Breaking bad news by pediatric nurses: a scoping review

Rosado, Viviane Layse Silva; Neves Júnior, Tarcísio Tércio das; Oliveira, Hellen Anaídh de; Silveira, Bruna Ruselly Dantas; Azevedo, Ana Teresa Leiros de; Pinto, Erika Simone Galvão; Silva, Carlos Jordão de Assis

doi:10.1590/1983-1447.2026.20250295.en

person Viviane Layse Silva Rosado

Conceptualization · Project administration · Supervision · Data curation · Formal analysis · Investigation · Methodology · Resources · Software · Visualization · Validation · Writing-original draft · Writing-review & editing

school Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem, Natal, Rio Grande do Norte, Brasil.

0000-0002-3146-1518

person Tarcísio Tércio das Neves Júnior

Conceptualization · Project administration · Supervision · Data curation · Formal analysis · Investigation · Methodology · Resources · Software · Visualization · Validation · Writing-original draft · Writing-review & editing

school Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem, Natal, Rio Grande do Norte, Brasil.

0000-0001-9026-0567

person Hellen Anaídh de Oliveira

Data curation · Formal analysis · Investigation · Methodology · Resources · Software · Visualization · Validation · Writing-original draft · Writing-review & editing

school Universidade Estadual da Paraíba, Departamento de Enfermagem, Campina Grande, Paraíba, Brasil.

0009-0000-9725-4100

person Bruna Ruselly Dantas Silveira

Validation · Writing-original draft · Writing-review & editing

school Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem, Natal, Rio Grande do Norte, Brasil.

0000-0002-8854-148X

person Ana Teresa Leiros de Azevedo

Validation · Writing-original draft · Writing-review & editing

school Universidade Federal do Rio Grande do Norte, Departamento de Psicologia, Natal, Rio Grande do Norte, Brasil.

0000-0003-0597-7630

person Erika Simone Galvão Pinto

Validation · Writing-original draft · Writing-review & editing

school Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem, Natal, Rio Grande do Norte, Brasil.

0000-0003-0205-6633

person Carlos Jordão de Assis Silva

Conceptualization · Project administration · Supervision · Data curation · Formal analysis · Investigation · Methodology · Resources · Software · Visualization · Validation · Writing-original draft · Writing-review & editing

school Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem, Natal, Rio Grande do Norte, Brasil.

0000-0002-9575-9030

personCorresponding author: Viviane Layse Silva Rosado E-mail:
vivianeerosado@gmail.com

The authors declare that there is no conflict of interest.

Associate editor:

Bruna Hinnah Borges Martins de Freitas

Editor-in-chief:

