Nursing Perspectives on Palliative and Supportive Care in Paediatric Oncology: A Multicentre Qualitative Study.
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AIM: To explore paediatric oncology nurses' perspectives on how supportive and palliative care are understood, delivered, and integrated within routine clinical practice in India. DESIGN: A multicentre qualitative study informed by a constructivist-interpretivist paradigm. METHODS: Twenty-four paediatric oncology nurses from three tertiary cancer centres in India were purposively recruited. Semi-structured interviews were conducted during 2023-2024, audio-recorded, transcribed verbatim, translated where necessary, and analysed using reflexive thematic analysis. Analysis was primarily inductive while sensitised by predefined working definitions of supportive and palliative care. RESULTS: Four interrelated themes were constructed: Clinical Stabilisation and Treatment Continuity; Relational and Communication Work; Embedded Palliative Care; and Emotional Labour. Nurses described continuous surveillance, symptom-responsive care, communication, navigation, comfort-focused support, end-of-life care, and the emotional work required under resource constraints. 'Embedded palliative care' is the researchers' interpretation of practices oriented towards relieving suffering and preserving dignity; participants did not consistently label these activities as palliative care. CONCLUSION: Nurses described clinical, relational, supportive, and explicitly palliative practices that responded to suffering across the illness trajectory. The findings indicate areas for service development but do not establish effects on patient safety, treatment continuity, distress, or service outcomes. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Practice considerations include strengthening generalist palliative-care competence, systematic assessment of symptoms and suffering, family communication and navigation, emotional support for nurses, and timely access to specialist palliative care. These approaches require implementation and prospective evaluation. IMPACT: The study clarifies how paediatric oncology nurses in three Indian tertiary centres understand and undertake supportive and palliative work, including activities that researchers interpreted as palliative-oriented even when participants did not use that label. REPORTING METHOD: The study is reported in accordance with the Standards for Reporting Qualitative Research (SRQR). NO PATIENT OR PUBLIC CONTRIBUTION: No patients, caregivers, or members of the public contributed to the study design, conduct, analysis, interpretation, or manuscript preparation. Nurses participated as research participants.