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Review Article
care, health and development
doi:10.1111/cch.12475

Understanding the school experiences of children

and adolescents with serious chronic illness: a
systematic meta-review
A. Lum,*† C. E. Wakefield,*† B. Donnan,*†‡ M. A. Burns,*† J. E. Fardell*† and
G. M. Marshall*†
*Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
†Discipline of Paediatrics, School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Sydney, NSW,
Australia, and
‡Ronald McDonald House Charities, Sydney, NSW, Australia
Accepted for publication 15 April 2017

Keywords
child development,
chronic illness, school,
systematic review
Correspondence:
Alistair Lum, Behavioural
Sciences Unit proudly
supported by the Kids
with Cancer Foundation,
Kids Cancer Centre, Level
1 South, Sydney
Children’s Hospital, High
Street, Randwick, NSW
2031, Australia.
E-mail:
a.lum@student.unsw.edu.
au
Abstract
Background Serious chronic illness can have a detrimental effect on school attendance, participation
and engagement, leaving affected students at risk of failing to meet their developmental potential. An
improved understanding of factors that help to explain or mitigate this risk can help educators and
health professionals deliver the most effective support. This meta-review critiqued the available
evidence examining the link between six chronic illnesses (asthma, cancer, chronic kidney diseases,
heart diseases, cystic fibrosis and gastrointestinal diseases) and children’s and adolescents’ school
experiences and outcomes, as well as investigating the medical, school, psychosocial and
sociodemographic factors that are linked to poorer or better school outcomes.
Methods We searched CINAHL, Cochrane Database, EMBASE, ERIC, MEDLINE, ProQuest Theses and
Dissertations, and PsycINFO (2000–2015). Systematic and narrative reviews, and meta-analyses, of
original studies examining students’ subjective school experiences and objective school outcomes
were eligible. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses
criteria to critically appraise all systematic reviews. The Grading of Recommendations Assessment,
Development, and Evaluation system guided our recommendations for practice and research.
Results Eighteen reviews of 172 studies including more than 40 000 students were eligible. Therefore,
we chose to conduct a meta-review to provide an overview of the literature on the relationship
between chronic illness and school experiences and outcomes. We also explored the associated
medical, school, psychosocial and sociodemographic factors affecting the relationship between illness
and school experiences and outcomes.
Conclusion Students with chronic illness demonstrate mixed school experiences and outcomes
that are often worse than students without chronic illness. Modifiable factors, such as students’
engagement with school, may be novel yet appropriate targets of educational support to ensure
that these students reach their full schooling potential.

© 2017 John Wiley & Sons Ltd 645

646 A. Lum et al.
Introduction
The primary aim of school is to promote children’s and
adolescents’ social, emotional, cognitive, mental and physical
potential to ensure ongoing development and lifelong thriving
(OECD 2015). The challenges associated with chronic illness
can adversely affect school experiences (Shaw et al. 2010). As a
result, children and adolescents with chronic illness may be at
risk of failing to reach their potential at school and in
adulthood (Maslow et al. 2011).
The literature reporting prevalence rates of serious chronic
illness varies significantly (van der Lee et al. 2007). Following
their review of relevant definitions, van der Lee et al. (2007)
defined a chronic illness as a condition that can be diagnosed
to professional standards (i.e. The International Classification
of Diseases, 10th Revision; National Center for Health Statistics
2007) and is expected to last longer than 3 months or to be
incurable. According to this definition, approximately 10% of
children and adolescents have chronic illness (Suris et al.
2008). Up to 6.5% of all students have health conditions that
limit their ability to perform school tasks (Shaw et al. 2010).
Growing research has examined the link between chronic
illness and many different and interrelated school experiences
and outcomes. Students with chronic illness often report
poorer school experiences when compared with students
without chronic illness, including lower peer and teacher
relationship quality (Hokkanen et al. 2004; Martinez et al.
2011; Moody et al. 1999; Sentenac et al. 2013) and lower levels
of student engagement with, and motivation towards, school
(Forrest et al. 2011). Chronic illness is also associated with
poorer school attendance (Crump et al. 2013; Reuben & Pastor
2013) and academic achievement (Duquette et al. 2007;
Martinez & Ercikan 2009; Pinquart & Teubert 2011), higher
rates of grade repetition (Gerhardt et al. 2007) and special
education provision (Mitby et al. 2003; Reuben & Pastor 2013),
and lower levels of educational attainment (Lancashire et al.
2010; Maslow et al. 2012; Champaloux & Young 2015). Poorer
school experiences and outcomes can contribute to higher
rates of unemployment (Maslow et al. 2011; Murray et al.
2014) and depression (Zebrack et al. 2002) among adults with
childhood-onset chronic illness.
While there is considerable research indicating that chronic
illness is associated with poorer school outcomes, some studies
have found that students with a chronic illness have the same or
better school experiences and outcomes as students without
illness (Gerhardt et al. 2007; Moonie et al. 2008; Dieluweit et al.
2011; Mackner et al. 2012). These findings are evidence that
students with a chronic illness can achieve well academically and
© 2017 John Wiley & Sons Ltd, Child: care, health and development, 43, 5, 645–662
can lead a psychosocially healthy school life. On the basis of this
evidence, researchers are raising the point that students with a
chronic illness should do as well as their healthy peers provided
that they are given the medical, academic and social support that
they require (Hilliard et al. 2015; Young-Hyman 2003). As
schools continue in their endeavors to provide support for
students with chronic illness, further research is required to
determine the factors associated with school success among this
student subpopulation. In an effort to inform education and
health professionals of current trends and to stimulate further
research in this field, we reviewed the literature examining the
relationship between chronic illness and students’ school
experiences and outcomes. We aimed to identify medical,
school, psychosocial and sociodemographic factors that help to
explain this relationship, including factors associated with equal
and better school experiences and outcomes.
A number of reviews examining the impact of chronic illness
on different school experiences and outcomes have been
conducted. No review to date, however, has systematically
examined all school outcome variables that have been
empirically linked to chronic illness. Furthermore, reviews to
date have often examined trends within illnesses, and not across
illnesses. Therefore, we chose to conduct a meta-review to
provide an overview of the literature on the relationship between
chronic illness and school experiences and outcomes. We also
explored the associated medical, school, psychosocial and
sociodemographic factors affecting the relationship between
illness and school experiences and outcomes. A meta-review, or
‘umbrella review’, is a systematic review of reviews that can
briefly address a broad scope of research (Grant & Booth 2009).
A meta-review provides a practical option for aggregating
research on the entire spectrum of school outcomes into a single
document (Becker & Oxman 2008). By compiling a meta-
review, an examination of consistency across studies is made
possible, thereby providing a more robust understanding of the
research trends (Grant & Booth 2009; Cooper & Koenka 2012).
We focused on the six chronic illnesses recorded as having
the highest rates of school absenteeism according to an
independent database of families seeking additional tutoring
for their ill child kept by the Australian Ronald McDonald
House Charities’ Learning Program: asthma, cancer, chronic
kidney diseases (CKDs), cystic fibrosis, gastrointestinal diseases
and heart diseases.
This meta-review aimed to
• Examine the school experiences and outcomes of children
and adolescents with chronic illness, emphasizing findings
from high-quality reviews.