João Lucas Campos de Oliveira

Database	Search strategies
VHL	(Nurses) OR (Pediatric nurses) AND (Disclosure) OR (Truth disclosure) OR (Health communication) AND (Child Health) OR (Adolescent Health) OR (Pediatrics) e (Enfermeiros) OR (Enfermeiros pediátricos) AND (Revelação da Verdade) OR (Comunicação em saúde) OR (Informação e Comunicação em Saúde) AND (Pediatria) OR (Saúde do Adolescente) OR (Saúde da Criança) OR (Criança) OR (Adolescente)
PubMed/ MEDLINE	(((Nurses OR “Pediatric nurses”)) AND ((Disclosure OR “Truth disclosure” OR “Health communication”))) AND (("Child Health" OR "Adolescent Health" OR “Pediatrics”)) e (((Enfermeiros OR “Enfermeiros pediátricos”)) AND ((“Revelação da Verdade” OR “Comunicação em saúde” OR “Informação e Comunicação em Saúde”))) AND ((Pediatria OR “Saúde do Adolescente” OR “Saúde da Criança” OR “Criança” OR “Adolescente”))
CINAHL	((((((((((Nurses[All Fields]) OR (Pediatric Nurses[All Fields])) AND Disclosure[All Fields])) OR (Truth disclosure[All Fields])) OR (Health communication[All Fields])) AND (Child Health[All Fields])) OR (Adolescent Health[All Fields])) OR (Pediatrics[All Fields])) e ((((((((Enfermeiros[All Fields]) OR (Enfermeiros Pediátricos[All Fields])) AND Revelação da Verdade[All Fields])) OR (Comunicação em saúde[All Fields])) OR (Informação e Comunicação em Saúde[All Fields])) AND (Pediatria[All Fields])) OR (Saúde do Adolescente[All Fields])) OR (Saúde da Criança[All Fields])) OR (Adolescente[All Fields])) OR (Criança[All Fields]))
SCOPUS	((((((((((Nurses[All Fields]) OR (Pediatric Nurses[All Fields])) AND Disclosure[All Fields])) OR (Truth disclosure[All Fields])) OR (Health communication[All Fields])) AND (Child Health[All Fields])) OR (Adolescent Health[All Fields])) OR (Pediatrics[All Fields])) e ((((((((Enfermeiros[All Fields]) OR (Enfermeiros Pediátricos[All Fields])) AND Revelação da Verdade[All Fields])) OR (Comunicação em saúde[All Fields])) OR (Informação e Comunicação em Saúde[All Fields])) AND (Pediatria[All Fields])) OR (Saúde do Adolescente[All Fields])) OR (Saúde da Criança[All Fields])) OR (Adolescente[All Fields])) OR (Criança[All Fields]))
Web of Science	ALL=((((((((Nurses) OR (Pediatric Nurses)) AND (Disclosure)) OR (Truth disclosure)) OR (Health communication)) AND (Child Health)) OR (Adolescent Health)) OR (Pediatrics)) e ALL=((((((((((Enfermeiros) OR (Enfermeiros Pediátricos)) AND (Revelação da Verdade)) OR (Comunicação em saúde)) OR (Informação e Comunicação em Saúde)) AND (Pediatria)) OR (Saúde do Adolescente)) OR (Saúde da Criança)) OR (Adolescente)) OR (Criança))
COCHRANE	(((Nurses OR “Pediatric nurses”)) AND ((Disclosure OR “Truth disclosure” OR “Health communication”))) AND (("Child Health" OR "Adolescent Health" OR “Pediatrics”)) e (((Enfermeiros OR “Enfermeiros pediátricos”)) AND ((“Revelação da Verdade” OR “Comunicação em saúde” OR “Informação e Comunicação em Saúde”))) AND ((Pediatria OR “Saúde do Adolescente” OR “Saúde da Criança” OR “Criança” OR “Adolescente”))
LILACS	((((((((((Nurses[All Fields]) OR (Pediatric Nurses[All Fields])) AND Disclosure[All Fields])) OR (Truth disclosure[All Fields])) OR (Health communication[All Fields])) AND (Child Health[All Fields])) OR (Adolescent Health[All Fields])) OR (Pediatrics[All Fields])) e ((((((((Enfermeiros[All Fields]) OR (Enfermeiros Pediátricos[All Fields])) AND Revelação da Verdade[All Fields])) OR (Comunicação em saúde[All Fields])) OR (Informação e Comunicação em Saúde[All Fields])) AND (Pediatria[All Fields])) OR (Saúde do Adolescente[All Fields])) OR (Saúde da Criança[All Fields])) OR (Adolescente[All Fields])) OR (Criança[All Fields]))

