Cognitive-behavioral interventions for physical symptom management in pediatric palliative medicine.

The alleviation of symptoms, with the ultimate intention of improvement of quality of life, is a fundamental component of pediatric palliative medi-cine. Psychological factors can exacerbate physical symptoms or influence the perception of symptoms in children with advanced disease. Cognitive-behavioral interventions have yielded positive outcomes for the management of symptoms across various disease populations. There is a paucity of evidence specific to the application of these interventions in pediatric palliation, although evidence-based treatments developed through investigation of other disease populations can be applied in pediatric palliation. Children tend to be receptive to these noninvasive interventions, which can decrease fear and anxiety, increase self-efficacy and sense of control, and improve overall coping. Continued investigation into the use of these interventions in pediatric palliation is encouraged.