Pretend play: children with cancer

Recent reviews show that children seldom participate in consultations and decisions regarding their care. There is disagreements between health care professionals on whether children should be involved or not.

Studies indicate that by being more active children's understanding of their illness might improve and their pain may be reduced. According to the UN Declaration of children's rights, every child has a right to acquire knowledge and skills for communication, enabling them to relate to the world around them in their own unique way.


  • To explore the usability of pretend play for increasing children's engagement in care situations
  • To investigate whether pretend play can contribute to increased communication skills and a broader behavioral /emotional repertoire in care situations
  • To examine the clinical ethical implications regarding involvement of children and their families in pediatric oncology care


This research is funded by the Swedish Childhood Cancer Foundation (Barncancerfonden)

About Pretend Play

In 2015, a pilot study of the project was conducted on five children with cancer and five healthy children. Lessons learned from the pilot study were that recruitment of children and parents can take time and that the number of questionnaires must not be too big. Positive aspects were that the play intervention worked well and that the videotaping of them was accepted by both parents and children.

The main project is designed in the same way as the pilot study, but with an increased number of children. Around 15 children, at the age 4-10 and with a cancer diagnosis from two Swedish hospitals, and their parents will be asked to participate. Each child will take part in six to eight play sessions led by a play facilitator. Each session includes three or four pretend play situations. The play sessions will be videotaped. Before and after the intervention both parents and children are asked to fill out a questionnaire, measuring quality of life, well-being, anxiety, self-efficacy and affect in play in the child. Both children and parents will also be interviewed after the intervention. In a concluding theoretical study the clinical ethical implications of increased participation and autonomy of children with cancer will be investigated.

The play intervention is designed to present something positive and funny for children with cancer. Through their participation, children with cancer and their parents can contribute to increased quality of care for children and make children more autonomous and participating in their care situation.


Collaborators outside CRB

  • Lena Ring, Adjunct Prof. Quality of Life Research in Health Care, Uppsala University
  • Sandra Russ, Professor of Psychology, Case Western Reserve University, Cleveland
  • Monika Bullinger, Professor of Medical Psychology, University of Hamburg
  • Gustaf Ljungman, Associate Professor of Paediatric Oncology at Uppsala University and Uppsala University Hospital

Nursing Ethics & Ethics of Care

Nursing ethics is concerned with the moral dimensions of nursing practice while the ethics of care is a normative ethical theory. For many years CRB has developed these fields from different angles. We have used qualitative studies to describe and explore the kinds of ethical dilemmas nurses encounter in their day-to-day work and how they solve them. Other studies have investigated the role of ethical guidelines in the building of ethical competence in nursing practice and in priority setting. In this report, we provide a summary of our research.

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