Title	Year	Country	Type of Material	Method	Objective	Healthcare Context
Truth-telling to the seriously ill child - Nurses' experiences, attitudes, and beliefs¹⁶	2023	Australia	Article	Systematic literature review	To explore the ethical role of nurses in truth-telling to children.	Hospital Care
Manual de Cuidados Paliativos ¹⁷	2023	Brazil	Manual	NA*	To facilitate the dissemination of knowledge about palliative care, presenting evidence from international medical literature and official Brazilian guidelines in a practical, objective manner compatible with the Unified Health System.	Home Care, Specialized Outpatient Care, and Hospital Care
Nurses' patterns of knowing about HIV disclosure to children¹⁸	2022	Brazil	Article	Exploratory and interpretive	To identify and analyze nurses’ knowledge patterns and experiences in preparing families for disclosing HIV status to children.	Specialized Outpatient Care
Using simulation to help paediatric nurses learn to break bad news¹⁹	2022	England	Article	Experience report	To report the experience of a simulation used to teach breaking bad news communication.	Not specified
Telling Children with Perinatal HIV About Their HIV Serostatus: Healthcare Workers' Practices and Barriers to Disclosing in a South African Rural Health District²⁰	2021	South Africa	Article	Qualitative exploratory	To examine healthcare workers’ involvement, practices, and barriers in disclosing HIV status to children.	Primary Health Care, Specialized Outpatient Care, and Hospital Care
Perceptions of the parents of deceased children and of healthcare providers about end-of-life communication and breaking bad news at a tertiary care public hospital in India: A qualitative exploratory study²¹	2021	India	Article	Qualitative exploratory	To explore the experiences of parents and healthcare professionals regarding end-of-life care and the delivery of bad news, as well as the related positive and negative factors, in the Indian context.	Hospital Care
Pediatric oncology nurses' perceptions of prognosis-related communication²²	2019	USA	Article	Mixed methods	To explore pediatric oncology nurses’ experiences with prognosis-related communication.	Specialized Outpatient Care and Hospital Care
Communicating cystic fibrosis newborn screening results to parents²³	2020	United Kingdom	Article	Observational	To examine the language used by specialist nurses when informing parents about suspected cystic fibrosis.	Hospital Care
Caring for HIV-positive children: healthcare providers' pre- and post-disclosure experiences in Nairobi, Kenya²⁴	2019	Kenya	Article	Qualitative exploratory	To explore healthcare providers’ experiences caring for HIV-positive children before and after disclosure.	Hospital Care
The use of a theatre workshop in developing effective communication in paediatric end of life care²⁵	2019	United Kingdom	Article	Mixed methods	To explore the effectiveness of a novel workshop in teaching transferable knowledge and skills in palliative care, end-of-life, and bereavement communication to a convenience sample of first-year pre-registration nursing students training at a UK university.	Hospital Care
Promoting Honesty and Truthfulness When Things Go Wrong During Care Delivery for Sick Children²⁶	2018	United Kingdom	Article	Editorial	To discuss why pediatric nurses should fully adopt transparency in care delivery.	Hospital Care
Advocacy care on HIV disclosure to children²⁷	2018	Brazil	Article	Qualitative exploratory	To unveil families’ experiences with HIV disclosure to children under 13 years.	Specialized Outpatient Care
Breaking Down Barriers to Tell: A Mixed Methods Study of Health Worker Involvement in Disclosing to Children That They Are Living with HIV in Rural South Africa²⁸	2018	South Africa	Article	Mixed methods	To contextualize low pediatric disclosure rates in South Africa and provide recommendations to strengthen HIV programs.	Primary Health Care
Need and acceptability of story books intended to help with the process of informing children about their HIV status in Malawi: a mixed methods study²⁹	2018	Australia	Article	Mixed methods	To assess the need for and acceptability of a series of age-appropriate children’s storybooks designed to help inform children about their serological status.	Hospital Care
A Guide to children’s palliative care. Supporting babies, children and young people with life-limiting and life-threatening conditions and their families³⁰	2018	England	Guide	NA*	To establish and implement a vision for the future sustainable development of pediatric palliative care that ensures children and their families have access to and receive comprehensive, high-quality, evidence-based services delivered by a properly trained and experienced workforce.	Primary Health Care, Home Care, and Hospital Care
Integrating palliative care and symptom relief into paediatrics: a WHO guide for health-care planners, implementers and managers³¹	2018	Switzerland	Guide	NA*	To provide practical guidance on integrating pediatric palliative care and symptom relief into health systems in order to improve the quality of life of children and their families.	Primary Health Care, Home Care, Specialized Outpatient Care, and Hospital Care
Pediatric Oncology Nurses' Experiences with Prognosis-Related Communication³²	2017	USA	Dissertation	Cross-sectional	To examine nurses’ experiences in prognosis-related communication (PRC) with parents of children with cancer.	Specialized Outpatient Care and Hospital Care
Revelação do diagnóstico de HIV para crianças e adolescentes: subsídios para prática assistencial ³³	2016	Brazil	Article	Convergent research	To collaboratively develop a guide to support the disclosure of HIV diagnosis to children and adolescents in a specialized service.	Hospital Care
Perspectives and Practice of HIV Disclosure to Children and Adolescents by Health-Care Providers and Caregivers in sub-Saharan Africa: A Systematic Review³⁴	2016	USA	Article	Systematic literature review	To review the current literature on the perspectives of healthcare professionals and caregivers of children and adolescents regarding age-specific and culturally sensitive HIV disclosure practices.	Not specified
Should we tell parents when we've made an error?³⁵	2015	Pakistan	Article	Experience report	To analyze the complex emotional and ethical issues that arise when physicians acknowledge that an error has occurred.	Hospital Care
Health care workers' perspectives about disclosure to HIV-infected children; cross-sectional survey of health facilities in Gauteng and Mpumalanga provinces, South Africa³⁶	2015	South Africa	Article	Cross-sectional	To examine healthcare professionals’ opinions on disclosure to HIV-infected children and determine their role in disclosure to children receiving antiretroviral therapy in health centers in South Africa.	Primary Health Care and Hospital Care
A story for children to help children with HIV understand the health-disease process³⁷	2014	Brazil	Article	Qualitative exploratory	To analyze how a children’s story addressing issues related to Acquired Immunodeficiency Syndrome contributes to children’s understanding of the health-disease process in those living with Human Immunodeficiency Virus.	Specialized Outpatient Care
Educating children’s nurses for communicating bad news³⁸	2013	United Kingdom	Article	Reflective	To enable pediatric nurses to reflect on their skills and preparedness to deal with difficult situations.	Primary Health Care and Hospital Care
Dilemmas of telling bad news: Paediatric palliative care providers' experiences in rural KwaZulu-Natal, South Africa³⁹	2013	South Africa	Article	Qualitative exploratory	To analyze the experiences of pediatric palliative care providers when attempting to fulfill one of their roles, namely preparing patients and families for a poor disease prognosis in a child.	Home Care
Are we allowed to disclose?': a healthcare team's experiences of talking with children and adolescents about their HIV status⁴⁰	2013	South Africa	Article	Qualitative exploratory	To explore the perspectives and experiences of a healthcare team regarding disclosure practices.	Hospital Care
Pediatric palliative care communication: resources for the clinical nurse specialist⁴¹	2012	USA	Article	Narrative literature review	To highlight pediatricians’ lack of communication skills when delivering bad news and introducing pediatric palliative care to families of children with life-limiting conditions.	Hospital Care
Comunicação de notícias difíceis: compartilhando desafios na atenção à saúde ⁴²	2010	Brazil	Book	NA*	To expand experiences in breaking bad news communication, share its challenges, and improve the network of care in public health by addressing this issue in an articulated and interdisciplinary manner, with different perspectives from the standpoint of knowledge.	Hospital Care
Simulation-based medical error disclosure training for pediatric healthcare professionals⁴³	2007	California	Article	Quasi-experimental	To investigate the effects of training in medical error disclosure in a simulated environment for pediatric oncology nurses.	Hospital Care
Breaking bad news to parents: the children's nurse's role⁴⁴	2006	United Kingdom	Article	Narrative literature review	To examine the literature on breaking bad news communication.	Not specified
A process for delivering bad news: supporting families when a child is diagnosed⁴⁵	2001	Canada	Article	Descriptive	To describe the development of a process guiding the delivery of bad news and illustrate the role nurses can play when a physician communicates a diagnosis to a family.	Hospital Care
‘Breaking bad news’ within a paediatric setting: an evaluation report of a collaborative education workshop to support health professionals⁴⁶	2001	United Kingdom	Article	Cross-sectional	To evaluate a workshop designed to prepare healthcare professionals to deliver bad news in a pediatric setting.	Hospital Care

