Legacy-Oriented Interventions for Supporting Family Bereavement and Psychosocial Adaptation in Pediatric Palliative Care: A Systematic Review

Background Legacy-oriented interventions (LOI) are increasingly integrated into pediatric palliative care (PPC) to support children and their families during serious illness and bereavement. However, its impact on family grief and psychosocial outcomes remains insufficiently explored. Objectives This systematic review evaluated the effects of LOI on children and families receiving PPC. Methods A systematic search was conducted in PubMed, Scopus, and Web of Science up to February 28, 2025. Eligible studies included children and families in PPC settings. Outcomes of interest encompassed relational and memorialization, psychosocial adaptation, family/care system, and clinical domains. Quality appraisal and narrative synthesis were performed. Results Nine qualitative studies met inclusion criteria, all conducted in the United States of America with 164 participants. Eight studies were rated as high quality and one as moderate. LOI facilitated emotional connection with the child, supported coping and meaning-making, and fostered sustained relationships with healthcare professionals. Several interventions were adapted to cultural or spiritual contexts. The effectiveness of LOI varied by type of legacy (tangible vs intangible) and the family’s stage of bereavement. Few studies explored symptom control or broader social outcomes. Conclusions LOI appear to provide valuable psychosocial support for families in PPC, particularly by sustaining emotional bonds and promoting grief adaptation. Nevertheless, the evidence base is limited to small, qualitative studies from a single country. Further research in diverse cultural settings, employing longitudinal and mixed-method designs, is needed to inform clinical practice and policy.