• Examine the association between illness-related medical,
school, psychosocial and sociodemographic factors and
school experiences and outcomes.
• Provide recommendations for educators, health professionals
and researchers.
Methods
Data sources and study selection
We used seven databases to locate articles: CINAHL, Cochrane
reviews, EMBASE, ERIC, ProQuest Theses and Dissertations,
PsycINFO and MEDLINE. We used the search terms (Child*
OR Adolescen* OR Student OR Teen* OR Youth*) AND
(Asthma OR Cancer OR ‘Heart disease’ OR Renal OR Gastro*
OR ‘Cystic fibrosis’ OR Kidney OR IBD OR Crohn* OR Colitis
OR Digestive) AND (School* OR Education OR Classroom)
AND (Cogniti* OR Social* OR Attendance OR Academic* OR
Psychosocial OR ‘Quality of life’) AND (Review OR Meta-
anal* OR ‘Literature review’ OR ‘Systematic review’ OR
‘Research synthesis’ OR ‘Narrative review’). An asterisk (*)
indicates truncation. We specified child and school search
terms to the title of the article, and all other search terms as
keywords. We also searched grey literature using four public
health libraries: New York Academy of Medicine: The Grey
Literature Report; Open Grey: System for Information on Grey
Literature in Europe; World Health Organization Iris; and
National Technical Reports Library. We modified search terms
for grey literature to (Child* OR Student*) AND (Asthma OR
Cancer OR ‘Heart disease’ OR Gastro* OR ‘Cystic fibrosis’ OR
Kidney) AND (School* OR Education).
Two authors screened the titles and abstracts (A. L. and
M. A. B.). These two authors then read all articles that were not
excluded in the initial screen in full. Disagreements were
subject to review by a third author (C. E. W.) and resolved
through discussion. We manually searched the reference lists
of all articles included in the meta-review for additional
reviews that were not identified through the electronic search.
Selection criteria
Considering the breadth and unique importance of possible
school experiences, we chose a priori to examine all school
experiences and outcomes that were available in the literature.
We did not examine indicators of cognitive performance as
measured by non-curriculum-based standardized instruments,
such as IQ tests, as they were deemed beyond the scope of this
review. Interested readers may refer to the following articles for
© 2017 John Wiley & Sons Ltd, Child: care, health and development, 43, 5, 645–662
Educational implications of chronic illness 647
further information (Karsdorp et al. 2007; Marino et al. 2012;
Moser et al. 2013; Iyer et al. 2015; Landier et al. 2015).
We selected review articles based on the study population,
the predictor variables and the outcome variables. Reviews
were eligible if
• The manuscript was a review of original quantitative and/or
qualitative studies.
• The study sample included school-aged children and
adolescents, or adults with childhood-onset illness who
provided retrospective accounts of their objective school
outcomes (i.e. educational attainment, grade repetition and
special education provision).
• The review focused on asthma, cancer, CKDs, heart diseases,
cystic fibrosis or gastrointestinal diseases – or a medical
treatment for these illnesses.
• Data for specific illnesses were reported separately (i.e. the
review did not examine a combination of illnesses as one
illness group).
• The review included, though was not limited to, dependent
variables that assessed school experiences, such as peer
relationships, educational engagement and classroom
behaviour, or school outcomes, such as school attendance,
academic performance (e.g. grade point average),
educational attainment and grade repetition.
• The review was published in or after the year 2000.
• The review was published in English.
• The review was published in a peer-reviewed journal or
scientific grey literature.
Reasons for excluding articles included the following:
• the article did not meet all inclusion criteria or
• the focus was on any form of intervention (other than
standard medical treatment/management).
When more than one review covered the same outcomes
and was written by the same author or research group, the
highest scoring article on the Preferred Reporting Items for
Systematic Reviews and Meta-analyses (PRISMA) criteria (see
later) or the review covering the most information was
included.
The final search was conducted on 27 September 2015.
Quality review
We assessed the quality of the included systematic reviews
using the PRISMA statement (Liberati et al. 2009). Review
648 A. Lum et al.
articles received a score of 1 for each of the 27 PRISMA criteria
that the review met. Higher scores indicate higher quality. Two
authors (A. L. and M. A. B.) assessed each review separately.
Disagreements were subject to assessment by a third author
(C. E. W.) and resolved through discussion. We contacted
authors to obtain further information where required. We did
not assess narrative reviews using the PRISMA criteria. We
considered systematic reviews that met 14 or more PRISMA
criteria as high quality and systematic reviews that met 13 or
fewer PRISMA criteria and narrative reviews as low quality.
These threshold criteria are based on the findings from an
examination of 236 reviews (using PRISMA criteria), which
found that 13 PRISMA criteria were met in 60% or more of the
reviews, indicating 13 criteria are a valid standard for reviews
(Willis & Quigley 2011). Thus, reviews reporting 14 or more
criteria were considered to report beyond the commonly
reported PRISMA criteria.
We further assessed the quality of evidence and strength of
recommendations using the Grading of Recommendations
Assessment, Development, and Evaluation (GRADE) system
(Guyatt et al. 2008). Quality of evidence was based on the
methodological quality, risk of bias, inconsistencies,
imprecisions and indirectness of pooled research for each
outcome. Strength of recommendations was determined by
quality of evidence and the perceived risk-benefit ratio of the
recommendations.
Data extraction
We extracted the following characteristics of the eligible
reviews: type of review, number of studies included, period
of time in which journals or databases were searched, sample
size, age of population, illness or other predictor variables and
education or other outcome variables (see Appendix A for the
full list of items).
Results
After removing duplicates, the search produced 1437 abstracts.
Two authors found 32 articles appropriate for a full-text
review. Inter-rater reliability was 98.4% (23 disagreements out
of 1437 abstracts). We identified 18 of the 32 full-text articles
as eligible for the meta-review (Fig. 1).
Of the 18 reviews included, half were systematic reviews,
and the other half were narrative reviews. No meta-analyses
were found. One review examined both cystic fibrosis and
CKD, while all other reviews examined only one illness
relevant to this review. Of these additional reviews, nine
© 2017 John Wiley & Sons Ltd, Child: care, health and development, 43, 5, 645–662
examined cancer, three examined CKD, three reviewed asthma
and there was one review each for heart disease and
gastrointestinal diseases. The school experiences and outcomes
addressed in reviews included academic performance (nine
reviews), grade repetition (four reviews), educational
attainment (eight reviews), special education provision (nine
reviews), school absenteeism (nine reviews), interpersonal
relationships (six reviews), educational engagement and/or
school connectedness (seven reviews), classroom behaviour
(three reviews) and school reintegration (three reviews). The
eligible reviews encompassed 172 original studies with more
than 40 000 participants (only inclusive of sample sizes as
reported in eligible reviews) (see Table S1 for references of
original articles).
The quality assessment was consistent across the two
reviewers, with an inter-rater reliability rate of 96.3% [nine
disagreements across 243 criteria (27 PRISMA criteria for nine
reviews)]. Quality assessment indicated that most systematic
reviews failed to meet multiple important components of the
PRISMA criteria (Table S2), including the risk of bias within or
across studies, reported summary measures or described
methods of handling data.
Six reviews were considered high quality, and 12 were
considered low quality (Table S3). Review characteristics and
key findings from all reviews are presented in Table 1 by review
quality. Throughout the results, we presented findings of
original articles where a trend for these findings was identified
in either high-quality reviews alone or in a combination of
high-quality and low-quality reviews. We presented findings by
school experience or outcome. We also present these trends
and other key relationships (i.e. identified once in a high-
quality review) of school experiences and outcomes with
illness, medical, school, psychosocial and sociodemographic
factors in Table 2. Using the information available in each
review, we developed a summary of findings, rated the quality
of evidence and gave recommendations using the GRADE
system (Table 3). Because of insufficient reporting of findings,
a quantitative analysis of results (i.e. a meta-analysis) could not
be conducted. To compensate for the large quantity of original
studies, we have stated the number (N) of original studies
reporting the stated findings throughout the text and placed
the corresponding references in supplementary Table S1.
Academic-based outcomes
Sixty-three articles within 17 reviews (including five high-
quality reviews) examined the relationship between chronic
illness (including asthma, cancer, CKD, cystic fibrosis,
gastrointestinal disease and heart disease) and academic

