EBSCOhost), Embase (Ovid), Web of Science, PEDro, ProQuest Dissertations and Theses Global, the World Health Organization, and Google Scholar. Eligible studies will be critically appraised for methodological quality using JBI appraisal instruments. Where possible, statistical meta-analysis will be conducted using a random-effects model. The certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, and a Summary of Findings will be created. REVIEW REGISTRATION: PROSPERO CRD420250655458.