Review Evidence Base

Only five studies from 3,067 screened records met eligibility criteria, together representing 55 participants from five countries. The final synthesis included 148 patients aged 13 years or older with bone and soft tissue sarcoma. Six studies remained in the final synthesis after one initially eligible study was excluded for low methodological quality. No studies were excluded based on quality; included studies scored 9–14 on the CASP qualitative checklist. Searches were run in Medline, Embase, PsycINFO and CINAHL from inception to 11 April 2025. The review followed PRISMA and ENTREQ reporting guidance and was registered in PROSPERO. The review assessed confidence in synthesised findings using GRADE-CERQual. No previous qualitative systematic review has exclusively synthesized caregiver experiences specific to NSSI. Reflexive thematic analysis following Braun and Clarke's approach was used rather than thematic synthesis to enable interpretive re-analysis rather than aggregative line-by-line translation. The review adopted a critical realist perspective, treating participants' accounts as reflecting real experiences shaped by social, cultural, and structural context. The review aim…