Informal caregivers' experiences of feeding children with cancer: a systematic review of qualitative evidence.
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OBJECTIVE: The objective of this review was to synthesize informal caregivers' experiences of feeding children with cancer. INTRODUCTION: Alterations in eating behaviors among children with cancer affect their nutritional status, resulting in various adverse consequences. Besides interventions provided by health care professionals, the role of informal caregivers, often parents, family members, or relatives, in supporting and maintaining adequate nutrition is equally important. Exploring informal caregivers' experiences of feeding their children can offer valuable insights for enhancing nutritional care. ELIGIBILITY CRITERIA: This review included qualitative studies, as well as the qualitative components of mixed methods studies, examining the experiences of informal caregivers in feeding children 2 to 18 years of age with cancer. Caregivers of any gender or age were included. Studies published in English or Thai up to August 18, 2025, were considered. METHODS: This review followed the JBI approach for qualitative systematic reviews. Published and gray literature were searched in PubMed, Embase (Ovid), CINAHL (EBSCOhost), Scopus, LILACS (BVS), ThaiJO (TCI), and ProQuest Dissertations and Theses (ProQuest). No language restrictions were applied and no date limit was set. Reference lists of the included studies were searched for additional relevant studies. Two reviewers separately screened for eligible studies and performed the critical appraisal. Two reviewers extracted the data, and 3 reviewers conducted the synthesis using meta-aggregation and summarized the findings. The final synthesized findings were graded using the ConQual approach. RESULTS: A total of 28 studies across 13 countries, spanning 6 continents, were included. There were 137 extracted findings (unequivocal=135, credible=2) with narrative illustrations. These findings were combined to form 19 categories based on similarity in meaning and 4 synthesized findings: i) Informal caregivers of children with cancer adapted their meal preparation strategies, at times prioritizing a child's intake over nutritional value when appetite is poor; ii) Informal caregivers of children with cancer used a spectrum of strategies during mealtimes to support nutritional intake, from positive encouragement and incentivization to more coercive tactics; iii) Informal caregivers of children with cancer perceived their children's altered eating behaviors as significantly affecting caregivers' well-being and family dynamics; and iv) Informal caregivers of children with cancer face feeding-related difficulties shaped by both personal understanding and external support systems. CONCLUSIONS: This review highlights the diverse feeding strategies used by caregivers during meal preparation and mealtimes. Caregivers reported difficulties in managing their children's altered eating behaviors, such as emotional distress at the individual level and disrupted shared meals at the family level. Multilevel facilitators and unmet needs were also identified, including caregivers' difficulty understanding their child's experiences and limited access to tailored dietary guidance. Health care providers should, therefore, offer practical dietary advice and support to ease caregiver burden while promoting children's nutritional well-being. Future research should explore feeding experiences both before and after a child's cancer diagnosis to provide a more comprehensive understanding. REVIEW REGISTRATION: PROSPERO CRD42024501382. SUPPLEMENTAL DIGITAL CONTENT: A translation of this abstract is available in Thai [ http://links.lww.com/SRX/A177 ].