{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:30:41Z","timestamp":1787725841165,"version":"build-2784847793"},"reference-count":90,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"NIH","doi-asserted-by":"publisher","award":["5T32HS017589"],"award-info":[{"award-number":["5T32HS017589"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016220","name":"CTSA","doi-asserted-by":"crossref","award":["TL1 TR001864"],"award-info":[{"award-number":["TL1 TR001864"]}],"id":[{"id":"10.13039\/100016220","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/objectives: High-quality pediatric critical care includes supporting children nearing the end-of-life (EOL) and their families. Cataloging existing interventions for children dying in the neonatal or pediatric intensive care unit (NICU, PICU) establishes critical areas for future research. In this scoping review, we evaluated characteristics of PICU EOL interventions. Methods: A librarian guided a search of OVID Medline, CINAHL, OVID PsycINFO, OVID Embase, Cochrane Central, and Web of Science, plus backwards and forwards reference searching. We included interprofessional interventions, defined as any systematic change (e.g., educational programs, symptom management, electronic medical record, etc.), for children dying from any cause. Studies were independently screened by two reviewers. Data were extracted by one team member and reviewed by a second. We extracted intervention elements, contextual factors, implementation barriers\/facilitators, and generated frequencies from qualitative coding. Results: Of 11,643 screened articles, 44 met the inclusion criteria. Most were in neonatal ICUs (n = 28\/44, 64%) and general PICUs (n = 10\/44, 23%). Most interventions aimed to improve clinician knowledge (25\/44, 57%), augment clinical structures and processes (n = 11\/44, 25%), or enhance communication (n = 8\/44, 18%). Common delivery methods included clinical practice changes (n = 25\/44, 57%; e.g., protocols, order sets [n = 12]), and educational sessions (n = 20\/44, 45%). Outcomes included clinician knowledge (n = 17\/44, 39%), qualitative feedback (n = 18\/44, 41%), feasibility\/acceptability (n = 12\/44, 27%), or treatment utilization (n = 11\/44, 25%). Few examined families\u2019 mental health (n = 3, 7%) or bereavement (n = 2, 5%). Few reported implementation facilitators or barriers. Conclusions: Most included studies targeted clinician outcomes through education. Designing, testing, and implementing interventions focused on family outcomes is a critical next step.<\/jats:p>","DOI":"10.3390\/children12111485","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T13:47:58Z","timestamp":1762177678000},"page":"1485","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Improving Intensive End-of-Life Care for Infants and Children: A Scoping Review of Intervention Elements"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1585-1786","authenticated-orcid":false,"given":"Elizabeth G.","family":"Broden Arciprete","sequence":"first","affiliation":[{"name":"National Clinician Scholars Program, School of Medicine, Yale University, New Haven, CT 06520, USA"},{"name":"School of Public Health, Yale University, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7864-0655","authenticated-orcid":false,"given":"Na","family":"Ouyang","sequence":"additional","affiliation":[{"name":"School of Nursing, Yale University, Orange, CT 06477, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2756-2583","authenticated-orcid":false,"given":"Sarah E.","family":"Wawrzynski","sequence":"additional","affiliation":[{"name":"Center for Healthcare Delivery Science, Nemours Children\u2019s Health, Delaware Valley, DE 19803, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9024-6228","authenticated-orcid":false,"given":"Ijeoma J.","family":"Eche-Ugwu","sequence":"additional","affiliation":[{"name":"Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA 02215, USA"},{"name":"Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0121-525X","authenticated-orcid":false,"given":"Janene","family":"Batten","sequence":"additional","affiliation":[{"name":"Harvey Cushing\/John Hay Whitney Medical Library, Yale University, New Haven, CT 06520, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7776-5349","authenticated-orcid":false,"given":"Deena K.","family":"Costa","sequence":"additional","affiliation":[{"name":"National Clinician Scholars Program, School of Medicine, Yale University, New Haven, CT 06520, USA"},{"name":"School of Nursing, Yale University, Orange, CT 06477, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelli L.","family":"Feder","sequence":"additional","affiliation":[{"name":"National Clinician Scholars Program, School of Medicine, Yale University, New Haven, CT 06520, USA"},{"name":"School of Nursing, Yale University, Orange, CT 06477, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M.","family":"Snaman","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA 02215, USA"},{"name":"Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1080\/07481180126147","article-title":"Parental Bereavement: The Crisis of Meaning","volume":"25","author":"Wheeler","year":"2001","journal-title":"Death Stud."},{"key":"ref_2","unstructured":"Klass, D. 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