Evidence-Informed Multidisciplinary Consensus Guidance for the Psychosocial Care of Adolescents With High-Risk Cancer: Recommendations From the Italian Association of Pediatric Hematology and Oncology.

BACKGROUND: Adolescents with high-risk cancer face complex developmental, psychosocial, and ethical challenges that extend beyond disease-directed treatment. Although international recommendations exist for communication, psychosocial care, pediatric palliative care, survivorship, and shared decision-making, these have largely evolved within individual domains rather than as an integrated operational approach tailored to adolescents with high-risk disease. We therefore developed evidence-informed multidisciplinary consensus guidance to support psychosocial care across pediatric oncology settings. METHODS: The guidance was developed through a multidisciplinary initiative of the Italian Association of Pediatric Hematology and Oncology (AIEOP), with leading experts in psycho-oncology, the medical and psychological care of adolescents, palliative and supportive care, and representatives from 12 pediatric oncology centers. A structured review of the literature and existing international guidance informed iterative multidisciplinary consensus. Recommendations integrated empirical evidence, international guidance, and multidisciplinary clinical expertise. To enhance transparency, recommendations were categorized as evidence-informed recommendations, consensus-based recommendations, or good practice statements, with recommendation-level traceability. RESULTS: The consensus process produced operational guidance organized into four domains: (1) core practice recommendations; (2) decision-making capacity and progressive assent; (3) routine psychosocial screening and stepped care; and (4) implementation and quality improvement. The guidance emphasizes developmentally appropriate communication, progressive adolescent participation in decision-making, systematic psychosocial assessment, family-centered care, educational continuity, timely integration of supportive and pediatric palliative care, and implementation strategies that support equitable, coordinated multidisciplinary care while allowing adaptation to local contexts. CONCLUSIONS: This AIEOP evidence-informed multidisciplinary consensus guidance complements existing international recommendations by integrating evidence, established guidance, and multidisciplinary expertise into practical operational recommendations, providing a transparent foundation for consistent, equitable, and developmentally appropriate psychosocial care and future implementation evaluation.