Multi-stakeholder perspectives into the experiences of siblings when a child is critically ill: A qualitative systematic review

Abstract

Objectives: A child's critical illness and admission to intensive care can have significant short- and long-term impacts for the parents and hospitalized child. While experiences of parents have been explored, the impact on siblings remains unclear. The aim was to systematically review and synthesize qualitative research exploring the experiences of siblings when a child is critically ill, from the perspectives of siblings and relevant key stakeholders.

Methods: Comprehensive searches were performed across six databases and three sources of grey literature on October 30, 2023 and September 23, 2024. Original qualitative research focusing on sibling experiences during a child's critical illness were included. Two independent reviewers screened studies, with conflicts resolved by a third reviewer. Data extraction and quality assessment were carried out by one reviewer and verified by a second reviewer using Covidence. Thematic synthesis was used to synthesize extracted data, ensuring the rigor of the findings.

Findings: Of 1,552 studies screened, 24 met inclusion criteria. Seven mixed methods and 17 qualitative studies were included. Experiences of siblings were categorized into eight themes and included elements such as visiting the ICU, being separated, changing roles, looking to the future, and getting support. Sibling experiences could be positively or negatively influenced by parents, healthcare professionals, hospital policies and environment.

Conclusions: This study provides a novel insight into the underrepresented sibling experience in critical care research. Siblings experience significant multi-faceted impacts when a child is critically ill. This review underscores the necessity for further research on siblings' perspectives in critical care, to aid development of appropriate supports and interventions for siblings and families during a child's critical illness.

Implications for clinical practice: Understanding siblings' experiences can enhance holistic family-centered care. Findings from this review demonstrate the need for more supportive practices for siblings in intensive care, through development of inclusive, family-centered care policies and guidelines.

Keywords: Critical care; Family centered care; Intensive care units; Neonatal; Pediatric; Siblings.