© Annals of Palliative Medicine. All rights reserved. Ann Palliat Med 2023; 12 (1): 10-12| https://dx. doi. org/10.21037/apm-22-1326 care services are synonymous with ‘giving-up’(13, 14). Early integration of palliative care has been shown to lead to improved outcomes of care including improved symptom management and quality of life (13, 14). Addressing misconceptions and educating health and social care professionals and families as to the benefits that palliative care can provide for children and young people with life-limiting and life-threatening conditions may increase likelihood of referral to paediatric palliative care teams for the benefit of children and young people and their families (15). Another key finding identified in this review was that even when health and social care professionals were knowledgeable and had positive attitudes towards palliative care, they were not always confident in delivering all aspects of palliative care (9). The World Health Organisation definition of palliative care consists of four domains of care: physical, emotional, social, and spiritual (16). Whilst most health and social care professionals feel confident in addressing physical symptoms, spiritual and existential concerns in particular have been seen to be difficult to discuss, in part due to clinicians lack of experience or confidence (9, 17) but also due to discomfort related to discussing issues such as death and dying with children (18, 19). This can contribute to the reluctance of health and social care professionals to refer families onto palliative care services due to the association of palliative care with death and dying (15).

However, findings from a multi-country qualitative study in Africa conducted by Namisango et al.(20) as well as a similar qualitative interview study in the UK conducted by Coombes et al.(17) both found that the symptoms and concerns that mattered most to children and young people and their families encompassed all four World Health Organisation domains of care (16). This further demonstrates the importance of providing health and social care professionals, and families accurate information about paediatric palliative care to increase positive attitudes and thus facilitate more timely referrals to these services to provide a holistic child-and family-centred care and to improve quality of life across the whole trajectory of the child’s illness and better support families (1). Saad et al. importantly acknowledge that as 82% of the studies included in their review are from high-income countries, with almost half being from the USA, as well as the search being restricted to English language articles (9) that there may be cultural differences that are important to consider that may not have been identified. Moreover, addressing knowledge and attitudinal barriers may also