Figure 1. Search process and articles captured for the meta-review.
outcomes (including academic performance, grade repetition,
educational attainment and special education provision)
(Basch 2011; Daly et al. 2008; Davis 2005; Doroshow 2001;
Gerson et al. 2006; Gipson et al. 2007; Gurney et al. 2009;
Herrmann et al. 2011; Kortmann et al. 2003; Langeveld et al.
2002; Marri & Buchman 2005; Milton et al. 2004; Moser et al.
2013; Palmer & Leigh 2009; Pini et al. 2012; Taras & Potts-
Datema 2005; Vance & Eiser 2002). Across all reviews, 31 out
of the 63 original articles reported that academic outcomes
were worse among students with chronic illness compared
with healthy controls or population norms. Within high-
quality reviews, 14 out of 16 studies found that students with
asthma achieved equal or better outcomes as healthy peers,
while 10 out of 26 studies reported that students with cancer
achieved poorer outcomes in comparison with controls
(Langeveld et al. 2002; Vance & Eiser 2002; Milton et al.
2004; Pini et al. 2012). Medical factors were strongly associated
with poorer outcomes among the cancer group.
A strong relationship between worse academic outcomes and
greater disease severity (N = 7), younger age at diagnosis (N = 5)
and treatments with stronger side effects (N = 6) emerged from
the original articles. Diseases (e.g. cancer and CKD) and/or
treatments (e.g. cranial radiation) that affect cognitive
functioning were also consistently linked to poorer academic
© 2017 John Wiley & Sons Ltd, Child: care, health and development, 43, 5, 645–662
Educational implications of chronic illness 649
outcomes (N = 6) compared with illnesses and treatments with
no impact on cognition. For example, a 2003 study of 12 340
childhood cancer survivors found that the risk of special
education provision and lower educational attainment was
highest among survivors of brain tumours who had received
central nervous system implicated treatment before the age of
6 years compared with cancer survivors of other diagnoses and
later age of diagnosis (Mitby et al. 2003). Lower socioeconomic
status (SES) (N = 2) and physical sequelae of treatment (N = 2)
were weakly associated with poorer academic outcomes. We
identified academic and social support at school as associated
with better academic performance in comparison with those
who did not report receiving support (N = 2).
Attendance
Twelve reviews (five high quality) including 88 original articles
examined school absenteeism among students with chronic
illness (including asthma, cancer, CKD, cystic fibrosis,
gastrointestinal disease and heart disease) (Doroshow 2001;
Langeveld et al. 2002; Vance & Eiser 2002; Milton et al. 2004;
Davis 2005; Marri & Buchman 2005; Taras & Potts-Datema
2005; Gerson et al. 2006; Basch 2011; Herrmann et al. 2011;
Pini et al. 2012; Moser et al. 2013). Eighty-two of the original
650 A. Lum et al.

Table 1. Review characteristics and key findings, by quality of review

Equal/better
Authors (date); country Sample characteristics Objectives; N of eligible studies Poorer outcomes† outcomes†

High-quality systematic reviews

Langeveld et al. Long-term survivors of Review research on QOL in adult Grade repetition Academic
(2002); the Netherlands childhood survivors of childhood cancer; 14 Special education performance
cancer, diagnosis pre-20 years, provision Educational
5 years since diagnosis and School absenteeism attainment
over 18 years
Milton et al. Individuals with childhood Review long-term consequences School absenteeism Academic
(2004); the UK onset asthma (under 18 years of having asthma in childhood performance
at diagnosis) and examine if effects were more Grade repetition
severe for children already
experiencing disadvantage; 29
Moser et al. Children and adolescents Review to estimate the quantitative ESRD ESRD
(2013); Canada (1–18 years) with ESRD or CF effect of disease on IQ; 1 (ESRD), 1 (CF) Academic performance CF
Special education Academic
provision performance
CF
School absenteeism
Educational engagement
Pini et al. (2012); Teenagers/young adults Review of primary issues involved in Academic performance Educational
the UK (13–19 years) diagnosed educational engagement for teenage Grade repetition attainment
with cancer, excluding cancer patients; 22 School absenteeism
brain tumours Peer relationships
Teacher relationships
Educational engagement
School reintegration
Vance and Eiser School-aged children Review literature investigating school Academic performance Classroom
(2002); the UK (5–18 years) diagnosed absence, behaviour problems and School absenteeism behaviour
with cancer social relationships of children on Peer relationships
return to school; 23
Wakefield et al. Under age 18 years Review of the psychological impact Classroom behaviour
(2010); Australia at diagnosis with cancer, (positive and negative) of completing Peer relationships
completed cancer treatment cancer treatment on children; 8 Teacher relationships
in last 5 years (5–23 years) School reintegration
Low-quality systematic reviews
Kortmann et al. Children with low grade Review of outcomes associated Special education provision
(2003); Germany glioma of brain with with radiation therapy to
radiotherapy manage low grade gliomas in
children; 4
Taras and Children (5–18 years) Review of the associations between School absenteeism Academic
Potts-Datema diagnosed with asthma asthma, school attendance and performance
(2005); the USA academic outcomes; 77
Marri and Adult survivors of childhood Review of the effects of IBD on the School absenteeism Educational
Buchman (2005); onset IBD continuum of education and Educational engagement attainment
the USA employment; 7
Narrative reviews
Basch (2011); the USA Urban minority youth Review of asthma-related implications Academic performance
aged under 18 years on academic achievement in urban School absenteeism
with asthma minority youth; 11 Peer relationships
School connectedness
Daly et al. (2008); Children with ALL or Review of research related to Educational attainment
the USA CNS tumours the cognitive aspects of paediatric Special education provision
cancer and sickle cell disease; 3
Davis (2005); Children and Review of renal transplant, including Academic performance
the USA adolescents with CKD indications for, and unique aspects School absenteeism