Strategies for breaking bad news communication in pediatrics and the nurse’s role
1. Strategies used in breaking bad news communication by nurses in pediatrics
1.1 Strategies related to the act of communication
Development of communication in a gradual and continuous way¹⁶^-¹⁷^,²⁰^,²⁷^-²⁸^,³⁶ Clarity/honesty in information¹⁹^,²²^,²⁶^,³⁰^,³³^,³⁸^,⁴⁵ Collaborative care/inter- or multiprofessional team¹⁷^,²⁰^,²²^,²⁷^,³³^,³⁵^,⁴¹ Privacy/appropriate environment/confidentiality¹⁹^-²⁰^,³⁴^,³⁸^,⁴⁴^-⁴⁵ Use of models/protocols/guide¹⁷^,¹⁹^,³³^,⁴¹^-⁴²^,⁴⁴ Empathy/sensitivity/care/support¹⁹^,³¹^,³⁵^,⁴²^,⁴⁴^-⁴⁵ Provision of written materials/notes to parents/caregivers/family²⁸^,⁴⁴^-⁴⁵ Ensuring/reserving sufficient time³¹^,³⁸^,⁴⁵ Consultation and involvement of another support person³⁰^,³⁹ Interpreter, if necessary³⁰^,⁴⁵ Early communication²⁶^,³⁵ Analysis with family and team of the most appropriate professional to lead communication³⁰^,³⁵ Assignment of roles and planning of breaking bad news communication¹⁹^-²⁰ Not overburdening the family³⁵ Individualizing the approach⁴⁵
1.2 Strategies related to the child/adolescent
Communication according to the level of cognitive development/maturity and prior knowledge/questions of the child/adolescent¹⁶^-¹⁸^,²⁰^,²⁸^,³⁰^-³¹^,³³
1.3 Strategies related to the family
Consideration of cultural, religious, cognitive, and emotional factors of the family¹⁶^-¹⁷^,³⁰^-³¹^,⁴¹ Recognition/permission for parents to express emotions/feelings¹⁷^,³¹^,⁴²^,⁴⁴^-⁴⁵ Assessment of parental preparedness, coping styles, and prior communication²⁰^,⁴¹
1.4 Strategies related to the child and the family
Understanding how children and families experience/cope with illness and deal with grief²⁰^,³⁰^-³¹
1.5 Strategies related to tools/resources used
Play-based approaches: therapeutic play, analogies, storytelling, role-playing, videos, use of dolls and/or drawings¹⁷^,²⁰^,²⁹^-³¹^,³³^,³⁷^,⁴² Support groups/community resources¹⁷^,³¹^,³³^-³⁴^,⁴⁰^,⁴⁵ Virtual: computer tools³³ Letters⁴²
2. Nurse’s role in the process of breaking bad news communication in pediatrics
Support/welcome/encourage the family and/or team¹⁶^-¹⁷^,¹⁹^-²²^,²⁴^-²⁵^,²⁸^-³⁰^,³²^-³⁶^,³⁸^,⁴⁰^,⁴²^-⁴⁶ Train/educate/counsel parents and/or children/adolescents¹⁶^,²⁰^,²⁷^-²⁸^,³⁶^,⁴⁴^-⁴⁵ Reiterate/clarify doubts/explain information provided¹⁶^,¹⁹^,³²^,³⁶^-³⁷^,⁴⁵ Advocate for the child and family¹⁶^,¹⁸^,²²^,²⁷^,⁴⁴^-⁴⁵ Initiate the disclosure process²³^,²⁵^,²⁹^-³⁰^,³⁷^,⁴⁰ Organize/manage/coordinate the process³⁸^,⁴¹^,⁴⁴^-⁴⁶ Prepare the family¹⁶^,¹⁸^,²⁰^,²⁸ Facilitator²²^,³³^,⁴⁴^-⁴⁵ Follow up with the family³⁸^,⁴²^,⁴⁴^-⁴⁵ Communicate bad news together with the physician¹⁷^,³² Prognosticator²² Ensure the child’s adherence to treatment³⁶

