Table 2.

Adaptation decision log linking stakeholder insights to intervention changes.

ID	Principle	Stakeholder insight	Adaptation decision	Implementation in the Irish context
1	Emotionally safe framing	Language implying “goodbye” caused distress for families	Reframed intervention as life-affirming storytelling	Sessions celebrate identity; prompts avoid end-of-life framing
2	Family and sibling inclusivity	Families wanted siblings and parents actively involved, especially in home settings	Expanded sessions to actively facilitate joint reflection and expression across the entire family unit	Manual includes sibling and family-friendly tools like drawing, music, allowing families to co-create stories together
3	Flexible, personalised participation	Children with low energy or limited communication need alternatives	Added emotion cards, visual prompts, drawing tasks, and audio/video options	Children and their families choose multiple expression tools and modes
4	Selective therapeutic recreation	Full Barretstown recreation cycle too structured for home-based PPC	Integrated only playful, creative elements of the model	Focused fun-centric practices maintain engagement without overstructure.
5	Family autonomy and pacing	Families wanted control over timing, story and final product especially during bereavement	Adopted family-led protocols allowing families to choose when and how the digital story is finalised	Families set the pacing and format preferences during a pre-intervention call
6	Facilitator preparedness	Facilitators may face emotional strain	Developed psychological preparation, resilience training, and ongoing support	Training covers emotional resilience, digital tools, ethical communication, and child engagement strategies and includes mock-up sessions