Continues

© 2017 John Wiley & Sons Ltd, Child: care, health and development, 43, 5, 645–662
 Educational implications of chronic illness 651

Table 1. (Continued)

Equal/better
Authors (date); country Sample characteristics Objectives; N of eligible studies Poorer outcomes† outcomes†

of caring for the child before and

after therapy; 2
Doroshow Adolescents Not stated (general overview of Educational engagement Educational
(2001); the USA with simple or corrected CHD in adolescence); 6 attainment
heart disease School absenteeism
Gerson et al. Children and adolescents Review of recently published Educational
(2006); the USA with CKD studies pertaining to the attainment
neurocognitive and psychosocial Special education provision
impact of CKD; 5 School absenteeism
Gipson et al. Children with CKD Review of CNS structure and function Educational attainment Special education
(2007); the USA in children with CKD; 6 provision
Gurney et al. Long-term survivors of Review to describe research Educational attainment
(2009); the USA childhood cancer findings relating to social outcomes Special education provision
among long-term cancer survivors; 8 Grade repetition
Peer relationships
Herrmann et al. Children with ALL Review to examine the need for special Academic performance
(2011); the USA education services for childhood cancer Special education provision
survivors; 8 School absenteeism
School phobia
Palmer and Leigh Survivors of paediatric Review impairment, risk factors Educational attainment
(2009); the USA posterior fossa tumour and school outcomes in survivors Special education provision
of paediatric posterior fossa tumour; 4

ALL, acute lymphoblastic leukaemia; CF, cystic fibrosis; CHD, congenital heart disease; CKD, chronic kidney disease; CNS, central nervous system; ESRD, end-
stage renal disease; IBD, inflammatory bowel disease; IQ, intelligence quotient; N, number.
†
Compared with control.

articles found that chronic illness was related to higher rates of
school absenteeism compared with healthy peers or population
norms. Greater absenteeism was reported across high-quality
and low-quality reviews for all illnesses except simple or
corrected heart disease (Doroshow 2001). Absenteeism profiles
were reportedly different across illnesses. For example,
students with cancer missed significant amounts of school in
the year following diagnosis that gradually returned to pre-
diagnosis levels 8–10 years post diagnosis (Vance & Eiser
2002), while students with asthma or cystic fibrosis missed
school on an irregular basis that accumulated to a significant
amount of absenteeism over the school year (Milton et al.
2004; Moser et al. 2013).
A greater amount of missed schooling was strongly
associated with greater disease severity (N = 20), frequent
hospitalization (N = 7), low SES (N = 5), belonging to a
minority ethnic group (N = 5) and non-adherence to
medication (N = 4). School absenteeism was also repeatedly
associated with students’ anxiety regarding returning to school
as well as concerns about participating and keeping up with
school work (Mancini et al. 1989; Waters et al. 1989; Williams
et al. 1991; Gregory et al. 1994; Sorgen & Manne 2002;
Hedström et al. 2005; Mattsson et al. 2007). The eligible
reviews did not include a significant amount of research
examining links between greater school attendance and
associated factors of chronic illness; however, there was some
evidence that greater support from school staff was associated
with fewer days of missed school (N = 2) (Rydstrom et al.
1999; Grieve et al. 2011). For example, accommodations that
addressed school absenteeism, such as flexible attendance
arrangements, may have reduced some of the students’
concerns (Grieve et al. 2011).
Interpersonal school experiences
Six reviews (three high quality) including 27 articles examined
the relationship between chronic illness (including asthma and
cancer) and school interpersonal relationships, such as those
between peers and teachers (Vance & Eiser 2002; Gurney et al.
2009; Basch 2011; Herrmann et al. 2011; Pini et al. 2012;
Wakefield et al. 2015). Twenty original articles, the majority of
which were qualitative research, indicated that chronic illness
may be associated with poorer school relationships compared
with students without chronic illness. For example, students
with chronic illness have reported being teased or bullied about
their body image, physical functioning and academic

© 2017 John Wiley & Sons Ltd, Child: care, health and development, 43, 5, 645–662
652 A. Lum et al.
Table 2. Trends and other key relationships between school experiences or outcomes and illness, and medical, school, psychosocial and sociodemographic
factors
Domain of school
experiences or outcomes
Findings from high-quality systematic reviews (N = 6)
Academic
(academic performance,
grade repetition,
educational attainment
and special education
provision)
School attendance
Interpersonal
(peer and teacher
relationships)
School
engagement
and connectedness
Classroom behaviour
School reintegration
Findings from low-quality systematic reviews and narrative reviews (N = 12)
Academic (academic
performance,
grade repetition,
educational attainment
and special education
provision)
School attendance
© 2017 John Wiley & Sons Ltd, Child: care, health and development, 43, 5, 645–662
Relationship between domain
and illness (N of studies with
finding/N of studies
examining domain)†
No link to asthma
(14/16) or CF (1/1)
Mixed results in cancer,
link to poorer
outcomes in cancer (10/26)
Link to poorer outcomes in
CKD (1/1)
Link to poorer outcomes
in asthma (12/12),
cancer (16/18)
and CF (1/1)
Link to poorer outcomes
in cancer (18/24)
Link to poorer outcomes
in cancer and CF
Mixed results, link to
poorer outcomes in cancer
(6/15)
Link to poorer outcomes
in cancer (6/8)
No link in asthma (9/11),
GD (6/7) or CHD
Link to poorer outcomes
in cancer and CKD
Link to poorer outcomes
in GD (2/2), asthma, cancer
and CKD
Factors associated with poorer Factors associated with average or
school experiences or outcomes better school experiences or outcomes
(N supporting original studies)† (N supporting original studies)†
Greater disease severity (N = 7), Greater academic and
stronger treatment side effects social support (N = 2),
(N = 6), younger age at diagnosis higher achievement prior
(N = 5), lower SES (N = 2), being to diagnosis and
male, older age, lower effective treatment
parental education levels, longer
duration of treatment, premature
at birth and greater school
absenteeism
Greater disease severity Higher SES, confidence in ability
(N = 20), frequent hospitalization to cope, support from school
(N = 7), lower SES (N = 5), staff and effective treatment
belonging to minority ethnic
group (N = 5), non-adherence to
medication (N = 4), stronger
treatment side-effects, lower
parental education levels and
shorter time since diagnosis
Greater disease severity (N = 6), Greater social support (N = 6),
greater school absenteeism, special friendship that links ill
younger age at diagnosis, stronger child from hospital to school,
treatment side effects and grade teacher and peer understanding
repetition of illness implications
Poorer peer relationships (N = 5), Social support at school and hospital
less hospital and school support (N = 5)
(N = 4) and poorer academic
functioning (N = 2)
Poor model of support Good hospital to school communication
and collaboration (N = 6),
clear understanding of impact of illness
and responsibilities of personnel (N = 4)
and flexible school arrangements (N = 2)
Sleep disturbances, disease severity,
lower SES, younger age at diagnosis,
stronger treatment side effects, and
ongoing treatment and hospitalization
Sleep disturbances, disease severity,
non-adherence to treatment, lower
SES, Black ethnicity, younger age, high
frequency of hospitalization, parental
factors, high ozone levels, stronger
treatment side effects, emotional
comorbidity and school phobia
Continues