Facilitators and barriers in breaking bad news communication by nurses in pediatrics
1. Facilitators in the process of breaking bad news communication by nurses in pediatrics
1.1 Facilitators related to the team
Existence/collaboration of a multi/interprofessional team¹⁷^,³³^,³⁶^,⁴² More time that nurses spend with the patient compared to other professionals¹⁶^,⁴¹^,⁴⁴
1.2 Facilitators related to the family
Ongoing follow-up in the same service, promoting the development of bonding and trust³³ Understanding disclosure as a right of the child and adolescent³⁴ Presence of a chronic illness in a family member³⁴ Detection during routine prenatal consultation in infected mothers³⁴
1.3 Facilitators related to Child/Adolescent
Ongoing follow-up in the same service, promoting the development of bonding and trust³³ Interest of the child or adolescent³⁴ Presence of chronic illness in the child³⁴
2. Barriers in breaking bad news communication by nurses in pediatrics
2.1 Barriers related to the team
Lack of knowledge, preparation, confidence, experience, and/or security¹⁶^,¹⁸^-²¹^,²⁵^,²⁸^-³⁷^,³⁹^-⁴¹^,⁴³^,⁴⁶ Lack of human resources/adequate space/structural problems¹⁷^,²⁰^-²¹^,²⁷^,³⁰^,³³^-³⁴^,⁴² Lack of material/guidance/guidelines to facilitate the disclosure process¹⁶^,²⁰^,²⁸^-²⁹^,⁴⁰^-⁴¹^,⁴⁶ Fear/overload/emotional and/or physical exhaustion¹⁷^,²⁷^,³⁵^-³⁶^,⁴⁰^,⁴² Omission/lack of clarity of information at the time of communication¹⁶^-¹⁷^,²² Lack of communication, planning, articulation, and integration among professionals³²^-³³ Exclusion of nurses from this process²²^,³² Reluctance or delay in carrying out disclosure²⁰^,²⁸ Lack of empathy and coldness²¹ Ethical conflicts³⁴
2.2 Barriers related to family and team
Stigma, prejudice, and discrimination¹⁸^,²⁷^,²⁹^,³⁴^,³⁷^,⁴⁰^,⁴²
2.3 Barriers related to family and/or child/adolescent
Parents’ desire to postpone or not want the disclosure¹⁶^,²²^,²⁴^,³³^,³⁹ Diverse cultural influences, practices, and beliefs of families and/or professionals¹⁶^,³⁹ Family disruption¹⁷^,⁴² Difficulty in understanding the existence of a reserved prognosis in a child¹⁷ Lack of knowledge among children about their condition²⁴ Emotional impact on the family¹⁷

[TFN1] NA*: Não se aplica.

Breaking bad news by pediatric nurses: a scoping review

Malas noticias por parte de enfermeras pediátricas: una revisión de alcance