A Nurse-Led, School-Based Social and Educational Intervention for Siblings of Children With Cancer (SUPREME): Process Evaluation of Perceived Impacts

PURPOSE: To explore siblings' and parents' experiences of, and perceived impacts of, a nurse-led school-based intervention (SUPREME) for siblings of children with cancer in Denmark.

DESIGN: A qualitative process evaluation.

METHODS: Fifteen siblings (aged 6-14 years) and 16 parents were recruited through criterion-based sampling following siblings' participation in the SUPREME intervention. Data consisted of semi-structured interviews and open-ended responses from an evaluation form, and were analysed thematically. Data were collected between May 2024 and February 2025.

RESULTS: The intervention created a sense of normality for siblings by providing age-appropriate and credible information in the familiar school context, thereby strengthening the understanding of the family's cancer journey. The SUPREME nurse played a key role in easing the communication burden on siblings and parents, while also promoting recognition of siblings within the hospital setting as active participants in the family's cancer journey. Additionally, the intervention was perceived to accommodate varying levels of support needs across families.

CONCLUSION: The SUPREME intervention benefited siblings-and, by extension, their families-by equipping siblings with essential information, guiding their class communities on how to offer appropriate support and fostering siblings' inclusion in the family's cancer journey. The SUPREME intervention constitutes a new strategy for accessible, universal sibling support.

IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE: The healthcare system should formally ensure that professionals working with families affected by severe paediatric conditions provide family-centred care that actively includes siblings.

IMPACT: What problem did the study address? The position of siblings of children with cancer is often complex, as they may simultaneously serve as visible front figures of the family while remaining overlooked. This study explored how parents and siblings of children with cancer experienced participating in a new sibling support intervention. What were the main findings? Nurses play a central role in supporting siblings of children with cancer by bridging family, hospital and school contexts. Where and on whom will the research have an impact? Nurse-led, cross-sectoral interventions such as SUPREME may help normalise siblings' everyday lives and promote their inclusion in the family's cancer journey.

REPORTING METHOD: This study followed the Standards for Reporting Qualitative Research checklist.

PATIENT AND PUBLIC INVOLVEMENT: No patients, participants, or members of the public were involved in the design of this specific study.