Table 2. (Continued)
Relationship between domain
and illness (N of studies with
Domain of school finding/N of studies
experiences or outcomes examining domain)†
Interpersonal Link to poorer outcomes in
(peer and teacher asthma and cancer
relationships)
School Link to poorer outcomes in
engagement CHD and GD
and connectedness
CF, cystic fibrosis; CHD, congenital heart disease; CKD, chronic kidney disease; GD, gastrointestinal disease; N, number; SES, socioeconomic status.
†
Data only provided for outcomes where data can be reliably extracted.
performance (Hokkanen et al. 2004; Drew 2007); concerns
about being different to peers, keeping up with peers and being
understood by peers (Decker et al. 2004; Duffey-Lind et al.
2006); and negative attitudes and behaviours (e.g. unsupportive,
inflexible and dismissive) displayed by teachers and peers
(Hokkanen et al. 2004). The three high-quality reviews were
limited to cancer, where each indicated poorer interpersonal
relationships compared with healthy peers or population norms
(Vance & Eiser 2002; Wakefield et al. 2010; Pini et al. 2012).
Consistent evidence in high-quality reviews on cancer
indicated that social support at the school (N = 6) was
associated with better relationships at school. Greater social
support may be due to greater teacher and peer awareness of
the illness (Mitchell et al. 2006). Greater disease severity was
repeatedly linked to poorer peer relationships and social
isolation (N = 6).
Engagement with school
Fourteen original articles within seven reviews (four high
quality) identified unique school experiences of children and
adolescents with serious chronic illness (including asthma,
cancer, CKD, cystic fibrosis, gastrointestinal disease and heart
disease) that related to students’ engagement with school
(Doroshow 2001; Vance & Eiser 2002; Marri & Buchman 2005;
Wakefield et al. 2010; Basch 2011; Pini et al. 2012; Moser et al.
2013). Student engagement experiences were primarily
identified using qualitative or non-controlled research
methods. These experiences included an eagerness to attend
school as it provided a sense of normality (Mancini et al. 1989;
Spirito et al. 1990; Bessell 2001); nervousness or reduced
willingness to attend school due to lower sense of confidence,
changes in body image and feeling different from peers
(Decker et al. 2004; Duffey-Lind et al. 2006; Palmer et al. 2000;
Educational implications of chronic illness 653
Factors associated with poorer Factors associated with average or
school experiences or outcomes better school experiences or outcomes
(N supporting original studies)† (N supporting original studies)†
Sleep disturbances, emotional
comorbidity and disease severity
Hostility from teachers
Sorgen & Manne 2002); alterations in educational goals due to
illness (Lansky et al. 1986; Mayberry et al. 1992; Dolgin et al.
1999; Grinyer 2007); and a sense of being treated differently by
teachers (Wright et al. 1985; Duffey-Lind et al. 2006).
Students’ experiences with teachers were most often positive
and supportive, but negative experiences were found in 10–30%
of cases (Mayberry et al. 1992; Mitchell et al. 2006; Enskär & von
Essen 2007; Moore et al. 2009). Poorer engagement experiences
were linked to poorer peer relationships (N = 5); poorer school-
oriented support from within the hospital (N = 4); and poorer
academic functioning (N = 2). Better school experiences were
linked to better school support from within the school or
hospital, such as structured hospital-to-school liaison or
supportive adjustments to school work requirements (N = 6).
Classroom behaviour
Three reviews (two high quality) of 20 articles that examined
the impact of cancer on classroom behaviour reported mixed
findings (Vance & Eiser 2002; Wakefield et al. 2010; Herrmann
et al. 2011). Seven studies identified classroom behaviour
problems that included aggression, withdrawal and lower
energy levels. In 13 studies, students, peers, parents and
teachers reported minimal or no significant behavioural
differences between those with cancer and healthy students.
Research findings on the relationship between cranial
irradiation and central nervous system tumour diagnosis on
poorer classroom behaviour were inconsistent (Carpentieri
et al. 1993; Mulhern et al. 1993; Adamoli et al. 1997).
School reintegration
Three reviews (two high quality) examining cancer that
included 15 original articles found evidence for both positive
© 2017 John Wiley & Sons Ltd, Child: care, health and development, 43, 5, 645–662
654 A. Lum et al.
Table 3. Summary of evidence for recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system
Methodology
(study types)
Academic-based outcomes
Five high-quality systematic reviews
(Langeveld et al. 2002; Milton et al.
2004; Moser et al. 2013;
Pini et al. 2012; Vance & Eiser 2002),
three low-quality systematic reviews
(Kortmann et al. 2003; Marri & Buchman
2005; Taras & Potts-Datema 2005)
and nine narrative reviews (Basch 2011;
Daly et al. 2008; Davis 2005; Doroshow
2001; Gerson et al. 2006; Gipson et al.
2007; Gurney et al. 2009; Herrmann
et al. 2011; Palmer & Leigh 2009)
(cross-sectional, cohort, case–control
and qualitative studies)
School attendance
Five high-quality systematic
reviews (Langeveld et al. 2002;
Milton et al. 2004; Moser et al. 2013;
Pini et al. 2012; Vance & Eiser 2002),
two low-quality systematic reviews
(Marri & Buchman 2005; Taras and
Potts-Datema 2005) and five
narrative reviews (Basch 2011;
Davis 2005; Doroshow 2001;
Gerson et al. 2006; Herrmann et al.
2011) (cross-sectional, cohort,
case–control and qualitative studies)
Interpersonal school experiences
Three high-quality systematic reviews
(Pini et al. 2012; Vance & Eiser 2002;
Wakefield et al. 2010) and three
narrative reviews (Basch 2011; Gurney
et al. 2009; Herrmann et al. 2011) (cohort,
case–control and qualitative studies)
Engagement with school
Four high-quality systematic
reviews (Moser et al. 2013;
Pini et al. 2012; Vance & Eiser
2002; Wakefield et al. 2010),
one low-quality systematic
review (Marri & Buchman 2005)
and two narrative reviews
(Basch 2011; Doroshow 2001)
(cohort and qualitative studies)
Classroom behaviour
© 2017 John Wiley & Sons Ltd, Child: care, health and development, 43, 5, 645–662
Evidence summary†
1. Descriptive studies suggested
that academic performance is
affected in some, but largely
dependent on associated factors.
2. Descriptive studies suggested
that grade repetition rates are
generally similar.
3. Descriptive studies indicated
comparable levels of educational
attainment, but largely dependent
on associated factors.
4. Descriptive studies indicated
higher levels of special education
provision, but largely dependent on
associated factors.
1. Descriptive studies indicated
higher school absenteeism rates.
2. Descriptive studies identified
many factors associated with
greater absenteeism, but few
identified factors associated
with greater attendance.
1. Descriptive studies
examining students with
cancer and asthma generally
reported poorer peer
relationships.
2. Descriptive studies
examining students with cancer
and asthma generally reported
poorer teacher relationships.
1. Qualitative studies indicated
challenges associated with
students’ engagement with
school.
Recommendation
Quality of evidence‡ (strength)
1. Very low quality given 1. Further research on
serious associated factors (↑↑)
risk of bias and inconsistent
findings from lower level
evidence studies
2. Very low quality given 2. Further research on associated
inconsistent findings from factors (↑↑)
lower level evidence studies
3. Low level quality given 3. Further research on associated
inconsistent findings from factors (↑↑)
lower level studies
4. Low quality given findings 4. Further research on associated
from lower level evidence factors (↑↑)
studies
1. Moderate quality given 1. Educational support to
consistent findings from increase school attendance (↑↑)
lower level evidence studies
2. Moderate quality given 2. Further research on factors
consistent findings from associated with greater
lower level evidence studies attendance (↑↑)
1. Very low quality given 1. Further research across all
indirect (i.e. cancer or chronic illnesses (↑↑)
asthma not representative
of all chronic illnesses) yet
consistent findings from
lower level evidence studies
2. Very low quality given i 2. Further research across
ndirect (i.e. cancer or all chronic illnesses (↑↑)
asthma not representative
of all chronic illnesses) yet
consistent findings from lower
level evidence studies
1. Very low quality of evidence 1. Further research using
given serious risk of bias quantitative methodology (↑↑)
and inconsistent findings
from lower level findings
Continues
 Educational implications of chronic illness 655

