Clinical Guideline Review

Evidence-Based Recommendations for the Appropriate Level of Sedation to Manage Pain in Pediatric Oncology Patients Requiring Procedures: A Systematic Review From the Children’s Oncology Group

Author(s): Elizabeth A. Duffy, DNP RN CPNP; Tara Adams, BSN RN CPON; Clifton P. Thornton, MSN BS RN CNMT CPNP; Beth Fisher, MSN CPNP CPON; Jennifer Misasi, BSN MS CPNP CPON CPHPN; and Sally McCollum, PharmD


Method of Review:  A subcommittee of the Evidence-Based Practice and Research Committee of the Association of Pediatric Hematology/Oncology Nurses conducted a group review of the clinical recommendations using the AGREE II criteria1. The committee had an overall assessment of approval for endorsement.

Review Summary: The treatment of children with cancer often includes repeated painful procedures. There is no standard level of sedation for these procedures or a comprehensive approach to managing the pain. This systematic review process was well conducted. Although this is still an underreported topic in the literature, the authors did find some evidence that is important for the nurses who perform or participate in the described procedures. More variations between the different age groups in pediatrics would be a plus, i.e., an adolescent may have a different pain experience during procedures than a small child. The review can be useful as an overview of current evidence and provide impetus to future research/EBP/QI work.

Recommendation for use: Recommend for endorsement.

Disclaimer: These are not Evidence-Based Practice (EBP) guidelines but are a systematic review of the literature with EBP recommendations. Not all components of the AGEE II review instrument are met. The instrument is designed specifically for guideline review. The AGREE II instrument does allow for an objective assessment of quality. The EBP/Nursing Research Committee agrees that the value of these pediatric oncology EBP recommendations merit their posting on the APHON website.


1AGREE Next Steps Consortium (2009). The AGREE II Instrument [Electronic version]. Retrieved May 2018, from