Background Symptoms and associated distress in children diagnosed and treated for cancer are uniformly common, yet structured and systematic symptom monitoring is not yet commonplace. With increasing pressures on the healthcare workforce, improved systematic approaches to symptom management are required. Methods Medical, nursing and allied health oncology clinicians developed algorithms using consensus techniques to ascertain thresholds of concern for each symptom for the Symptom Screening in Pediatrics (SPPedi) tool, a Patient Reported Outcome Measure (PROM). Algorithm vetting and refinement were achieved through iterative interviews and consultation with clinicians. Self-management evidence-based recommendations for each symptom were developed. The algorithms were incorporated into an existing smartphone application (MyQCH), as part of the Oncology Hub, and an iterative evaluation is planned to test the feasibility, acceptability, safety, usefulness, and other domains including a hybrid effectiveness trial (ACTRN12621001084875). Discussion Digital solutions provide alternative options for communication, information, and education and opportunities to harness the best of community and hospital services. The Oncology Hub and RESPONSE system is a comprehensive approach to symptom management that includes a suite of tools and resources including a smartphone app that collects PROMs and delivers symptom management advice, as well as written resources for both the families of children with cancer and clinicians. Conclusions Using technology offers new ways to think about how clinicians and families communicate and share information. Understanding how information is exchanged using technology, and how this impacts clinical workflow is critical to successful implementation, and to ultimately optimise symptom assessment management in children with cancer.

Objective: To synthesise existing qualitative research exploring the experiences of parents caring for children with cancer during the end-of-life phase, and the factors that influence parental decision making when choosing the location of end-of-life care and death for their child. Results: This review included 15 studies involving 460 parents of 333 children and adolescents who died from progressive cancer. Where reported, the majority (58%) of children died at home or in a hospital (39%), with only a small fraction dying in a hospice. Factors impacting decision-making for location of care included the quality of communication and the quality of care available. Themes related to choosing home for end-of-life care and death included: honouring the child’s wishes, familiarity of home, and parents’ desire to be their child’s primary carer. Preference for location of death in hospital included trust in hospital staff, practical logistics and the safety of the hospital environment.