title: Palliative care of children with brain tumors: a parental perspective.
abstract: OBJECTIVE
  To explore the end-of-life experience of children with brain tumors and their families.
  
  
  METHODS
  Qualitative analysis of focus group interviews.
  
  
  METHODS
  Children's Hospital, London Health Sciences Center.
  
  
  METHODS
  Twenty-five parents of 17 children who had died of brain tumors.
  
  
  METHODS
  Parents participated in 3 semistructured focus group interviews.
  
  
  METHODS
  Themes identified through thematic analysis of interview transcripts.
  
  
  RESULTS
  Qualitative analysis identified 3 primary themes. (1) Parents described the dying trajectory of their child as characterized by progressive neurologic deterioration, with the loss of the ability to communicate as a turning point. Parental coping mechanisms included striving to maintain normality and finding spiritual strength through maintaining hope and in the resilience of their child. (2) Parental struggles during this phase included balancing competing responsibilities and speaking with their child about death. (3) Barriers to achieving a home death included suboptimal symptom management, financial and practical hardships, and inadequate community support. A fourth, secondary theme concerned the therapeutic benefits of the interview.
  
  
  CONCLUSIONS
  The neurologic deterioration that characterizes the dying trajectory of children with brain tumors may create significant challenges for health care professionals and the children's parents, supporting the need for increased awareness of the distinct issues in the palliative care of children with brain tumors and for early anticipatory guidance provided for families.
authors.affiliation: Pediatric Hematology Oncology, Children's Hospital, London Health Sciences Center, 800 Commissioners Road E, London, Ontario, Canada. shayna.zelcer@lhsc.on.ca
authors.forename: Shayna
authors.initials: S
authors.lastname: Zelcer
authors.forename: Danielle
authors.initials: D
authors.lastname: Cataudella
authors.forename: A Elizabeth L
authors.initials: AE
authors.lastname: Cairney
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bannister
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001293:Attitude to Death; D001932:Brain Neoplasms / Q000523:psychology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology; D010290:Parents / Q000523:psychology; D036301:Qualitative Research; D029181:Spirituality; D055815:Young Adult