Role and competencies of healthcare professionals in pediatric advance care planning: A systematic mixed-methods review

To synthesize evidence on the roles and competencies of healthcare professionals involved in pediatric advance care planning. A systematic mixed-methods review was conducted. APA PsycINFO, CINAHL, Cochrane Library, Embase, PubMed/MEDLINE, and Web of Science were searched from inception to January 3, 2026. Original studies examining healthcare professionals’ roles or competencies in pediatric advance care planning were included. Two reviewers independently screened studies and extracted data. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools and the Mixed Methods Appraisal Tool, and findings were integrated using a data-based convergent synthesis approach. Twenty studies were included, comprising 12 qualitative studies, three mixed-methods studies, four quasi-experimental studies, and one cross-sectional study. Physicians, nurses, and psychosocial professionals contributed distinct yet interdependent roles in pediatric advance care planning. Physicians primarily led discussion initiation, prognostic communication, decision integration, and documentation. Nurses emphasized relational continuity, readiness assessment, family advocacy, and care coordination. Psychosocial professionals focused on values clarification, emotional support, conflict mediation, and facilitating child participation. A layered competency structure emerged, consisting of shared foundational competencies across professions and role-advanced competencies specific to professional scope of practice. Pediatric advance care planning is supported by differentiated yet interconnected professional roles underpinned by shared foundational competencies. Aligning professional responsibilities with competency depth may strengthen interprofessional collaboration and facilitate effective implementation of pediatric advance care planning. Findings support the development of competency-based pediatric advance care planning education and clearer interprofessional role delineation. Strengthening communication, collaboration, and readiness assessment skills across professional groups may facilitate earlier and more consistent family-centered advance care planning. The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews (registration number: CRD420251028203). This systematic mixed-methods review synthesizes healthcare professionals’ roles and competencies in pediatric advance care planning. It highlights differentiated yet interdependent contributions of physicians, nurses, and psychosocial professionals, and underscores the importance of aligning role expectations with competency depth to strengthen interprofessional collaboration, training, and implementation.