Table 3. (Continued)

Methodology Recommendation
(study types) Evidence summary† Quality of evidence‡ (strength)

Two high-quality systematic
reviews (Vance & Eiser 2002;
Wakefield et al. 2010) and
one narrative review (Herrmann
et al. 2011) (case-controlled, cohort
and qualitative studies)
School reintegration
Two high-quality
systematic reviews (Vance & Eiser
2002; Wakefield et al. 2010)
and one narrative review
(Herrmann et al. 2011)
(qualitative studies)
1. Descriptive studies examining
students with cancer generally
reported that classroom behaviour
is generally appropriate but may
be affected in some.
1. Qualitative reports suggested
that students with cancer have
concerns about reintegrating into
school.
1. Very low quality given 1. Further research across all
indirect (i.e. cancer not chronic illnesses (↑↑)
representative of all chronic
illnesses) and inconsistent
findings from lower level
evidence studies
1. Very low quality given 1. Educational support for
indirect (i.e. cancer not all students experiencing
representative of all chronic ongoing school absenteeism (↑?)
illnesses) yet consistent
findings from lower level
evidence studies

↑↑, strong recommendation; ↑?, weak recommendation.

†
Evidence is comparing the illness group with the control group or population norms.
‡
As presented in the review, not original studies.

and challenging school reintegration experiences (Wakefield
et al. 2010; Herrmann et al. 2011; Pini et al. 2012). School
reintegration was not examined in other illnesses. Students
reported that returning to school promoted normalcy but was
also met with nervousness in re-joining peers and keeping up
academically (Manne & Miller 1998; Decker et al. 2004; Koch
et al. 2004; Suppiah et al. 2005; Duffey-Lind et al. 2006; Drew
2007).
These experiences appeared to be strongly linked to the
model of support available in the school and hospital. Evidence
from the literature indicated that a good model included
structured communication and collaboration pathways
between hospital, school and family (such as that performed
by school liaison personnel) (N = 7); a clear understanding of
the educational implications of the illness and the roles and
responsibilities of teachers, school psychologists, nurses and
medical specialists in facilitating a successful return to school
(N = 4); and flexible adjustments that allowed the ill child to
attend partial school days or reduce homework load (N = 2).
Discussion
This meta-review aimed to aggregate the available evidence
examining the impact of six chronic illnesses on school
experiences and outcomes in 18 reviews incorporating 172
studies of more than 40 000 students. The reviews covered
academic, attendance, interpersonal, engagement, reintegration
and behavioural domains. The quality of review articles varied,
yet all domains included at least two high-quality reviews. We
found the most consistent evidence for a link between chronic
illness and lower attendance rates. The findings relating to
academic, interpersonal and behavioural domains were mixed.
Students’ engagement and reintegration experiences were
investigated primarily using qualitative methods, and a number
of challenges were identified among the largely positive
experiences. Poorer school experiences and outcomes were
consistently linked to greater disease severity, stronger
treatment side effects and lower SES. Effective models of
school support were repeatedly associated with school success
among students with chronic illness. Further research
examining ameliorating factors to prevent chronic illness
causing poorer school experiences and outcomes is warranted
to determine the most effective model of school support.
Our research highlighted that school support is strongly
associated with better school experiences and outcomes among
students with chronic illness. A combination of research and
government-initiated services exists to support the educational
needs of students with chronic illness, including homebound
education, school reintegration programmes and individualized
education plans (Boonen & Petry 2012; Centre for Disease
Control and Prevention 2015; Kupper 2000; Prevatt et al. 2000).
While encouraging, there are limitations in some of these
services. For example, homebound education does not
consistently lead to better academic outcomes and can be
socially isolating for some students (Bessell 2001; Searle et al.
2003). Alternative support options that account for academic
and social needs must be considered.
School practices promoting students’ engagement with
school may be a viable support approach that addresses the
academic and social needs of students with chronic illness.

