The lived experience of resilience in families of children with cancer: a meta-aggregative synthesis of qualitative studies.
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BACKGROUND: Childhood cancer imposes substantial psychological, social, and practical challenges on families, often disrupting emotional stability, caregiving roles, financial security, and family functioning. Family resilience has increasingly been recognized as a dynamic process that supports adaptation under prolonged adversity. However, qualitative evidence regarding how families develop and sustain resilience in the context of childhood cancer remains fragmented. OBJECTIVE: This qualitative systematic review aimed to synthesize existing qualitative evidence on family resilience among families of children with cancer and to identify key resilience processes, coping strategies, and influencing factors associated with adaptive family functioning. METHODS: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Joanna Briggs Institute (JBI) methodology for qualitative evidence synthesis. Relevant studies were identified through systematic database searches using structured combinations of terms related to childhood cancer, family resilience, caregiving, and parental adaptation. Eligible qualitative studies were critically appraised using the JBI Critical Appraisal Checklist for Qualitative Research. Findings were synthesized using meta-aggregation to generate categories and broader synthesized findings. RESULTS: Four synthesized findings emerged. First, family resilience involved emotional and cognitive transformation, in which families initially experienced fear, uncertainty, guilt, helplessness, and psychological disruption, followed by emotional adjustment, acceptance, and reconstruction of hope and meaning. Second, behavioral adaptation and family reorganization represented critical resilience processes, including redistribution of caregiving responsibilities, restructuring of daily routines, and strengthened family cohesion. Third, external support functioned as an important protective factor in resilience development, with healthcare professionals, peer networks, and relatives providing emotional, informational, and practical support, although financial strain, caregiving intensity, and emotional exhaustion could limit access to such resources. Fourth, coping strategies employed by parents influenced resilience sustainability, with problem-focused coping, emotional regulation, and meaning-making facilitating adaptation, whereas avoidance and passive withdrawal were associated with weaker long-term adjustment. CONCLUSIONS: Family resilience in childhood cancer should be understood as a dynamic and multidimensional adaptation process shaped by emotional transformation, behavioral reorganization, external support, and coping strategies. Family-centered interventions that strengthen resilience-promoting coping, improve access to support systems, and facilitate adaptive family functioning may enhance long-term psychosocial outcomes in pediatric oncology care. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024551729, identifier CRD42024551729.