Parental experiences in pediatric advance care planning for children with life-limiting illnesses: a qualitative meta-synthesis

To systematically synthesize the experiences of parents of children with life-limiting illnesses (LLIs) in pediatric advance care planning (pACP), extract core perceptions and influencing factors, and provide practical guidance to optimize the clinical implementation of pACP. A systematic search was conducted in the Cochrane Library, PubMed, Embase, CINAHL, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature Database (CBM) for qualitative studies related to parental involvement in pACP for children with LLIs. The search period was from database inception to April 2025. The aggregative meta-synthesis method was employed for data analysis and synthesis. A total of nine qualitative studies were included, from which 33 themes were identified and structured into ten themes and corresponding subthemes. These themes and subthemes were further synthesized into three core findings: (1) Behavioral coping patterns of parents in pACP; (2) Parental perceptions and experiences regarding the value of pACP; and (3) Challenges and barriers encountered by parents in engaging with pACP. To facilitate the effective implementation of pACP, it is crucial to respect children’s preferences, address parental decision-making needs, and enhance palliative care services along with educational and support systems for pACP. These efforts will improve the acceptability and practical application of pACP in pediatric care.