© 2017 John Wiley & Sons Ltd, Child: care, health and development, 43, 5, 645–662
656 A. Lum et al.
Student engagement is the affective, behavioural, cognitive and
academic relationship each student has with school (Appleton
et al. 2008). Engagement with school is a core factor promoting
greater academic performance, school attendance and
psychosocial health (Pianta et al. 2012). We identified
compelling evidence linking supportive teacher attitudes with
greater levels of engagement with school among students with
chronic illness (Vance & Eiser 2002; Milton et al. 2004; Marri
& Buchman 2005; Wakefield et al. 2010; Grieve et al. 2011;
Moser et al. 2013). School and teacher support aiming to
engage students with school, such as supportive teacher
attitudes and practices that promote school belonging and
model the long-term value of school, may complement the
traditional academic focus of other support practices, such as
homebound learning support.
Teacher focused interventions may lead to the most effective
approach to improving students’ academic and social
functioning and engagement with school. Teacher training
programmes aiming to improve teachers’ knowledge of and
attitudes towards students with chronic illness may promote
more supportive teacher attitudes through the reduction of
teachers’ uncertainty about the impact of chronic illness (West
et al. 2013; Hinton & Kirk 2015). In their 2015 review of 61
studies examining teachers’ perspective of chronic illness in
school, Hinton and Kirk (2015) found that most teachers do
not receive professional training on chronic illness and
schooling and that they often ‘lack the knowledge and
confidence to meet pupils’ medical, academic and social
needs’. Improved communication and collaboration between
health and education sectors are required to ensure that
teachers’ educational practices towards students with chronic
illness are supportive across all needs (Hinton & Kirk 2015).
For example, health professionals may deliver training for
educators to manage the needs associated with chronic illness
(Brown et al. 2011; Hinton & Kirk 2015).
Limitations
This meta-review had some limitations. The broad nature of
the search terms and eligibility criteria allowed us to collect the
greatest number of reviews but also resulted in a heterogeneous
participant group. As we reviewed reviews, we may have
missed some findings in the original articles that were not
included in the reviews.
Half of the reviews were not systematic, limiting the
reliability of the findings. Only two systematic reviews received
PRISMA scores of 20 or above, a threshold previously used to
categorize reviews as ‘high quality’ (Willis & Quigley 2011;
Wakefield et al. 2015). Few reviews presented data on risk of
© 2017 John Wiley & Sons Ltd, Child: care, health and development, 43, 5, 645–662
bias, summary measures or methods of data handling. These
limitations may reduce the reliability of findings that may lead
to further discrepancy in a field already containing inconsistent
findings (Boekaerts & Röder 1999).
Many reviews also identified common limitations of the
original articles that they examined. Sampling limitations
included small sample sizes, high sample heterogeneity, non-
representative samples, potential recruitment-based sampling
bias and the inclusion of multiple stakeholders, including those
who may not reliably represent students’ perspectives (Vance
& Eiser 2002; Milton et al. 2004; Wakefield et al. 2010; Moser
et al. 2013). Original articles were also limited by their use of
differing criteria to define absenteeism and each illness,
especially for asthma (Milton et al. 2004; Taras & Potts-
Datema 2005), potentially limiting the validity of the findings
presented in the reviews.
Recommendations for practice
This meta-review highlighted the breadth of challenges
associated with chronic illness in the school environment,
and thus the need for school support that caters for academic,
social, emotional and physical needs. A co-ordinated and
collaborative approach involving educators, healthcare
professionals, psychologists, and the student and their family
is necessary to meet this range of needs (Shiu 2001; Shaw et al.
2010). Specifically, teachers have stated that healthcare
professionals are important and preferred sources of health
information when compared with public media and parents
(Shiu 2004; Hinton & Kirk 2015). School psychologists also
play a critical role in assessing and supporting students’
cognitive and emotional needs (Palmer & Leigh 2009). Daily
management of the students’ medical, psychological and
educational needs may be best achieved by students, their
families and teachers (Shaw et al. 2010).
The findings of this meta-review also suggested that students
with chronic illness need individualized educational plans
(IEPs) that clearly communicate the students’ unique needs
and how these needs can be met by tailored support within the
school. The individualized education plan and 504 plan that
are available in the USA are examples of these policy
documents (Kupper 2000). Our findings and concurrent
research indicate that IEPs for students with chronic illness
could be enhanced if they incorporated information that
extended beyond learning/curriculum outcomes and also
accounted for the physical, psychological, and social health
and functioning needs of the student (i.e. taking a
biopsychosocial approach) (O’Connor et al. 2015). The

additional biopsychosocial components that are relevant to the
IEP may include students’ illness; its academic, physical, social
and emotional implications; the specific manifestations unique
to the child; and the school-based healthcare management
(Miller & Wood 1991). A biopsychosocial-inclusive IEP will
help teachers engage in practices that promote healthy
psychosocial development in the school (Miller & Wood 1991;
O’Connor et al. 2015). To achieve the most effective support
plan, the biopsychosocial component of the IEP may undergo
collaborative development involving the school (i.e. educators
and school psychologists) and hospital personnel (e.g. paediatric
specialists, clinical nurse consultants and social workers)
(Prevatt et al. 2000; Shiu 2004); however, research is required
to examine the feasibility and effectiveness of this approach.
Recommendations for research
We examined outcomes within each review to provide
recommendations for research in line with the GRADE system
(Table 3). The GRADE recommendations were limited by low-
quality studies. Future researchers may wish to invest in
prospective longitudinal cohort studies with a comparison
group using validated questionnaires to produce the highest
quality evidence, but other observational methods may be
warranted to promptly address research gaps. Research gaps
are particularly prevalent in quantitative research addressing
school experiences, such as student engagement. Furthermore,
while disease severity and other medical variables were
consistently linked to poorer outcomes, there was less evidence
regarding the mechanisms through which these variables affect
school outcomes (e.g. cognitive deficits and psychosocial
functioning). We encourage researchers designing future
studies to examine multiple school experiences and outcomes
alongside medical, school, psychosocial and sociodemographic
covariates. This would allow a more nuanced examination of
the associations between social, emotional, academic and
physical variables affecting students with chronic illness.
We gave strong recommendations for the need for
intervention-based research when the quality of evidence in
outcomes of included reviews was low to moderate (Table 3).
Intervention development, piloting and evaluation should
target a range of school experiences and outcomes.
Quantitative and qualitative assessments provided by students,
parents, teachers and peers over multiple time points will
further enhance the quality of intervention research. We
encourage researchers to examine the intervention costs in
addition to intervention effectiveness and feasibility (Balshem
et al. 2011). Our strong recommendations reflect our belief
© 2017 John Wiley & Sons Ltd, Child: care, health and development, 43, 5, 645–662
Educational implications of chronic illness 657
that although the quality of evidence is not high, educational
needs of students with chronic illness appear to be higher than
students without chronic illness, these needs are of great
significance for healthy development and educational support
is likely to have largely positive implications with few risks for
negative consequences.
We also suggest that researchers evaluate the practices that
we have recommended. Specifically, we encourage
examination of the feasibility of collaborative support across
health, education and psychosocial sectors in the context of
barriers associated with the sectors’ bureaucracy and time,
financial and personnel resources (Shaw et al. 2010).
Conclusion
Our meta-review has provided a comprehensive insight into
the state of research examining the impact of chronic illness on
students’ educational experiences and outcomes. Students with
chronic illness may miss long periods of school, underperform
academically and experience challenges with friendships and
engaging with school. Teachers may play a critical role in
protecting students with chronic illness from disengaging
academically and socially at school. Health professionals can
also support students’ educational functioning by collaborating
with schools to identify strategies that accommodate for
disease symptoms, hospitalizations and cognitive impairments.
Continued research is required to develop evidence-based
educational support that recognizes students’ complete school
needs and ensures that these students thrive in the school
environment and beyond.
Key messages
• School students with chronic illness often have poorer
school experiences and outcomes than students without
chronic illness.
• Disease severity, stronger treatment side effects and lower
socioeconomic status are consistently associated with
worse school experiences and outcomes.
• Supportive teacher attitudes can promote engagement
with school among students with chronic illnesses, which
may improve academic, social and other school outcomes.
• Significant improvement to the quality of research, and
more quantitative research examining students’ subjective
school experiences, is required for an improved
understanding of the educational implications of chronic
illness.
658 A. Lum et al.
Acknowledgements
Alistair Lum is supported by an Australian Government
Research Training Program Scholarship in association with
the Kids Cancer Alliance, the Kids Cancer Centre and Ronald
McDonald House Charities. Claire Wakefield is supported by a
Career Development Fellowship from the National Health and
Medical Research Council of Australia (APP1067501). The
Behavioural Sciences Unit is proudly supported by the Kids
with Cancer Foundation. Glenn Marshall is supported by the
National Health and Medical Research Council of Australia,
Cancer Institute New South Wales and Cancer Council New
South Wales.
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Appendix A. Data extraction list
Hewett, K. (1990) Social adjustment of children successfully treated
1. What is the reference?
for cancer. Journal of Pediatric Psychology, 15, 359–371.
Suppiah, R., Patton, M. & McGrath, P. (2005) Re-entering life: 2. What type of review was conducted?
paediatric acute myeloid leukaemia at one year post treatment. The 3. What country was the review conducted in (main author)?
Australian Journal of Holistic Nursing, 12, 23–34. 4. What were the objectives of the literature review?
Suris, J.-C., Michaud, P.-A., Akre, C. & Sawyer, S. M. (2008) Health 5. What years were included in the search?
risk behaviors in adolescents with chronic conditions. Pediatrics, 6. How many databases were searched?
122, e1113–1118. 7. What databases were searched?
Taras, H. & Potts-Datema, W. (2005) Childhood asthma and student
8. Were other forms of data collection (identifying other
performance at school. The Journal of School Health, 75, 296–312.
studies) were used prior to screening articles (i.e. grey
van der Lee, J. H., Mokkink, L. B., Grootenhuis, M. A., Heymans, H. S.
& Offringa, M. (2007) Definitions and measurement of chronic literature and author contact)?
health conditions in childhood. JAMA: The Journal of the American 9. What were the search terms?
Medical Association, 297, 2741–2751. 10. What was the exact date of the final search?
Vance, Y. H. & Eiser, C. (2002) The school experience of the child 11. What were the inclusion criteria?
with cancer. Child: Care, Health and Development, 28, 5–19. 12. What were the exclusion criteria?
Wakefield, C. E., McLoone, J., Goodenough, B., Lenthen, K., Cairns, 13. How many articles were collected from the database
D. R. & Cohn, R. J. (2010) The psychosocial impact of completing
search?
childhood cancer treatment: a systematic review of the literature.
14. How many articles are included in the review? What is the
Journal of Pediatric Psychology, 35, 262–274.
Wakefield, C. E., Butow, P. N., Aaronson, N. A., Hack, T. F., Hulbert- percentage (of initial search)?
Williams, N. J., Jacobsen, P. B. & Committee, I. P.-O. S. R. (2015) 15. Were any other methods of identifying articles used after
Patient-reported depression measures in cancer: a meta-review. The the initial database search was conducted?
Lancet Psychiatry, 2, 635–647. 16. What were the reasons for excluding studies?
Waters, B. G., Said, J., Cousens, P. & Stevens, M. (1989) Behavioral
17. What types of studies were included (i.e. randomized
side-effects of CNS prophylaxis. Journal of the American Academy of
Child and Adolescent Psychiatry, 28, 299–300.
controlled and correlational)?
West, A. M., Denzer, A. Q., Wildman, B. G. & Anhalt, K. (2013) 18. Was a quality assessment of original articles used?
Teacher perception of burden and willingness to accommodate
children with chronic health conditions. Advances in School Mental a. What was its name/reference?
Health Promotion, 6, 35–50. b. How was quality assessed?
Williams, K. S., Ochs, J., Williams, J. M. & Mulhern, R. K. (1991) c. What was the range of scores?
Parental report of everyday cognitive abilities among children d. What was the average score?
treated for acute lymphoblastic leukemia. Journal of Pediatric e. Was quality assessment considered when interpreting
Psychology, 16, 13–26.
the findings of the study?
Willis, B. H. & Quigley, M. (2011) The assessment of the quality of
reporting of meta-analyses in diagnostic research: a systematic 19. What illness/es was/were examined as independent
review. BMC Medical Research Methodology, 11, 163. variables?
Wright, M., Jarvis, S., Wannamaker, E. & Cook, D. (1985) Congenital
20. What treatment type/s was/were examined as independent
heart disease: functional abilities in young adults. Archives of
Physical Medicine and Rehabilitation, 66, 289–293.
variables?
Young-Hyman, D. (2003) Diabetes and the school-age child and 21. What age group was examined?
adolescent: facilitating good glycemic control and quality of life. 22. Were any other independent variables specifically
In R. T. Brown (ed.) Handbook of Pediatric Psychology in examined (i.e. demographic features)?

© 2017 John Wiley & Sons Ltd, Child: care, health and development, 43, 5, 645–662
662 A. Lum et al.
23. What was the range of sample sizes in original articles
included?
24. How many children were included in the review in
total?
25. What are the primary education variables examined?
26. Are education variables the primary or secondary variables
of the review?
27. What other, non-educational outcome variables are
examined separately in the review?
28. What were the findings?
29. What risk factors to poor educational outcomes are
outlined?
30. What facilitative factors to positive educational outcomes
are outlined?
31. Has data been included in the review (including ES, CI,
sample characteristics and means)?
a. Are data presented as a meta-analysis or separately for
each study?
b. Are data comparable with other reviews (i.e. same
measure used, similar study and control group)?
32. What limitations of the review did the author outline?
© 2017 John Wiley & Sons Ltd, Child: care, health and development, 43, 5, 645–662
33. What were the conclusions made?
34. Was the role of school staff outlined in any way?
35. Was the role of medical staff outlined in relation to
education?
36. Was the role of parents outlined in relation to education?
37. Was the role of psychosocial support staff outlined in
relation to education?
38. Additional comments.
Supporting information
Additional Supporting Information may be found online in the
supporting information tab for this article.
Supplementary Table 1. Original study references of key
findings
Supplementary Table 2. Number and percentages of PRISMA
criterion met by systematic reviews (N = 9)
Supplementary Table 3. Methodological characteristics,
number of included articles, and PRISMA scores of systematic
reviews.